Manage Learn to apply best practices and optimize your operations.

Hospital CIO, CEO Turn to COO to Help Tackle IT Projects

After a two-year freeze on IT projects, Antelope Valley Hospital had to update its technology. The CIO and CEO discuss how they prioritize projects with their new COO.

Antelope Valley Hospital
REVENUE: $763.8 million
IT CHIEF: CIO Humberto Quintanar
IT/BUSINESS CHALLENGE: To stay competitive by completing numerous IT projects after a freeze on IT spending
UPSHOT: Hired a COO to prioritize projects and work on major initiatives

Like a scene from a Clint Eastwood movie, the dusty town of Lancaster, Calif., suddenly emerges out of the high desert some 70 miles northeast of Hollywood. Along one of its streets is Antelope Valley Hospital, a 379-bed acute care hospital that itself has elements of a Western drama playing out.

Only a few years ago, the hospital was in dire straits, with a reported 2003 operating loss of more than $5.4 million on revenues of $689.9 million. This came on the heels of unceremonious departures by the CEO and CIO, as well as an eventual shakeup of the board of directors. In the same year, then-CFO Les Wong took the reins as CEO and has held onto them ever since.

Wong's recovery plan called for freezing spending on IT projects for a couple of years. Under the previous CIO, Antelope Valley Hospital appeared in many technology trade magazines as a successful adopter of emerging technologies such as wireless networking and biometric devices. But many of those projects failed to deliver on expectations and resulted in millions of wasted dollars, says CIO Humberto Quintanar. IT's reputation got a black eye.

"We had hundreds of [computer] mouses with fingerprint recognition that weren't working. Some were 'recognizing' the wrong people," Quintanar says. "I had to throw them away."

Once cash flow and the board of directors stabilized last year -- the hospital posted $241,288 in profit on $763.8 million in revenues in 2005 -- Wong did an about-face. He opened the floodgates to IT, green-lighting projects such as bar-coding medications, document imaging, computerizing physician order entry (instead of having doctors handwrite prescriptions) and adopting electronic medical records. Antelope Valley's IT now has to spearhead a massive retooling of the technology infrastructure to support these planned improvements.

"Technology can help us speed information," Wong says, adding, "You look at how IT can improve patient safety."

Because Quintanar faces huge challenges with project overload, Wong brought in a new COO, Edward Mirzabegian, to help prioritize projects and ensure technology and business goals stay aligned on a day-to-day basis. This has freed up Wong to concentrate on nontechnology-related concerns. (Quintanar previously reported to Wong, but he now reports to Mirzabegian.)

Of course, Antelope Valley Hospital won't be riding off into the digital sunset anytime soon. After years of missteps and standstills, Wong, Quintanar and Mirzabegian have only just begun the next leg of their high-tech adventure.

How has your tech-spending mind-set changed?

Les Wong: The previous board and administration was, for the past five or 10 years, too [politically] preoccupied and could not focus on what this hospital really needed from an IT perspective. With the inability to get attention and dollars, we just sort of stood still until a new board came on with a new administration. The last couple of years, we've had an elected public board. And they have begun to allow us to strategize and focus on those key things that we need to do to move this hospital forward.

Humberto Quintanar: You can only stay still for so long until you start feeling the real pain, where the computers are getting old and users are fed up with things breaking down. The younger doctors are coming in from other hospitals and saying, "How come I can't access this?"

Little by little, those forces are going to push you no matter what. We are at a point where we don't have much of a choice. We've got to embrace the technology and make it work, because otherwise we are going to fall far behind.

After "standing still" for two years, how do you start up again?

Wong: We are doing a lot of little things, but I think we're going to have to face the larger, more expensive system soon -- upgrading the backbone IDX system -- which will take us further down the road but is much more complex to install. It's a lot more money.

But I think you keep a focus on patient safety and look at how IT can improve it. How do we prevent drug errors? Duplicating orders? IT will certainly help us improve our safety in terms of making sure we deliver the right thing at the right time to the customer. I approach it from the patient safety standpoint.

So some real-life examples might be when drug addicts come in and try to get prescriptions. They'll say, "I've got an ache in my leg and need some painkillers." Then the next day, they'll come in and say, "I've got an ankle problem." But this system will see right away the encounters and flag those types of things.

Quintanar: And there are various ways to do that with technology, like bar coding on the medication and electronic medical records. Computerized physician order entry, for instance, lets doctors put prescriptions in the computer instead of handwriting notes. The whole process is done automatically, so there's no chance of errors in terms of [the pharmacist] not being able to read the physician's handwriting and filling the drugs the wrong way.

Because the technology in the hospital is a little behind, as Les points out, we are trying to get into a position where we are not necessarily way ahead of everybody else but are at least catching up to the majority of hospitals.

