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Holy Name Medical Center Modernizes with IBM Power Systems

Holy Name Medical Center
Mike Skvarenina CIO, Holy Name Medical Center-Photo by Bill Bernstein

Mike Skvarenina, CIO at Holy Name Medical Center, has been working in the midrange environment since the days of the IBM System/38. Throughout that time, he’s seen myriad changes in that space, not the least of which is how much the platform has changed from the earliest systems to the latest IBM Power Systems* servers. Now, he notes, it’s “much more flexible” than it’s ever been.

Holy Name was established in 1925 in Teaneck, New Jersey by two surgeons, with the support of a Catholic sister, Mother General Agatha Brown of the Sisters of St. Joseph of Peace. When the first patient arrived, the facility had 115 beds and fewer than a dozen physicians. A short five years later, however, it had added a 70-bed unit to meet the needs of area residents suffering through the Great Depression.

Today, Holy Name has a 361-bed acute-care facility and almost 1,000 physicians. Additionally, among other specialized services, it currently boasts the Patricia Lynch Cancer Center, The Interventional Institute, The MS Center, The Institute for Simulation Learning and The Institute for Clinical Research.

Putting Users (and Patients) First

As one might expect, a medical facility of this size requires a robust hardware and software infrastructure. In this case, that includes two active IBM Power Systems servers—a production 824 and a backup 750—with the 750 acting as an IBM PowerHA* mirror of the 824.

The software, well, it’s been around for seemingly forever. Holy Name’s electronic health record (EHR) system comprises a set of homegrown applications that Skvarenina has collectively dubbed WebHIS—i.e., web-based hospital information system.

In 1986, Skvarenina’s then-employer sold Holy Name a small outpatient and clinical billing information system running on a System/38. After acting as a vendor-supplied consultant for several years, Skvarenina was hired full time by Holy Name as a programming manager in 1992.

Despite the name changes over the years (the AS/400, iSeries, System i and now Power Systems), Holy Name and Skvarenina stuck with the platform, seeing it as the lynchpin in its overall operations. It was so vital, in fact, that the organization decided in 1999 to begin modernizing the constantly evolving 1986 application to a browser-based system.

In doing so, Skvarenina leapfrogged another party that had come in to also modernize the system. “The other party was going down the client/server route using Borland’s Delphi as the foundation. But I wanted something better, something more flexible that didn’t require a fat-client install and had to be constantly maintained as enhancements were developed. I thought to myself, ‘This needs to run in a web browser,’ so I set out to find a technology to bring a web browser interface to Holy Name,” Skvarenina recalls.

At the time, screen-scraping technologies were available that could take a 5250 green screen and allow it to run in a web browser, but these options didn’t offer the type of high-end user experience Skvarenina was seeking. He then discovered the CGIBIN service program by Giovanni B. Perotti, which allowed browser-based applications to be powered by RPG programs and, as Skvarenina puts it, “the rest is history.”

Build Your Own EHR

Skvarenina wrote a few experimental programs and, once convinced this was a viable solution, tasked two of his lead developers to begin writing a menu system and the beginnings of the hospital’s electronic medical record. He coined this new interface/system WebHIS.

“Our president and CEO, Michael Maron, insisted that Holy Name develop and perfect its own proprietary software that would be far more cost effective and adaptable compared to what any outside vendor would provide. It had to be a differentiator for Holy Name to attract top physicians and employees,” Skvarenina says.

While the marketplace is cluttered with commercially available EHR systems, clinical staff often find these programs difficult to learn and use. “In the same sentence, they’ll start comparing WebHIS to XYZ product, praising WebHIS for what it does,” Skvarenina says. What’s more, Holy Name experienced a significant cost savings by developing its own EHR system. “Software development on an IBM i is much less expensive than buying a commercial product,” Skvarenina says, noting that most commercial products require an annual maintenance fee—typically 15 to 18 percent of the original purchase price.

