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The Accidental CEO

1993-2003

In 1993, Rick Samco and David Moffenbeier, two of the early founders of Mentor Graphics, joined me. At Mentor, they had been through all phases of a fast-growing business, but my only experience was managing a handful of staff in my medical office. With physicians being the key customers for our EMR, they insisted I leave my medical practice and be MedicaLogic’s full-time CEO. Thus began my 10 year on-the-job learning experience.

My comfort zone had been as a solo programmer writing software. Now that was over, because we needed a larger team to move quickly, upgrading from a character-based program in MS-DOS to a more modern graphical user interface. By 1994 this team had created Logician, a fully-featured EMR running on Microsoft Windows. Records were securely stored on an Oracle database back-end.

It was the CEO’s job to articulate the company’s vision to potential investors — a big change from writing code in my basement at night. I had to go from being a reluctant public speaker to a confidence-inspiring leader. Thanks to Dave and Rick’s track records, by 1995 we were pitching to the venture capital firms of Silicon Valley. Sequoia Capital and other firms were sufficiently convinced to plunk down several million dollars for our first round. Later rounds brought in even more capital.

What next? Well, of all the careers I’d ever dreamed of, “salesperson” was never one of them, but now I was needed as a key sales asset. Doctors, nurses, and healthcare leaders wanted to hear a physician explain the benefits of an EMR. I morphed into a road warrior, delivering conference presentations, EMR seminars, and outright sales pitches to prospects across the country.

Going Public

Our sales kept doubling every year, putting us on the Inc 500’s list of the fastest growing companies for 3 years in a row while we acquired marquee customers, even including the NASA astronaut program. But the late 90’s dot-com boom drove the expectations for startup companies even higher. “Get big and go public, or go home” was the challenge, and we accepted it, joining the parade of companies preparing for an IPO in 1999.

While the IPO may be considered the holy grail by many entrepreneurs, for me it just felt like a necessity of the moment we lived in, and it was exhilarating and terrifying in equal measures. Once public, we joined the frantic wave of mergers and acquisitions underway, buying Medscape, which operated both physician- and consumer-facing medical news websites, a digital records transcription firm, and smaller companies with technologies (such as electronic prescribing) that rounded out our offerings.

Within months, the dot-com bubble popped, dragging the NASDAQ market — and all newly public companies — down with it. Customer confidence and sales deflated along with the stock price. We sold off Medscape and slashed expenses while we searched for a corporate buyer that might recognize the value of our product and customer base, if not our stock certificates.

On the morning of September 11, 2001, as I drove to the Portland airport to fly to a meeting with General Electric executives about an acquisition, the news came on the radio. The staff at our Medscape office in New York were shell-shocked but unhurt. Beyond that, time just stopped.

GE did eventually acquire MedicaLogic in 2002, but by then it required going through a bankruptcy proceeding to clear up various liabilities. The acquisition restored customer confidence, and the EMR product, renamed Centricity, remained one of the leading products in the ambulatory care market for many years to come.

My personal fit with the customs of a huge corporation was not ideal, but I was intrigued when serving as GE’s representative on various healthcare IT policy initiatives. So after 18 months with GE, I departed for the nonprofit healthcare IT sector, thinking it would provide a relatively calm respite after my saga as CEO of a publicly held company. Instead, yet another adventure lay ahead.

Nonprofit (not necessarily nonstressful)

2004-2014

Certification Commission for Health Information Technology

In 2003, I became Medical Director at HIMSS, the Health Information Management Systems Society, a nonprofit trade and educational association. In this role I organized various committees and events to spread the word about the benefits of electronic medical records. But in 2004, things became more serious: a National Coordinator for Health IT (informallly called the Health IT Czar) was appointed by then-President Bush. The first National Coordinator, David Brailer, MD, PhD, immediately published a strategic plan for speeding up health IT adoption, with a key element: government-approved testing and certification of EHRs (renaming EMRs to EHRs was another thing he did).

HIMSS and other health IT organizations felt strongly that any such effort should come from the private sector, so we quickly recruited a blue-ribbon panel to demonstrate our readiness, and somehow I was named Chairman. Simultaneously, the Federal government announced a Request for Proposal for an organization to develop standards and processes for testing and certification. We called our panel the Certification Commission for Health Information Technology (with the acronym CCHIT), drafted a proposal, and won a three-year federal contract beginning in 2005.

Leading CCHIT to execute a federal contract was the complete mirror-image to presiding over a for-profit company. Every step and relationship had to be completely transparent. The work of drafting our standards was done by over 300 volunteer subject matter experts, in a multi-stage process with opportunities for public comment at every step. We held Town Halls at conferences, and Town Calls online, to communicate with all stakeholders many times each year.

Once CCHIT’s first Ambulatory EHR certification program was Federally approved in 2006, every medical setting and specialty clamored for an extension to their domain, keeping us very busy and raising our visibility. I provided testimony at Congressional hearings to report on our progress, and appeared on the list of the “Most Powerful Executives in Health Care”. It was not the low-key respite I had expected from my transfer to the nonprofit sector, and the intense travel (I’d hit the million-mile flyer mark) adversely impacted my health. So I promised my wife Carolyn that I’d retire in 2010.

Under newly-elected President Obama, legislation was drafted offering $30 billion in incentives to healthcare providers adopting EHRs — providing they were certified. CCHIT had a front-row seat to this legislative process, being experts on certification, but with so much money on the table, competition appeared for the work of setting standards and doing the testing. Our mission had been to demonstrate that it could be done, not to compete in a marketplace. I retired as full-time Chair in 2010, though I continued to consult for CCHIT until 2014, when it wrapped up its work and closed its doors.