Southeast Texas Medical Associates, LLP James L. Holly, M.D. Southeast Texas Medical Associates, LLP

In The News - On the Occasion of SETMA’s Eighteen Anniversary: August 1, 1995 – July 31, 2013
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Today is a remarkable day!

This is the end of SETMA’s 18th year of existence. Tomorrow, we start our 19th year. Next week, on August 7th, Mrs. Holly and I conclude our 48th year of marriage and start our 49th. I cannot help but be grateful for both milestones. Of course, if I would ever have had to make the chose, I would have chosen my marriage over SETMA, but fortunately I have never been confronted with that choice. I am grateful that I have had the BEST of both my personal and my professional life.

Our webmaster (the person who maintains and supports our website) has told me after a recent major overhaul of that if we printed out all of the materials displayed there that it would be over 50,000 pages. In order to summarize the past 18 years and to acknowledge what you have accomplished, it would require the distribution of that content. This week, we printed a copy of the Syllabus for the Fourth Year Medical Student Patient Centered Medical Home Month-Long Externship. The Syllabus is 1,100 pages long and is two-volumes long. If that is an accurate assessment of the website, it would take 100 note books to contain the documentation of SETMA’s work. You are to be congratulated.

Monday last, as I gave Summer Scavone, our first, senior medical school student extern, a tour of part of SETMA, she commented about how happy everyone seemed. Even the judgment of how excellent our care is and how advance our systems are is not as valuable to me as is the observation of the contentment of all of our employees. You are a special group.

In 18 years, SETMA has come through many challenges, adversities and pressures, but we have always kept our eyes focused on the prize of excellence in care and transformation in systems. The following are significant milestones in SETMA’s history - they of course leave out many important people and events - but they do provide an outline of our progress:

