McKesson's Paragon electronic health record system originated in the 1990s as an executive information system called Paragon. It was re-written in the 1990s as a client-server system to replace aging legacy systems. Early implementations struggled but subsequent releases stabilized. By the 2000s, Paragon was successfully implemented at many hospitals due to its modern Microsoft-based architecture. In a surprising decision, a merged hospital network selected Meditech over Paragon to provide system consistency for users during a challenging transition period, demonstrating a focus on the overall needs of the organization. Paragon went on to become very successful for McKesson due to its flexible, standards-based design.

1. H.I.S.-tory
by Vince Ciotti
Episode #122:
McKesson
Part 9 = Happy
Ending
Who knew Paragon started out in 1991
as an Executive Information System
(EIS) running on DEC!?
© 2013 by H.I.S. Professionals, LLC, all rights reserved.

2. IT Rage Of The Nineties
• This last segment of the McKesson saga actually goes back to
the per-merger days of HBOC in the mid-90s, when the IT
world was all abuzz with the concept of “client/server”
systems. In essence, PCs replaced the inhouse mainframes
that dominated the 60s, shared mainframes that ruled the
70s, and minicomputer-based systems that swept the 80s.
• Instead of the large mini or mainframe doing the work, PC
workstations (clients) split the processing with a handful of
central PCs (servers), running under a 3-tiered architecture:
– User Services = a GUI on the PC clients (viz: Windows 95)
– Business Services = modular, customizable applications
– Data Services = a relational data base, e.g: SQL or Cache
• Seems a little trite today, but 20 years ago, it represented a
hugechallenge to the dozens of legacy HIS systems…

3. A Saint Reborn
• One of HBOC’s many acquisitions had been FDC,
formed by AMEX out of SAI and McAuto. FDC
didn’t do much with Mac’s systems which were
sadly sunset, but SAI had almost 300 Saint clients
running on their Point Four minis (right) that had
evolved to Saint Plus or Saint Express, keeping the
upgrade & maintenance revenues flowing.
• HBOC inherited this challenge and with the same
daring Walt Huff showed in creating MedPro, they
launched a project to re-write Saint as a true C/S
system, just when Meditech was launching their
C/S version of their venerable MAGIC system.
• The name for this HBOC product was itself re-cycled from an early
DEC-based EIS system per the 1991 ad on the first slide: Paragon,
appropriate for what was hoped to be the latest & greatest HIS!

4. The Big Splash
• HBOC announced Paragon with the usual sales & marketing
hype touting the advantages of its modern C/S architecture:
– Huge booth at that year’s HIMSS conference,
– Hot new brochures, proposals, ppt files, etc., &
– “Special offers” targeting the 300 Saint Plus clients.
• One of them, Olean General Hospital in frozen upstate NY,
contacted us in late 1996 for help negotiating a contract for
Paragon to replace their Saint Plus. As former vendor reps who
have sold a number of systems before their time, we were
skeptical of future promises even from a giant like HBOC
• We protected Olean the best we could,
frustrating their IT Director (she was very
excited about the potential of a C/S system)
with all of our contract terms & conditions.
Olean signed and began the conversion…

5. Time Old Story…
• Readers who have been out there a few years can guess what
happened next to Oleanand the 50-odd (sic) other pilots:
– Development took rather longer than expected (by years…),
– Releases came out with pieces of the system (a fraction…), &
– New modules & apps came with extra charges (surprise?).
• It’s the same old story as was played out with almost every new
product ever introduced in HIS-tory: SMS’ Unifile in the 70s,
Millennium in the 90s, Soarian & Release 6.0 in the 2000s…
• As Y2K neared, some Paragon early adopters
sued, others bought replacement systems,
while some waited patiently through the
releases and delays limping along with Saint…
• Protected by our stringent contract Ts & Cs, Olean asked us for
helpagain searching for a replacement in 2000, that wound up
being QuadraMed’s Affinity, that lasted them for a good 10 years...

6. A Case Of Indigestion
• When McKesson acquired HBOC in 1999, they inherited the ≈30
remaining Paragon early adopters, suffering from “agida…”
• Their new CEO, Graham King, who had cut his teeth at SMS and
Micro Healthsystems (see episode 47 at hispros.com), turned to
his trusted lieutenant from NJ, Jim Pesce, to handle the problem.
• Graham sent Jim to Charlotte, NC (FDC’s HQ) to shut down the
Paragon project. When he got there, Jim looked into the system
and was impressed by what he saw: sharp people, a modern C/S
design, and a lot of progress made since the early problems…
• He returned to Atlanta and appealed to
Graham to save Paragon – it had far more
potential than aging the Star, Series, etc.
Graham trusted Jim’s opinion, but just to be
sure, put Jim in charge of it, just like McAuto
had done to Chuck Barlow with OSF in 1970!

