It is most of three years since President George H. W. Bush outlined a plan for electronic health records as a priority in his 2004 State of the Union speech. At the time, the president cited the need for innovation and cost control to begin to offset the estimated $300 billion health dollars spent annually with no impact on patient outcomes, and safeguards to prevent annual accidental deaths of between 44,000 and 98,000 patients due to medical errors.

The president's remarks might have awakened observers with little insight to the cost/opportunity mix of health care and technology, but major medical institutions were already well into programs addressing beneficial patient outcomes, cost and efficiency. Trinity Health, a not-for profit group of 30 owned and 15 managed hospitals across seven states in the Midwest was already close to four years into a project called Genesis, which upon completion would become the third largest initiative in the nation. Trinity arose from the merger of Holy Cross and Mercy Health Services in May, 2001. Prior to that, predecessor organizations had an IS history of hospitals that operated independently and pursued best-of-breed strategies. "At the end of 1999 there were a couple things going on," says Paul Browne, SVP and CIO at Trinity Health. "Y2K readiness was winding down. There were many requests for investment in new systems, so senior management was pondering whether to continue 20 years of everyone doing their own thing, or maybe, find a better way."

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