Breathing Room for IT Investment

John Wegener says he was “more than a techie” when he became Vice-President and CIO of Toronto’s St. Michael’s Hospital. Wegener began his career as a respiratory therapist and has also done some teaching, so he understands the requirements of both patients and students. “All this experience lets me look at the use of information from different perspectives,” he says, “from the provider, from the researcher and from the educator.”

Those different perspectives came in useful when Wegener had to grapple with the financial realities of updating the hospital’s information technology infrastructure. New approaches were called for, and Wegener came up with one that would be particularly useful in transforming St. Mike’s networking environment into one that would better serve all the hospital’s users.

St. Michael’s is a Catholic teaching hospital that is committed to innovative patient care, teaching and research. Affiliated with the University of Toronto, it has a vision to be recognized internationally as Canada’s finest academic healthcare provider. The 590-bed institution has over 25,000 in-patient admissions and over 500,000 outpatient visits every year.

When Wegener joined St. Michael’s as its first CIO in December, 1998, the hospital was in the midst of developing its corporate strategic plan, and he became part of that process. President and CEO Jeffrey Lozon recognized early on that information technology would play a major role in helping the hospital realize its goal. In addition, hospital amalgamation was happening; St. Michael’s was taking over another downtown Toronto institution, the Wellesley Central Hospital.

“My mandate was to evaluate our information-management processes and bring this organization into the 21st century,” says Wegener, who admits that the healthcare sector is somewhat behind other sectors and, as a whole, is just beginning to adopt technology as a means of furthering its business objectives.

Lagging Systems


According to its corporate strategic plan, St. Michael’s will strive for excellence in clinical care, education and research in each of its six clinical programs. Technology, however, was a problem. According to Wegener, the support wasn’t there. Most of the information processes such as order entry, results reporting and patient scheduling were paper-based, which, he says, was pretty unusual for 1998.

A few years earlier, St. Michael’s had managed to pay back its debt – no simple feat. But that meant the fiscal belt was pulled tight and there was little or no funding for enhancements to existing systems. To make matters worse, the transfer of staff and programs as a result of the Wellesley Central integration had a devastating impact on the performance of the network. The original network was designed for 750 users, but by the time Wegener came along that number was up to 1,500 and the forecast for 2002 was 2,700.

“It was so bad that our users – managers, doctors and nurses – couldn’t access the system, and as more users were added, the system reached capacity and consistently kept crashing,” he says. “Applications had been added in a piecemeal fashion over the years without any modifications to the existing process and

without any consideration of the overall corporate need for information. The result? We had tons of data within each application – silos of data and very little real information.”

Tackling The Problem

Wegener’s first response was to evaluate the situation. He brought in outside consultants to help develop a comprehensive, five-year information management strategic plan that would provide the hospital with the ability to take advantage of emerging technologies and the developing Canadian infostructure. Then he crafted an information management vision for the hospital that focused on ‘connectivity’, enabling access to reliable information where and when it is needed. As part of this five-year plan, St. Michael’s will have the ability to electronically distribute patient records and diagnostic images, order tests and procedures, and review corresponding results throughout its facilities and outpatient clinics in nine different buildings.

One thing Wegener had learned from previous jobs was that while users knew what decision-making information they needed, they sometimes needed a little help to source the appropriate information. In his former job at the Hamilton Health Sciences Centre, he established a ‘Decision Support Unit’. He did the same at St. Michael’s, but called it the ‘Healthcare Improvement Unit’. It’s a group of experts that provides corporate support for both clinical and business decision-making.

Another important thing he had learned was that one cannot build on a poor foundation. A reliable infrastructure must be in place to allow users to access the data they need. “I came from a background of data use and data analysis,” he says, “and that’s what I brought to this position.”

Adopting A Utility

Management Model

The first year of the five-year information management strategic plan was devoted to redeveloping the infrastructure that was in obvious decay. A new reliable network was needed, but what about cost?

