Ann C. Sullivan inherited a mess when she began working as the chief information officer at Maimonides Medical Center. When she arrived in 1996, it was clear that physicians and other staff had lost faith in the Brooklyn, N.Y., facility's ambitious, costly but foundering information systems initiatives.
Two years later, the center won a prestigious Computerworld/Smithsonian Innovation Award in information technology. So what happened in the interim? "Let me just say this -- I love challenges," says Sullivan.
Awards aside, the 700-bed facility is the showcase for a thriving set of computer initiatives involving clinical information, Internet access and digital imaging, all endorsed fully by their clinical constituencies.
Without doubt, Sullivan's brand of leadership has been a factor in the turnaround. And the basis of that leadership is an intricate knowledge -- firsthand experience, in fact -- of what's happening in literally every corner of the institution.
Sullivan started her career in hospital financial management. She made the transition to information technology management after becoming chief financial officer of Elmhurst General Hospital (now Elmhurst Hospital Center) in 1978. The facility in Queens, N.Y., had no CIO, but she became the first to hold the title later that same year after successfully implementing financial and patient-care information systems.
Remarkably, she also was completing an internship requirement at Elmhurst General as a graduate student in business administration at St. John's University in New York. That helped her when she became Elmhurst's CIO, and the front-line experience continues to be useful. "I had the advantage of working in every department, literally from the bottom up," she says.
Unfortunately, the program at St. John's was discontinued before she could earn a degree. (She eventually earned an MBA at Dowling College in Oakdale, N.Y.)
First a CFO. Sullivan's career swung back to the financial side for a while. She was CFO at her next two stints in the New York area, Metropolitan Hospital Center in Manhattan and Jacobi Medical Center in the Bronx.
But amid the financial duties, "I began to think more strategically about information technology," she says. "I was interested in using it to reduce lengths of stay, to target certain populations with specific health services and to build a Medicaid managed plan." The strategic role of IT became a lasting part of Sullivan's approach to technology management.
These days, Sullivan is wearing both a CFO and CIO hat. She came to Maimonides -- named for a medieval Jewish scholar and physician -- as the medical center seemed to be wrapping up merger talks with nearby Lutheran Medical Center. Maimonides' CFO was preparing to leave.
"I was asked to stand in for a short duration until Lutheran's CFO could take over those responsibilities," she says of the now four-year stint, the result of years of on-again, off-again merger talks. (The current status: on-again.) As the chief of both IT and finance, Sullivan has been deeply involved with the center's efforts to expand beyond its Borough Park community base in Brooklyn to nearby Bay Ridge, Coney Island and Bensonhurst.
A major objective was to attract more independent physicians to the 20 faculty-practice and ambulatory-care facilities Maimonides developed in those communities. Sullivan saw a strategic opportunity to make information technology serve the center's business plan.
"We asked, `What would make a doctor's life easier, and make (doctors) move their patients to Maimonides?' " she says. Maimonides decided to put its patient-record system in doctors' offices and homes.
This meant the doctors now had access to digital dictation, digital imaging, order entry and results reporting.
The move added 100 physicians. Admissions rose to 37,000 in 1999 from 27,000 in 1994. Emergency-room visits soared to 75,000 from 48,000. This occurred during a period of declining admissions at most other New York City hospitals, the result of New York's decision to end regulation of hospital rates and the growth of managed care.
Free portal. The Internet evolution in healthcare takes things a step further. This year, Maimonides began letting the doctors sign up for two years of free access to an Internet-based portal developed by Atlanta-based Healtheon/WebMD. The company supplies medical information for consumers and providers and is building connections to insurers, laboratories and other sources of data about patients.
Building bridges. Bridges to the physician community are built into the foundation of information systems strategy. For example, clinical department chairmen sit on the hospital's information systems committee, where they can vote on capital decisions and vendor selections.
The cooperation is critical to managing managed care, which now represents 35% of Maimonides' revenue. "Every managed-care dollar is less money," Sullivan says. What she calls "the revenue game" challenges the institution's ability to improve processes and invest in technology.
In response, Maimonides is renewing its focus on using computers to help with revenue management. "The kind of technology we need today to beat the revenue game can track approvals, referrals and denials," she says. "You can't afford to have any inefficiencies."
The center also continues to deploy IT to improve operations. For instance, Maimonides claims to have achieved filmless radiology. "You can't afford lost films, repeat films, lost interpretations or billing, or repeat transcription costs," Sullivan says.
Since implementing an image storage and transfer system in 1998, Maimonides has improved its ability to keep track of billable services, increasing charges 15% to 20%. But most important to Sullivan is the speeding up of results. "A patient's interpretation is now available in a few hours," she says.
Instead of having information professionals handle the training, Maimonides first trained nurses with backgrounds in family education. The nurses were naturals for the task of getting specifics of the new system across to the hospital's employees, because training ability is an essential skill of nurses in that field.
When it came time to lure the doctors to Maimonides' new order-entry system, Sullivan first offered training in using the Internet to search medical literature.
Once the doctors were comfortable using a mouse and the systems, it was much easier to move them along into other systems such as order entry. "The training sessions were standing-room only," she says.
Andrew Pasternack is a Richmond, Calif.-based freelance writer specializing in information services.