B. Alton Brantley Jr., M.D., got involved with computers and medicine by accident; he's now in charge of ensuring that Medlantic Health Systems' technology strategy is no accident.
Brantley, chief information officer at Washington-based Medlantic since 1994, is responsible for installing computer systems to link the hospital, its affiliated services and its 1,600 physicians to fit current needs in a way that will be adaptable to future demands.
Linking up Medlantic's system involves 8,000 employees at an acute-care hospital, a rehabilitation hospital, a Visiting Nurse Association, an ambulatory surgery center, two intermediate-care nursing homes and a renal facility-a tricky task given how quickly technology can change. According to Moore's law, the 30-year-old axiom from Intel Chairman Gordon Moore, the power of computer chips doubles about every 18 months.
Brantley solves this problem by focusing not on systems, but on their backbone. Before joining Medlantic, Brantley designed a high-speed data network at Penn State University Hospital-Milton S. Hershey Medical Center in Hershey, Pa. His method is to worry about whether wiring and telephone-switching equipment can stand up to the needs of a computer network before worrying about what computer system to buy.
"First and foremost, the job of a CIO is not to pick the right system," Brantley says. "A system by its definition is a product. A product that exists today was implemented over the last year or two, which means it was designed over the last three or four years, which means it was conceptualized five years ago. A lot changes in five years.
"What I do is I focus on architecture, which is how do things fit together. I would encourage people as they go forward not to pick systems, but to have a structure in which they think about how their systems fit together. Then, at any point in time, you select the system that advances your architecture, at the same time you're getting rid of old parts of your architecture. But your architecture may stay quite consistent."
That's not to say that Brantley, 49, ignores hardware and software. Part of his task at Medlantic is replacing systems built on past generations of technology that were not "forward looking," he says. But he learned an important lesson just about the time Gordon Moore was coming up with his law: "The management of information wasn't a matter of how powerful the computer was, but how structured the information was."
Brantley's first experience with computers came as a high-school student in 1965, when the Columbia, S.C., native spent a summer at a National Science Foundation program at Illinois Institute of Technology in Chicago. Brantley planned to take a numbers theory class, but instead he was shifted to computer programming--"which I had never heard of"--because the other class was full.
Brantley quickly became hooked on computers. When the 17-year-old went back to Columbia for his senior year, he knocked on a lot of doors "and got a lot of laughs" before convincing the University of South Carolina's computer center to hire him to help graduate students with statistical analysis.
Brantley moved on to study mathematics at Duke University, where between his sophomore and junior years he answered a job posting to work with a cardiologist on a computer-aided project. That work led to research for IBM, which in 1968 was trying to develop the first patient-data collection computer system. Brantley worked for a biomedical engineering professor named W. Edward Hammond, who currently directs Duke's medical informatics training program and continues to develop computerized patient record programs. The IBM project never made it to market because it was "too large and cumbersome," Brantley says.
But Brantley's cardiologist boss convinced him he should give medical school a try. Brantley went back to Duke and spent the next eight years earning his M.D. and his doctorate in computer science. He followed with two years of specialty training in oncology. From 1982 to 1985 he developed technology plans for Duke's gerontology and cancer centers while a member of the medical school's faculty. He became the first director of campuswide academic computing in 1985, while continuing his clinical duties.
With his insistence on common systems throughout the campus, along with his construction of a fiber-optic network for high-speed data transmission, Brantley at Duke started what would become his focus at Penn State and, currently, at Medlantic.
His notion is that when a department creates information other departments consume, that department is a publisher, and it should publish according to certain sets of standards."
At Medlantic, which reported $535 million in revenues for 1997, Brantley has put together an intranet-based system called MEDSnet. It receives data and messages from various departments, then reformats and redistributes them across a computer network. Unlike the Internet, an intranet-based system is restricted to certain people using specific dial-in numbers.
This year Brantley is leading a test of an Internet-based network that would allow doctors to look up patient data by dialing in through any Internet service provider. The link is not dependent on any software and would allow doctors to look up data at home.
Also, visiting nurses carry laptop computers and update clinical databases using a dial-up access to the Medlantic network. Staff members use e-mail to coordinate their work. And clinical and financial systems have been linked to allow administrators to get a true sense of what procedures cost.
"When you go into managed-care contract negotiations, you have to have an understanding of what your costs are," Brantley says.