Says Wegener: “Hospitals have challenges when it comes to funding. It would cost $4 to $5 million to build a new network, so how could we finance that?

Today hospitals are forced to finance information technology projects through

internal operations, but that could mean reducing staff, and I wasn’t prepared to do that. We could also raise funds through donations, but it’s hard to get charitable donations for something that’s not easily visible. It’s not like raising funds to purchase a new MRI or CAT scan machine. I mean, who wants to donate money to pay for wires?”

Wegener had to be innovative. He came up with an interesting alternative – a Utility Management Model. It’s a new approach to financing and running something like a network.

Wegener describes it with an analogy: as far as the user is concerned, a network is just a utility, like the telephone you order from Bell. He reasoned that building networks isn’t the hospital’s business so he wanted to find an organization – a partner – who would. But that wasn’t all. According to the hospital’s Request For Proposal, the outside vendor would design, install and own the network, but the people at St. Michael’s would use it and the hospital would pay for that use.

St. Michael’s received responses to its RFP from six vendors. Three were

dismissed immediately because, in Wegener’s words, “most vendors just didn’t understand what we wanted.”

One that did understand was Getronics Canada, an Amsterdam-based services provider of information and communication technology. The company’s expertise included integrated computing and data, voice and video network technologies, all pulled together in e-business applications. In 1999 Getronics acquired the former Wang Global, a company with an established client base in Canada.

St. Michael’s and Getronics signed a four-year agreement, but Wegener says the whole idea of a Utility Management Model really points to a longer-term relationship. He calls it a ‘partnership’ and though that word is thrown around a lot in the IT sector, Wegener says it really is the most accurate way to describe the relationship.

How The Model Works

“Why go to a Utility Management Model?” he asks. “There are several reasons. First, the vendor is responsible for the technology. If we need another server, it’s up to them to provide it. That allows us to focus on our core business processes – health care. Another offshoot is that it helps me overcome the challenge of retaining good network people. Now that’s the vendor’s problem. And the really big advantage is that the Utility Management Model doesn’t treat this project as a capital expense, but as an ongoing operational expense. So Getronics has a guaranteed cash flow and we get what we need, but without the technology risk and capital cost.”

The specs for the model are ambitious, to say the least. For example, the system’s uptime must be 99.9995%, which translates to a maximum allowable downtime of only eight minutes a year. While Wegener admits this is unusually demanding, he stresses that it is absolutely critical in a health care environment. He adds that the throughput for the entire network must be a minimum of 40 megabits per second to the desktop and that the system must be non-blocking.

A New Deal For Patients

Now that the implementation of the network is near completion, Wegener is

moving on to the next phase of his plan: clinical systems. For that he needs buy-in from his healthcare providers – the doctors, the nurses, and all the other users of clinical systems in the hospital. He says he has it.

“While I believe that I have their buy-in, the next big challenge will be in managing their expectations. Technology changes the way people do business and you have to manage those process changes.”

Wegener’s thinking isn’t confined to the present. He knows what he wants for

tomorrow too. He envisions a hospital where patients actually admit themselves to the ward. He calls it a ‘patient communication centre’.

“Patients can complete their admission through a computer screen at their bedside,” he says. “This means you no longer need a centralized registration area. Patients could also order their meals from their bed, as well as the movie they want to watch. If they’re awaiting surgery, they can watch a video that explains the procedure prior to their operation. They can contact their nurse, who will have a cellphone that’s connected to the hospital network, so the nurse can get them any information they need.”

Wegener smiles and takes a deep breath. It’s plain that he doesn’t think any of this is mere pie-in-the-sky. “Not at all,” he says. “We have the broad bandwidth to do all this right now. It’s currently very feasible.”

With a continuing emphasis on innovative solutions to IT problems, we expect St. Michael’s will begin turning Wegener’s vision into reality.

Jerry Amernic is a Toronto-based writer and public relations professional. The author of four books, he is a consultant to many leading corporations and organizations, many in the high-tech sector. He is a regular contributor to magazines and newspapers.