How do you prioritize projects?

Quintanar: We've put together a group of five or six people, including our COO, who meet on a regular basis to look at [project] requests. It's sort of an executive committee that tries to put a priority in place. But unfortunately, there are certain priorities that we just have to do, even if we already have 100 projects in our basket. It has to be done. It's a lot more money.

Now, I'm of the mind-set that we have to continue to add. But if you add, then you've got to subtract one -- and we can't do that. The bottom line is that the hospital has adopted a policy that says, "Just do it. No excuses."

Wong: I think that's the challenge. Otherwise we will not gain ground.

So what's the rush?

Wong: With the rising cost of health care, the government believes that high quality is low cost. By lowering cost and reducing unnecessary treatments, it's going to cost the government less money. So they are creating incentives for us to look at certain things, and IT is a way to get into it.

Hopefully in three or four years, most of our information will be in the computer and accessible in multiple points throughout the hospital. It'll be Web-based, so the physicians can access it at home or at the office.

This will improve everybody's lives in terms of speeding things up. It will improve quality because the information will be more current, and so [physicians] can make better decisions about the patient.

Quintanar: We need to have electronic medical records in place by a certain time according to government regulations. And we are looking to get a lot of our doctors to embrace the technology as well. You can put a lot of technology out there, but if it's not embraced by the users -- in this case, the doctors and the nurses -- then it's not going to help you.

And that's what we are looking at right now: carefully moving in the right direction but making sure that the technology is being embraced by the right people.

Are doctors a reluctant user group in embracing technology?

Quintanar: Doctors are basically focused on taking care of patients and don't really want to bother with learning anything else. They just want tools that are basically an extension of their hands.

My challenge is to make sure [technology] is easy for them so they don't have to spend two days in training. On the other side of the spectrum, doctors want to use PDAs and wireless. You've got to find a median -- and that's a difficult task.

Wong: Doctors can take two patients with similar problems and treat them differently. They are individuals. And so doctors want a system that is flexible. A lot of the failures in the past were because the systems did not reflect how they do their business. Our systems have "personal order sets" or "personal order ways" that allow a doctor to have a degree of flexibility based on the way that he or she likes to practice.

What are your metrics for success?

Wong: From my perspective, it sometimes takes us a long time to make decisions about the system because it takes a long time to install and is rarely installed in the time frame that you want. Even when it's installed, it takes a fair amount of time before users actually know how to use the system. And so when you look at it, it could be two or three years before you actually start to see benefits. It's very difficult to measure, and in the past you never knew if you got the benefits.

It is so complicated to even try to quantify because you are really saying this piece of software is going to improve your life. It will speed things up and provide information to you quicker. Yeah, but how much quicker? How much is that worth? It's very difficult to quantify and then go back and say, "Did we get it?" And so a lot of times, we don't really know. But we do know it's going to improve life. You have to make that leap of faith that this is good stuff.

Quintanar: This makes the decision to move forward with a large project very cautious, very slow because you want to see that return on investment.

On the other hand, we have to deal with it. For example, in the past we used a lot of traveling nurses. They constantly change, and so you're constantly training and retraining. If you have a brand-new system and you are constantly training, then [ROI] becomes even longer.

How has new COO Edward Mirzabegian affected technology decisions?

Wong: He's beginning to see what technology has to be here in order for us to move forward. I think it spreads our workload so that I don't have to be into everything. It just helps me concentrate on other areas.

Quintanar: From my perspective, he brings a lot of experience to the table in terms of technology. He understands it and realizes that the hospital needs the technology in order to move forward. Now the support comes from both ends: operations and administration. They are both behind me, making it a lot easier to bring the technology that we need in front of the board and the rest of the people in the hospital.

Wong: We still expect to get a lot done. [Laughs.]

How has the transition been, first reporting to the CEO and now to the COO?

Quintanar: [The COO] position hadn't been filled for two years because we were trying to turn the hospital around. So now we are bringing that position back to work on our operations. We know that there are a lot of changes that need to take place.

It's the divide-and-conquer solution. Les has the ability to do all of the duties that the CEO is supposed to be doing for the hospital with the community. So he has very little time to work with me on a lot of the initiatives, the minor things that the hospital has to take care of.

Now I have somebody else that can work with Les and work with me. Now there is another force that has the ability to give [technology] a little more attention. It's not just me running around saying, "Hey, we need this, we need this, we need this."

Wong: Before, [Quintanar] was more out on his own trying to sell the need. Now it's being supported by an operations person saying, "I need it because it's going to help me solve this problem."

Tom Kaneshige and Ellen O'Brien were senior editors at CIO Decisions. To comment on this story, email [email protected].

Dig Deeper on Small-business IT strategy