From green screen apps to the cloud: One CIO's challenge

Moving from an entertainment-industry business to a healthcare company is a big change in environment and culture, says Brett Michalak, former CIO of Tickets.com, who became CIO at Crescent Healthcare in May.

It's also an opportunity to make fundamental changes to a growing company in a segment of the healthcare industry where growth will be fueled by the aging of the U.S. population.

The technological challenge for Crescent's new CIO wasn't simply to improve usability and reliability, however, Michalak says. It was to drag ancient green-screen applications out of the early 1990s and into the cloud, where they could be used to make a service that is inherently slow and inefficient more effective by cutting through the latency in every process except direct, hands-on patient care.

"In healthcare, the quality of patient care is paramount, so that's been one of the immovable priorities applying IT for efficiencies in business process and overall improvements for the customer, " Michalak says. "What we're trying to do is give all our customers -- hospitals, physicians, payers and patients -- the most up to date clinical information on the status of their patient and our service to them."

Infusion Business

Crescent Healthcare is essentially a pharmacy service, but not the kind that sells aspirin and cold medicine to walk-ins.

It and between 700 and 1,000 other companies nationally specialize in infusion therapies -- drugs for chronic, serious, often life-threatening conditions such as cancer, hemophilia, multiple sclerosis and immune-system deficiencies, that have to be dispensed by intravenous drip, rather than pill or injection.

The drugs themselves are often expensive, and difficult to administer. Managing the cost and logistics is the real trick, however, Michalak says. Visit times, treatments, drugs and equipment needed can change up until the minute a nurse hits the road in order to make sure each caregiver's time is used most efficiently.

Still, Michalak says, once they're on the road or on site, nurses are in touch only by cell phone, and data on the patient's condition doesn't get into the system or out to the doctor and insurance company until after the nurse returns.

"There can be a lot of delay," he says. "That's one reason we're making mobile connectivity a priority for the next stage of the project."

Lots of Legacy Issues

The next stage of the project is a long way from the first stage.

When Michalak walked in to Crescent in May of 2010, he says he found an IT infrastructure that had been updated only around the edges practically since the company was founded in 1992.

The core business application -- a homegrown pharmacy management application -- was character based and accessibly only from dumb terminals. Because the data was difficult to extract and use for capacity planning, scenario planning, market analysis and other business-intelligence functions, Crescent did without.

It did without a lot of things.

"Most of the real business applications were homegrown and a lot of it had to be replaced," Michalak says.

"The idea [from top managers] a wholesale legacy replacement -- to create from scratch a pharmacy management system that is essentially soup to nuts, that touches all aspects of the functional business departments," he says. "The original intent was to do all the development with a cloud based solution to get the cost and efficiency benefits available there and a path to other initiatives."

"We went through the legacy systems to try to evaluate what were the true business processes they represented and how well we could replicate that with Force.com services," he says. "It turned out there was a certain percentage of business processes that could be handled through a specific cloud environment, while others created some challenges for us."

Tradeoffs Part of SaaS

That tradeoff is an unavoidable part of any legacy migration to commercial software, but especially migrations to cloud- or SaaS-based applications, according to Patrick Kuo, a Washington, D.C.-area consultant responsible for the cloud infrastructure at political-news site The Daily Caller. "The important part is to not try to fix something right away like an emergency," Kuo says. "I try to take a step back and ask where do you want to go in six, 12, 18 months and figure out a plan to get there and not worry as much right away about what technology to use."

For Crescent the first step was to gather, clean and recycle the company's data to make it usable in applications other than the homegrown versions. So the first thing on the agenda, rather than a cloud platform, was to build a data warehouse to receive the data, install Salesforce.com to automate business operations and add some business-intelligence features to help plan operations and marketing.

"The initial approach was to do a full Force.com development, but as we moved through that we had to make some adjustments based on specific requirements that didn't quite fit the cloud plan," Michalak says. "We followed the goal as closely as we could, while accommodating immovable priorities that meant we had to reconfigure some areas."

One of those was replacing the green-screen pharmacy management system with something more modern -- in this case, the CPR+ from Definitive Homecare Solutions -- a specialized set of applications designed for patient- and business-management.

Among other things it provides the data interface and presentation for the portal patients and insurers can use to check on each other.

"CPR+ is focused on our specific industry, and there are only a handful of vendors who do that kind of software," Michalak says. "We needed that specialization; we also needed people who could use it.

Crescent's edition of the CPR+ system in limited testing right now, but should hit full production within the next few months.

After that, the main migration will be largely finished and it will be time to move on to the next step: putting all that scrubbed, redefined, repackaged information in the hands of caregivers in the field.

"We'll be giving nurses, people in the field a user friendly interface we can use to get the most current information into their hands and that of patients to improve the logistics, improve the care and get information back from the field as quickly as possible."

That level of communication isn't just an improvement in operational efficiency, it's a competitive advantage in an industry with 700 to 1,000 competitors, among which Crescent's 500-person company is one of the larger.

"I absolutely do see this as a competitive advantage in attracting clients and caregivers and payers; being able to keep everyone up to date in real time is light years ahead of where we were," Michalak says.

This story, "From green screen apps to the cloud: One CIO's challenge" was originally published by CIO.

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