H.I.S.-tory

by Vince Ciotti

© 2013 by H.I.S. Professionals, LLC, all rights reserved.

Episode #122:

McKessonPart 9 = Happy

Ending Who knew Paragon started out in 1991 as an Executive Information System

(EIS) running on DEC!?

IT Rage Of The Nineties• This last segment of the McKesson saga actually goes back to

the per-merger days of HBOC in the mid-90s, when the IT world was all abuzz with the concept of “client/server” systems. In essence, PCs replaced the inhouse mainframes that dominated the 60s, shared mainframes that ruled the 70s, and minicomputer-based systems that swept the 80s.

• Instead of the large mini or mainframe doing the work, PC workstations (clients) split the processing with a handful of central PCs (servers), running under a 3-tiered architecture:– User Services = a GUI on the PC clients (viz: Windows 95)– Business Services = modular, customizable applications– Data Services = a relational data base, e.g: SQL or Cache

• Seems a little trite today, but 20 years ago, it represented a huge challenge to the dozens of legacy HIS systems…

A Saint Reborn• One of HBOC’s many acquisitions had been FDC,

formed by AMEX out of SAI and McAuto. FDC didn’t do much with Mac’s systems which were sadly sunset, but SAI had almost 300 Saint clients running on their Point Four minis (right) that had evolved to Saint Plus or Saint Express, keeping the upgrade & maintenance revenues flowing.

• HBOC inherited this challenge and with the same daring Walt Huff showed in creating MedPro, they launched a project to re-write Saint as a true C/S system, just when Meditech was launching their C/S version of their venerable MAGIC system.

• The name for this HBOC product was itself re-cycled from an early DEC-based EIS system per the 1991 ad on the first slide: Paragon, appropriate for what was hoped to be the latest & greatest HIS!

The Big Splash• HBOC announced Paragon with the usual sales & marketing

hype touting the advantages of its modern C/S architecture:– Huge booth at that year’s HIMSS conference,– Hot new brochures, proposals, ppt files, etc., &– “Special offers” targeting the 300 Saint Plus clients.

• One of them, Olean General Hospital in frozen upstate NY, contacted us in late 1996 for help negotiating a contract for Paragon to replace their Saint Plus. As former vendor reps who have sold a number of systems before their time, we were skeptical of future promises even from a giant like HBOC

• We protected Olean the best we could, frustrating their IT Director (she was very excited about the potential of a C/S system) with all of our contract terms & conditions. Olean signed and began the conversion…

Time Old Story…• Readers who have been out there a few years can guess what

happened next to Olean and the 50-odd (sic) other pilots:– Development took rather longer than expected (by years…),– Releases came out with pieces of the system (a fraction…), &– New modules & apps came with extra charges (surprise?).

• It’s the same old story as was played out with almost every new product ever introduced in HIS-tory: SMS’ Unifile in the 70s, Millennium in the 90s, Soarian & Release 6.0 in the 2000s…

• As Y2K neared, some Paragon early adopters sued, others bought replacement systems, while some waited patiently through the releases and delays limping along with Saint…

• Protected by our stringent contract Ts & Cs, Olean asked us for help again searching for a replacement in 2000, that wound up being QuadraMed’s Affinity, that lasted them for a good 10 years...

A Case Of Indigestion• When McKesson acquired HBOC in 1999, they inherited the ≈30

remaining Paragon early adopters, suffering from “agida…”• Their new CEO, Graham King, who had cut his teeth at SMS and

Micro Healthsystems (see episode 47 at hispros.com), turned to his trusted lieutenant from NJ, Jim Pesce, to handle the problem.

• Graham sent Jim to Charlotte, NC (FDC’s HQ) to shut down the Paragon project. When he got there, Jim looked into the system and was impressed by what he saw: sharp people, a modern C/S design, and a lot of progress made since the early problems…

• He returned to Atlanta and appealed to Graham to save Paragon – it had far more potential than aging the Star, Series, etc. Graham trusted Jim’s opinion, but just to be sure, put Jim in charge of it, just like McAuto had done to Chuck Barlow with OSF in 1970!

