My role is twofold. First I have the CIO role, which is kind of the gatekeeper of the technology itself. I have a couple of Microsoft certifications—MCDBA and MCSE. I'm also in a corporate role as Vice President, which is more organizationally, strategically, and operationally focused. In general I set the technology strategy for the organization, working very closely with other entities. That includes everything from the operational and administrative side of our organization all of the way through to the clinical function, which is our business.

Years and years ago at the Department of Defense, they had a PLATO mainframe system in place at a United States Army military post where one could

do research work. I believe that was my first encounter with any type of computer. My first job in IT was while I was in college. I was a graveyard shift computer operator working with a Honeywell mini-mainframe.

Two years ago, I formed two groups to comb through the organization and take inventory of what technology we had and garner what we needed. We developed a list of potential initiatives and worked with the Information Technology Steering Committee to turn that list into a three-year IT strategic plan. It was important to me, and to the organization, to make sure that we had the right folks at the table making these decisions.

If you look at regulations such as the Health Information Portability and Accountability Act, or many of the financial guidelines, or the reimbursement process, those regulations seem to change annually. It's a constant challenge to keep up and make sure that your algorithms and toolsets are operating so that you're compliant. I think you also have the challenge in healthcare that technology really hasn't been the primary focus to date. I think that is changing, but it's still relatively new.

It's always primarily the features, functionality, and robustness of the application. But it's also the strategic vision of the manufacturer, as well as the level of training and education that is available. Ultimately, what level of support exists?

The biggest initiative that we have going on is with electronic medical records. We have a large outpatient presence, probably half a million provider-to-patient encounters per year, and several electronic systems. Our first goal was to house all of that data in one location and make it available to our end providers and clinicians via a Web-based application. We built that system and turned it on in 2006. We will expand it in 2007 to include advanced messaging capabilities and improved workflow within our clinics.

We do not have any Linux or open source on the desktop. My philosophy is that it's probably fine for research or for small locations that aren't major businesses, but from a major business perspective, I'm not willing to risk the lack of support that I believe exists in open source for my major applications, whether it be financial, clinical, or otherwise. We have a world of support with Microsoft and are able to recruit and retain staff that have the appropriate skill sets we need to make sure that a 24x7, 365-day-a-year business is running.

It's an ongoing process, especially in healthcare where you have always-on operations. We assess anything that we put into the data center to determine what the worst case scenario is for that system or application; and what process, technology, and methodology give us the quickest response time to recover from that.

I think it's rapid expansion. The good news is that hardware footprints are shrinking. But you are also rapidly adding applications, because each and every functional entity within an organization has a need, and there's now an application out there to service that need. So we have to manage those and make sure they're redundant, make sure they're in line with all of our standards, and watch the growth factors.

I'd have to say Star Trek. It's the final frontier, you know? "To boldly go where no man has gone before"—isn't that kind of the motto of all of us in the IT industry?