Today, WebHIS comprises more than 500 RPG programs that facilitate patient care, including WebMAR (an electronic “medication administration record” for documenting medications administered to the patients), WebNOTE (for physician progress notes writing) and WebSIG (physician electronic signature). Clinicians compliment Skvarenina on WebHIS frequently, saying it’s much easier to use than the systems at other area hospitals.

That ease of use for clinical staff is by design. “All clinical applications are designed with input from clinical staff,” he says. “When a decision is made to build some new functionality, meetings are held with the right clinical staff to collect requirements, discuss workflows and critique the development as the product or functionality comes together.”

Developing RPG Skills

Even though WebHIS has reliably managed virtually every aspect of Holy Name’s medical record system for years, Skvarenina has some concerns about future RPG CGI development and application maintenance.

According to Skvarenina, RPG skills are declining, largely because experienced developers are retiring and few schools teach RPG.

“Once in a while, you hear of a young RPG programmer out there, but otherwise, the market is slim. When I post a job that requires RPG experience, most respondents are very seasoned RPG developers lacking any real browser experience. Since it takes a year or more to become proficient at web-based development using RPG, I just can’t take them on,” Skvarenina remarks. “So I have this crucial information system that provides tools for physicians, nurses and other clinical staff, but I don’t have the resources to maintain it.”

Recognizing the reality of both the now and the future, Skvarenina has begun a multipronged approach to dealing with the issue. First, Holy Name has developed an internship program as a gesture of goodwill to reach out to current programming students and recent graduates. Skvarenina hopes to find a few people who will appreciate and adopt the RPG to support its legacy applications now and into the foreseeable future.

“We’ll run these interns through the RPG courseware from ATS (Automated Training Systems) teaching them RPG with the hope that some will embrace the language and want to stay on beyond their internship period. Skvarenina says. “In my opinion, it’s a great language and recent enhancements—RPG free-form—have only made it better. Now, we just have to teach other people that.”

Mature, Seasoned and Reliable

Holy Name is also shifting to a bimodal application development model. This will involve RPG application support and the development of new PHP apps, APIs and the eventual rewrite of all of its RPG code. This approach will allow the organization to continue using its existing and proven medical information system while also setting itself up for the future.

“Mode 1 will cover the RPG side of things. I don’t want to call it ‘legacy,’ because it’s very mature, seasoned and reliable, but it needs to be maintained and even enhanced. Hence why we began our RPG internship program,” Skvarenina remarks. “Mode 2 is more focused on what’s new, modern and mainstream.”

Skvarenina envisions this on a sliding scale. It would start at 95 percent Mode 1 and 5 percent Mode 2. In two to three years, slide those numbers to 30 percent Mode 1 and 70 percent Mode 2. In 10 years, the needle will have completely flipped, with Mode 1 at 1 percent and Mode 2 at 99 percent. In keeping with this, all existing RPG code would be rewritten as PHP or another, more accessible language.

“We like the reliability of our Power Systems platform. We like the performance it provides. We like that it supports hundreds of users with sub-second response times.”
—Mike Skvarenina, CIO, Holy Name Medical Center

He notes, however, that whatever language is used, the application would likely still run on the Power Systems platform. “When everything transitions to PHP, we could switch to Linux* on PCs, but why? The platform is incredible. The OS is bulletproof. And the database is fantastic,” Skvarenina says. “We like the reliability of our Power Systems platform. We like the performance it provides. We like that it supports hundreds of users with sub-second response times. We just like it.”

Developing for the Future

As the application-development world trembles—no matter the OS or hardware—it’s important that organizations flex with it. To its considerable credit, Holy Name has recognized and embraced this.

It’s educating a new generation of RPG programmers and adopting new languages and development techniques. It hasn’t forgotten its long-ago computing roots, however—and nor has Skvarenina.

“RPG is a very powerful language, and many companies are still using it for their application development. I mean, we even used it to jump from the green-screen interface to a web-based interface—and early at that. And our core medical information system is still running without a hiccup,” Skvarenina notes.

Jim Utsler, IBM Systems Magazine senior writer, has been covering the technology field for more than a decade. Jim can be reached at jjutsler@provide.net.

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