Whenever an organization’s core vendor is acquired, there’s going to be some trepidation. But when a CIO has the opportunity to sit down with leaders and talk about the intended roadmap, those fears can be quickly assuaged — especially when that group includes John Glaser and Kent Gale. In this interview, veteran CIO George Hickman discusses his feelings on the Siemens-Cerner merger, why his organization is happy to serve as a reference site, and what has helped NY’s HIE remain successful. He also talks about the prioritization challenges facing CIOs (which he handles using a Ouija board), the “Henry Kissinger skills” he picked up as a consultant, and the road that took him to Albany.
- About Albany Medical Center
- Being a Soarian development site — “There were a lot of fits and starts.”
- Siemens-Cerner merger
- “There’s a direction there and an investment pattern that’s going to continue.”
- Meeting with John Glaser & Kent Gale — “They gave us an early preview of the intended roadmap.”
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There were a lot of fits and starts in the early days, as is usually the case when you’re trying to do something brand new.
There’s a direction there and an investment pattern that’s going to continue for at least 10 years. I think that’s a very important position for Cerner to have taken if you consider that many organizations are fairly new in their implementations.
I think the general feeling walking out of the room by our senior management team was that this is a very good thing for us. We were working with a company that was under international ownership and the HIT piece of that company was a very, very small piece of its business, and perhaps one that it wouldn’t emphasize.
We were glad to see that it was Cerner that made the acquisition, and I will say also that their leadership has very much engaged here and have likewise been very good to engage me and others in what we consider a very important directional conversations.
Gamble: Hi George, thank you so much for taking the time to speak with us today.
Hickman: Hi Kate, thanks for inviting me to do so.
Gamble: Sure. So to give our readers and listeners some background, can you just talk a little bit about Albany Medical Center — what you have in terms of bed size, ambulatory, where you’re located, things like that?
Hickman: I’d be glad to. Albany Medical Center is located in Albany, New York, which is the capital of New York State and we play a unique role to this region of upstate New York. We serve, as our primary catchment, about 25 counties. We’re the only academic health science center in the region. We’re the largest acute care hospital, right now standing somewhere between 750 and 800 beds, given that number keeps changing; we keep opening beds.
We’re the area’s only level 1 trauma center and one of the busiest trauma centers in New York State. We have a helicopter transport. We’re the region’s only children’s hospital. We have the region’s only level 4 NICU, the only PICU, the only children’s cancer center, and the region’s only pediatric-trained general surgeons, heart surgeons, and neurosurgeons. We have an organ transplant program. We are a state-designated AIDS treatments center and we like to refer to ourselves as the hospital to other hospitals. Our transfer rate between 2004 and 2014, from other hospital providers to us has grown more than 200 percent in that span. So, I’d just say, in short, we are kind of the tertiary and quaternary services provider for 25 counties of New York State.
Gamble: And now as part of that you also have the medical college and a physician’s group?
Hickman: That’s true. Albany Medical Center has two hospital campuses. But then as to geographic dispersion, I know we’re now over 41 geographic sites. Our sites span from Glens Falls to the north of us, down to Kingston, New York, all along what we would call the I-87 corridor. So, structurally, you’re correct. We do include inside of our organization a medical college. That medical college grants between 125 and 130 MD degrees a year, plus Master’s and PhDs in the life sciences as well as supporting some other allied health professional degree programs.
The college includes a faculty practice, and while we are what I’d call an open medical staff, meaning we have community physicians practicing here who are not faculty members, all of our employee physicians — which that number now is probably in the 350 to 400 physician range — are faculty members who have both teaching and research responsibilities.
Gamble: As far as the clinical application environment, what type of EHR system are you using in the hospitals?
Hickman: The electronic health record centerpiece on the hospital side would be the Cerner Soarian suite, formerly the Siemens Soarian. And in fact, we have many products from the Soarian family, including the financials and electronic document management and all of the pharmacy closed loop solutions, and we still reside on a Siemens syngo radiology management solution as well.
We’re well populated with Cerner EHR capabilities and highly integrated with a host of other vendor products in all of the various ancillary areas. And we do serve as one of Cerner Soarian’s national reference accounts, because that’s what folks used to call it. We do a lot of site visit activity here as well, a lot of conference calls and such, given our deployment has been a very rich one with regards to Soarian.
