All systems down

CIO - Among the 30-odd CIOs who serve Boston's world-famous health-care institutions, John Halamka is a star among stars. He has been CIO of the CareGroup health organization and its premier teaching hospital—the prestigious Beth Israel Deaconess Medical Center—since 1998. He helps set the agenda for the Massachusetts Health Data Consortium, a confederation of executives that determines health-care data policies for New England.

Until 2001, the 40-year-old Halamka also worked as an emergency room physician, but he gave that up to take on the additional responsibilities of being CIO of Harvard Medical School in 2002. However, as a globally recognized expert on mushroom and wild plant poisonings, he is still called when someone ingests toxic flora.

All of this has earned Halamka a considerable measure of renown. For two years running, InformationWeek named Halamka's IT organization number one among hospitals in its yearly ranking of innovative IT groups. In September 2002, CareGroup was ranked 16th on InformationWeek's list of 500.

Two months later, Beth Israel Deaconess experienced one of the worst health-care IT disasters ever. Over four days, Halamka's network crashed repeatedly, forcing the hospital to revert to the paper patient-records system that it had abandoned years ago. Lab reports that doctors normally had in hand within 45 minutes took as long as five hours to process. The emergency department diverted traffic for hours during the course of two days. Ultimately, the hospital's network would have to be completely overhauled.

This crisis struck just as health-care CIOs are extending their responsibilities to clinical care. Until recently, only ancillary systems like payroll and insurance had been in the purview of the CIO. But now, in part because of Halamka and his peers, networked systems such as computerized prescription order entry, electronic medical records, lab reports and even Web conferencing for surgery have entered the life of the modern hospital. These new applications were something for health-care CIOs to boast about, and Halamka often did, even as the network that supported the applications was being taken for granted.

"Everything's the Web," Halamka says now. "If you don't have the Web, you're down."

Until last Nov. 13, no one, not even Halamka, knew what it really meant to be down. Now, in the wake of the storm, the CIO is calling it his moral obligation to share what he's learned.

"I made a mistake," he says. "And the way I can fix that is to tell everybody what happened so they can avoid this."

Sitting in his office three weeks after the crash, Halamka appears relaxed and self-possessed. There's another reason he's opening up, talking now about the worst few days of his professional life at CareGroup. "It's therapeutic for me," he says, and then he begins reliving the disaster.