Skip to main content

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.

Adventures in Health IT Policy

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 a nonprofit, 501C(3) organization under a federal contract was the complete opposite to presiding over a private-sector for-profit company. Every decision 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”.¬†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, the pressures only became more intense, and the weekly cross-country travel (I’d hit the million-mile flyer mark) adversely impacted my health. So I decided to retire in 2010, although I continued to consult for CCHIT until 2014. Soon afterward, with its mission complete, CCHIT wrapped up its work and ceased operations.

Take Me Home, Country Roads

2000-2019

Harmony Oaks Farm

When Carolyn and I married in 1999, she sold her farm in Coos Bay before moving to my home in Portland, but brought along her beloved Quarter Horse named Lady and an Arabian gelding called Spri. My home had a beautiful view but no land for horses, so they had to be boarded many miles away, an unhappy situation for Carolyn, Lady, and Spri. We soon remedied this by moving to a farmhouse on 50 acres of land near North Plains, which we named Harmony Oaks Farm.

This was a bit of an adjustment for me, a guy who previously might list dirt, smells, and manual labor as his least favorite things. With only a dirt road for access, my nice shiny Lexus SC400 suffered flat tires and was always dusty, and there was no one to clear snow from our long driveway. Our vehicular fleet needed a makeover: a Toyota pickup replaced the Lexus, and a Kubota BX24 tractor with front-end loader and backhoe was added. I learned how to make compost using the front-end loader to combine the horse manure with grass clippings. Then I had to learn to operate the backhoe to dig trenches for various water and electrical lines. My favorite tractor job was building trails and roads!

Besides the tractor, there was a lawn mower, a chipper, a tiller, a blower, a trimmer, a pressure washer, a chainsaw and I can’t remember what else. That meant a lot of fussy small gasoline engines to maintain! My solution: an electric utility cart (basically a Yamaha golf cart with a dump bed), modeled here by Carolyn and Riley. Once I added a 48VDC to 110VAC inverter, we had a rig that could pull a dump trailer and supply 1500 watts of AC power anywhere on the property. The small gas engine tools were replaced with electric ones, and even larger electrical appliances — like a shop vac — gained new uses. Finally, mounting an electric leaf blower to the cart’s front bumper gave us a driveable street sweeper that made quick work of our 1/2 mile of driveways.

We needed to keep the crop area productive, but many farmers in the neighborhood were retiring. Eventually we found a farmer who, though elderly,  planted alfalfa on our land and brought in several harvests a year. We fed our horses some and sold off the surplus.

Building A Woodworking Shop

2007-2010

Preparing to Retire ReWIRE

Woodworking had been a casual hobby ever since wood shop in high school, but I’d never really had the space it required until we moved to the farm. As retirement approached, I got deeply involved in designing a woodworking shop inside a corner of the barn. True to form, I made mechanical and electrical drawings of everything before I pounded the first nail, and researched the advantages of every machine tool before buying it.

Building the shop was my first real carpentry project, and I had to learn as I went. The electrical part was easier: ample 220V power, heat and A/C, and a vacuum sawdust collection system that activated automatically with the tools. The pictures below show some of the features of the shop.

For raw woodworking material, I hoped to draw upon our orchard of Black Walnut trees. They were 80 years old and a couple of them fell over each year. After cutting the trunks to 3-4 foot lengths, I hauled them to a shed for drying, and rigged up a home-built milling sled for my bandsaw. While I was able to produce some boards, the over-aged wood was full of internal cracks and warped badly as it dried. It was a disappointment but a valuable learning experience.