7. Stabilization Program
• As his first step in charge of Paragon Jim pulled a
gutsy move: rather than stepping up sales (the
usual move by any vendor on trouble), Jim pulled
Paragon 2.9 off of the market and concentrated on
getting the next releases out on time & schedule,
to save as many of the early adopters as possible.
• This radical move paid off: the remaining pilot sites
saw the next releases in 2001 come out almost on
time, with promised features, and no extra fees!
• The next year, Jim put Paragon back on the market,
and word of its C/S architecture spread. It caught the
eye of a sharp IT Director attending one of our HIS
Buyers Seminars - Dave Witton of St. Johns in Jackson
Hole, WY. Dave was quite the techie, having written
apps himself, and even using Apple servers!

8. Tough Selection Process
• Dave hired our firm in 2002 to follow our “Non-RFP” selection
process, which replaces the old “Request For Prevarication” with
users calling their peers at references, in-depth review of user
manuals, and tough contract terms, all scored numerically.
• By 2002, Paragon scored very well in our demanding process, as
can be seen in the chart below for the 3 semi-finalists vendors:
• Mindful of Olean’s debacle,
we negotiated the same
stringent contract protection
so if things turned south, St.
John’s would only lose time,
not money. Dave signed,
went live and low & behold,
Paragon worked! Not
perfect (what HIS is?), but
the solid C/S architecture

9. Third Time Around
• Throughout the 200s, Paragon started selling like proverbial hot
cakes as CIO after CIO learned like Dave the advantages of a
pure Microsoft platform with a Windows GUI & SQL data base.
• Ironically, around 2009 we heard from Olean again (some
people never learn…): after 10 years with Affinity, they wanted
to search the market to see what were the alternatives to
prepare for the upcoming CPOE, E.H.R. and MU tidal wave.
• The plot had thickened this time
around, however, as just when we
+
were ready to start our selection
process, word came down that a
merger with neighboring hospital had
been approved: Bradford Regional
Medical Center in nearby PA, with the
=
new entity to be called Upper
Allegheny Health Systems (UAHS).

10. The Results
• Bradford had used our
firm years ago to select
Meditech’s Magic, which
they had implemented
pretty well, so we paired
off Meditech’s C/S against
Paragon’s C/S to see
which system would run
in the merged entity.
• As the results on the right
show, Paragon edged out
Meditech’s C/S in the
(objective) eyes of the
users at Olean, while
Bradford favored their
more familiar Meditech.

11. Surprise Ending
• During the selection process, most of the C-Suite at Bradford
retired, and Olean executives took over management there.
• At one of the most inspiring afternoons of my 45-year career in
HIS, the executives met to decide the system, which seemed to
me to be a foregone conclusion: Olean ruled and their users
wanted Paragon, period, right? Wrong! The UAHS execs at
Bradford spoke up for their users who were going through
atough time with budget cuts & layoffs stressing their bottom
line, productivity and morale. They appealed to their peers at
Olean to select Meditech so they could turn Bradford around
and avoid the inevitable travail of a system conversion…
• Incredibly, after a thoughtful discussion, the combined team
agreed: they would do what was best forUAHS overall, not just
the top dog, and went with Meditech C/S! What a great team of
people: if you’re everadmitted, hope it’sin Olean, NY!

12. The New Med-Pro?
• Olean’s decision was a rare loss for Paragon as it has since swept
hundreds of decisions around the country beating out almost all
competitors (many still with proprietary DBs), thanks to the
pure-Microsoft architecture that gives CIOs enormous access to
their data for PC downloads, report writers, interfaces, etc.
• So an amazing ending to the saga of
OSF/HBO/SAI/FDC/HBOC/McKesson that led to the creation of
the “go-forward” Paragon of systems from the largest vendor in
the HIS industry today.
• And to think it all started about fifty years ago with
– Walt Huff, Bruce Barrington & Rick Owens’ “CRASH” and
“SHIS” systems at OSF in Peoria, IL, in the mid-60s, and
– Jack Weil & Mason Chrisman “Saint” system written for
Charlotte Memorial at SAI in 1966 in Charlotte, NC.
• A fitting ending to the amazingly long HIS-story of our industry!