On the ambulatory side, the electronic health record is the Allscripts TouchWorks solutions suite. Similarly, it’s highly integrated with all of the necessary components from the ancillary space. And I’d say similarly, we do position well in terms of what we’ve been able to do from a capability standpoint with TouchWorks.
Gamble: And how long has it been since you put Soarian into place?
Hickman: Soarian, yeah, you’re right, we started with that first. In fact, I’ll offer a little history. When I showed up here at the very end of 2003, the organization had signed on to be a Soarian development site, so that’s how far back that relationship goes. There were a lot of fits and starts in the early days, as is usually the case when you’re trying to do something brand new, but we brought up the first module of Soarian in 2005.
As you know, these EHRs are modular solutions, so we’ve continued to bring up variants of the applications across time since then. But we would post patient records as far back as 2003 in some cases electronically, and today we’re residing on a couple of million patient electronic health records. If you consider that in our population catchment for the 25 regions we serve there are 3 million people, two-thirds of the people that are in our region, we have electronic health records on here at the medical center.
Gamble: Right. Now when the merger happened or was first announced with Cerner and Soarian, is that something that’s going to be a significant change for you as far as changing the systems or updating — what do you foresee there?
Hickman: Well, not just yet. Your question is good one, because for some folks who reside on Legacy Siemens application suites, I believe it would be fair to assume that they may need to see changes in time. For instance, some smaller organizations still run a product called MedSeries4. There are some larger customers who are still running their Legacy mainframe application suite, which is referred to as Invision. And in those cases, as I understand it, development will not continue at the same pace, but they will continue supporting those suites for a long time. But without development, that sort of tells you the tale of needing to do something else, because the world is changing. We all need to have things done differently with those particular kinds of applications.
Soarian is intended to have a much longer destiny. In fact, Cerner has laid out product-by-product roadmaps so that as a customer, we are informed as to what products they’ll continue developing. And in fact, in some cases if they have two products, which one they may have a bias toward in development and then which products they’re going to slow down. In the case of Soarian, we’ve heard it spoken many times over that there’s a direction there and an investment pattern that’s going to continue for at least 10 years. I think that’s a very important position for Cerner to have taken if you consider that many organizations are fairly new in their implementations, and by ‘new,’ I’d say less than five years old. That means they’re also carrying probably a material asset value on the balance sheet and need to be able to see that value advantaged over its useful life. So in accounting terms, that means you want to be able to see it all play out and not have a P&L writeoff. And so I think Cerner did the right thing for the Siemens Soarian customers when they did the pickup.
I’ll also offer to you that shortly after the transaction closed — I want to say in the span of a week — Dick Flanigan (president, Cerner Health Services), John Glaser (senior VP) and Mike Long (senior VP), and Kent Gale from KLAS all came for a visit to sat in with my senior management team. But also, we had them sit in and do a bit of a roundtable presentation discussion with our board’s technology committee. We invited finance committee members and full board members and we had a very good showing, because people were very curious about the investment we had made in the former Siemens organization suite. I think the general feeling walking out of the room by our senior management team was that this is a very good thing for us. We were working with a company that was under international ownership and the HIT piece of that company was a very, very small piece of its business, and perhaps one that it wouldn’t emphasize. Since they’ve put it up for sale, we all worried about who that might be that would come along and buy it, and the choice was a good one. Because with Cerner, of course it’s very origins was always about being an HIT company, a US-based company here in the heartland of Kansas, and the principles all came from the understandings of how to run a healthcare IT company and do it very successfully here.
So we were glad to see that it was Cerner that made the acquisition, and I will say also that their leadership has very much engaged here and have likewise been very good to engage me and others in what we consider a very important directional conversations.
Gamble: Right. And when those executives from Cerner and Siemens and even Kent Gale showed up for the roundtable, because you’ve had this relationship for a while, I would imagine you weren’t shying away from voicing your concerns and kind of maybe felt that level of comfort being a long-time customer?
Hickman: They gave us an early preview of the intended roadmap, which I believe offered some comfort. But you’re correct, there were some direct questions as to destiny and intention from our senior executives.
Additionally, I had invited Kent to come in to talk about his perspective of what’s happening in the HIT market on the whole. He called out his views as to where he thinks things are going on the whole in the HIT marketplace. And there was a bit of, I would say, boardroom confidential point and counterpoint that went on between Kent and Dick, which added a remarkable feeling of authenticity to the conversation. So all told, it was a good feeling coming out of the room.