Stabilization Program• As his first step in charge of Paragon Jim pulled a

gutsy move: rather than stepping up sales (the usual move by any vendor on trouble), Jim pulled Paragon 2.9 off of the market and concentrated on getting the next releases out on time & schedule, to save as many of the early adopters as possible.

• This radical move paid off: the remaining pilot sites saw the next releases in 2001 come out almost on time, with promised features, and no extra fees!

• The next year, Jim put Paragon back on the market, and word of its C/S architecture spread. It caught the eye of a sharp IT Director attending one of our HIS Buyers Seminars - Dave Witton of St. Johns in Jackson Hole, WY. Dave was quite the techie, having written apps himself, and even using Apple servers!

Tough Selection Process• Dave hired our firm in 2002 to follow our “Non-RFP” selection

process, which replaces the old “Request For Prevarication” with users calling their peers at references, in-depth review of user manuals, and tough contract terms, all scored numerically.

• By 2002, Paragon scored very well in our demanding process, as can be seen in the chart below for the 3 semi-finalists vendors:

• Mindful of Olean’s debacle, we negotiated the same stringent contract protection so if things turned south, St. John’s would only lose time, not money. Dave signed, went live and low & behold, Paragon worked! Not perfect (what HIS is?), but the solid C/S architecture rocked.

Third Time Around• Throughout the 200s, Paragon started selling like proverbial hot

cakes as CIO after CIO learned like Dave the advantages of a pure Microsoft platform with a Windows GUI & SQL data base.

• Ironically, around 2009 we heard from Olean again (some people never learn…): after 10 years with Affinity, they wanted to search the market to see what were the alternatives to prepare for the upcoming CPOE, E.H.R. and MU tidal wave.

• The plot had thickened this time around, however, as just when we were ready to start our selection process, word came down that a merger with neighboring hospital had been approved: Bradford Regional Medical Center in nearby PA, with the new entity to be called Upper Allegheny Health Systems (UAHS).

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The Results• Bradford had used our

firm years ago to select Meditech’s Magic, which they had implemented pretty well, so we paired off Meditech’s C/S against Paragon’s C/S to see which system would run in the merged entity.

• As the results on the right show, Paragon edged out Meditech’s C/S in the (objective) eyes of the users at Olean, while Bradford favored their more familiar Meditech.

Surprise Ending• During the selection process, most of the C-Suite at Bradford

retired, and Olean executives took over management there.• At one of the most inspiring afternoons of my 45-year career in

HIS, the executives met to decide the system, which seemed to me to be a foregone conclusion: Olean ruled and their users wanted Paragon, period, right? Wrong! The UAHS execs at Bradford spoke up for their users who were going through a tough time with budget cuts & layoffs stressing their bottom line, productivity and morale. They appealed to their peers at Olean to select Meditech so they could turn Bradford around and avoid the inevitable travail of a system conversion…

• Incredibly, after a thoughtful discussion, the combined team agreed: they would do what was best for UAHS overall, not just the top dog, and went with Meditech C/S! What a great team of people: if you’re ever admitted, hope it’s in Olean, NY!

The New Med-Pro?• Olean’s decision was a rare loss for Paragon as it has since swept

hundreds of decisions around the country beating out almost all competitors (many still with proprietary DBs), thanks to the pure-Microsoft architecture that gives CIOs enormous access to their data for PC downloads, report writers, interfaces, etc.

• So an amazing ending to the saga of OSF/HBO/SAI/FDC/HBOC/McKesson that led to the creation of the “go-forward” Paragon of systems from the largest vendor in the HIS industry today.

• And to think it all started about fifty years ago with– Walt Huff, Bruce Barrington & Rick Owens’ “CRASH” and

“SHIS” systems at OSF in Peoria, IL, in the mid-60s, and– Jack Weil & Mason Chrisman “Saint” system written for

Charlotte Memorial at SAI in 1966 in Charlotte, NC. • A fitting ending to the amazingly long HIS-story of our industry!