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From Green Screen Apps to the Cloud: One CIO's Challenge

Kevin Fogarty | March 4, 2011
How do you drag a company running core business processes using green screen apps circa 1990 into the age of cloud? One CIO discusses his strategy.

Moving from an entertainment-industry business to a healthcare company is a big change in environment and culture, says Brett Michalak, former CIO of, 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.


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