May 15, 1995 Four physicians, including Dr. Mark A. Wilson and Dr. James L. Holly, at the recommendation of Mr. Cliff Cavett, CPA, meet to begin discussing the formation of a group medical practice.
August 1, 1995 SETMA is launched operating in four different locations.
September, 1995 SETMA’s decision-making policy is enunciated:  legal, fair, moral.
October, 1995 SETMA learns “system thinking from Peter Senge’s book The Fifth Discipline and it becomes the foundation of SETMA’s business model and eventually guides the develop of SETMA’s EMR.
December 3, 1995 One of SETMA’s partners was struck by a car while crossing the street and was out for several months.  SETMA’s philosophy of supporting colleagues during and through crisis is established and put to the test
March 17, 1996 2929 Calder Clinic remodeling completed and all SETMA partners occupy one office.
March, 1996 SETMA established a moderately complex medical laboratory and purchases a COBIAS Integra - the first one sold in America.
June 17, 1996 SETMA’s first nurse practitioner, Mrs. Sandra Fowler, joined SETMA.
October 16, 1996 A SETMA partner filed an injunction against his partners
October 17, 1996 Dr. Holly’s friend and attorney, Wayne Reaud, and Mark Wilson’s friend and attorney, Mike Ramsey, reach negotiated settlement with the disgruntled partner and on October 21st, he left SETMA
October, 1997 SETMA’s Managing Partner became the Medical Director of GTPA, an IPA.
November, 1997 SETMA launches - In June, 2013, a healthcare executive said, “SETMA has the most informative web site I have ever utilized. Bravo, for sharing valuable information with the entire medical community.”
August 1, 1997 SETMA’s first internist Dr. Anwar, joined SETMA.
October 10, 1997 SETMA partners attend MGMA meeting and preview electronic medical records, strategic planning and enterprise practice management systems.
November 10, 1997 SETMA has an open house to celebrate our 2929 Calder Clinic.
March 30, 1998 SETMA partners purchased NextGen EMR and EPM and signed a $650,000 note to buy an enterprise practice management system and an electronic medical records system.  SETMA’s accountant and community colleagues decry the move as a waste and a mistake.
March, 1998 SETMA began writing a weekly column for The Examiner.
March, 1998 SETMA began a personal relationship with the founder of NextGen, Mr. Pat Cline.
August 8, 1998 NextGen’s enterprise practice management system was put into place.  For the first time SETMA was able to get “good information” about the business side of SETMA.
January 26, 1999 SETMA began using the EMR.  It a Tuesday and was a very long and hard day.
Mary 16, 1999 SETMA moved from EMR to electronic patient management leveraging the power of electronics to improve patient and population care.
February, 2000 SETMA developed its first disease management tool for diabetes
September, 2000 SETMA’s weekly column in The Examiner became a healthcare column.  All columns for the first fifteen years are published at under Your Life Your Health.
January, 2002 SETMA opened second clinic on College Street
January, 2002 SETMA began using the EMR to complete History and Physical Examinations in the Hospital
February, 2002 SETMA launches the Less Initiative, which in 2010 was published by the Agency for Healthcare Research and Quality on their Innovation Exchange
March, 2002 SETMA made a presentation to Diabetes Center of Excellence in Boston, Massachusetts this resulted in SETMA becoming a Joslin Affiliate in 2010.
January, 2003 Richard Bryant joined SETMA as the Chief Operating Officer.  He expanded SETMA’s daily cash flow report, established a budgetary process, and added a management structure and improved organizational reporting process to SETMA.
January, 2003 Physician Practice Magazine names SEMTA Southwest Region clinic of the Year.
February, 2003 SETMA named one of 50 Exemplary Primary Care Practices by the American Board of Internal Medicine Foundation
February, 2003 SETMA began using the EMR to complete discharge summaries in the hospital
January 2004 Physician Practice Magazine named SETMA Runner-up National Clinic of the Year
February, 2004 Microsoft Healthcare Users Group named SETMA Clinic of the Year
September, 2005 SETMA acquired clinic on Dowlen Road and named it SETMA West; after Dr. Wilson’s death, it was renamed The Mark A. Wilson Clinic.
February, 2006 SETMA was awarded the HIMSS Davies Award for excellence in EMR
March, 2006 Former owner of SETMA West filed suit and left SETMA.
January, 2007 Founded the SETMA Foundation which helps pay for the care of our patients when they cannot afford it. 2009, 2010 and 2011, the SETMA partners have given an annual gift to the Foundation of $500,000. None of this money can be paid to or profit SETMA.
February, 2007 The SETMA Model of Care defined and described.
February, 2007 World Healthcare Innovation and Healthcare Congress, Innovation to Transform Awards, Group Practice Runner-up, SETMA. WHIT 3.0 1st Annual Editors Choice Awards
April 12, 2007 Two SETMA Partners declared their intention to leave SETMA and announce that in six months SETMA will not exist
July-August, 2007 Eight physicians left SETMA - four moved to other cities for family reason; four formed another group.  In 2011, one of the new group rejoined SETMA as a partner
August, 2007 After these eight left, SETMA thought nothing could be worse; at which time, Dr. Wilson announced that he had a terminal illness.
October, 2008 A team from Diabetes Center of Excellence visits SETMA
October, 2009 SETMA deploys Business Intelligent - COGNOS - for auditing and reporting
February 16, 2009 SETMA attends lecture in Houston to learn about Patient-Centered Medical Home - over the next 16 weeks, SETMA writes a weekly article about Medical Home
March 23, 2009 SETMA’s says good-bye to Dr. Wilson in a sad departing.
October, 2009 Began public reporting by provider name over quality metrics at
February, 2010 SETMA’s Pier Reviewed Stories of Success published by HIMSS with highest honor.
June, 2010 SETMA recognized by NCQA as a Tier III PC-MH, renewed for three years in 2013.
August, 2010 SETMA accredited by AAAHC as a Medical Home and for Ambulatory Care, renewed in 2011 for three years.
August, 2010 SETMA recognized by NCQA for Diabetes Care Excellence; recognition renewed in 2013 for three years.
August, 2010 SETMA establishes the Department of Care Coordination.
November, 2010 SETMA became a Joslin Diabetes Affiliate - the first multi-specialty, primary-care dominated affiliate.
November, 2010 All SETMA Providers Successfully Completed Joslin Program and designated as Certified Joslin Primary Care Providers
March, 2011 SETMA named one of 30 Exemplar Practices for Clinical Decision Support by the Office of National Coordinator.
February, 2011 SETMA opens clinic in Port Arthur, Texas.
February, 2011 Healthcare Informatics named SETMA as Innovator of the Year
February, 2011 CMS and RTI International Invites SETMA to participate in a project contrasting 312 Medical Home practices with 312 non-coordinated practices.  The results supported the value of Medical Home.
May, 2011 SETMA named as Semi-Finalist in Gardner Business Intelligence Excellence Award.
February, 2012 eHealth Initiative name SETMA has Innovator of the Year.
September, 2012 SETMA selected by Robert Wood Johnson Foundation as one of 30 Exemplar Primary Care Practices in America and invited SETMA to participate in a three-year research project.
June, 2012 SETMA opened an office in Orange, Texas
April, 2013 Texas Physician Practice Quality Improvement Award Committee recognized SETMA with the Texas Physician Practice Quality Improvement Award
June, 2013 SETMA starts construction on clinic in Lumberton
July 29, 2013 SETMA’s Institute for Patient-Centered Medical Home welcomed the first Senior Medical Student, Ms. Summer Scavone, from the University of Texas Health Science Center at San Antonio School of Medicine to the Institute’s Externship.

SETMA continues with growth and development. This review is barebones and only gives only a skeletal outline mentioning firsts. SETMA entire history can be seen at


Recently, a New York physician and healthcare executive said that SETMA has “kaizen” - a Japanese word meaning, “a system of continuous improvement in quality, technology, processes, company culture, productivity, safety and leadership. Kaizen was created in Japan following World War II. The word Kaizen means "continuous improvement". It comes from the Japanese words ("kai") which means "change" or "to correct" and ("zen") which means "good". Kaizen is a system that involves every employee - from upper management to the cleaning crew. Everyone is encouraged to come up with small improvement suggestions on a regular basis. This is not a once a month or once a year activity. It is continuous. Japanese companies, such as Toyota and Canon, a total of 60 to 70 suggestions per employee per year are written down, shared and implemented.

“In most cases these are not ideas for major changes. Kaizen is based on making little changes on a regular basis: always improving productivity, safety and effectiveness while reducing waste. Suggestions are not limited to a specific area such as production or marketing. Kaizen is based on making changes anywhere that improvements can be made. Western philosophy may be summarized as, ‘if it ain't broke, don't fix it.’ The Kaizen philosophy is to ‘do it better, make it better, improve it even if it isn't broken, because if we don't, we can't compete with those who do.’

“Kaizen in Japan is a system of improvement that includes both home and business life. Kaizen even includes social activities. It is a concept that is applied in every aspect of a person's life. In business Kaizen encompasses many of the components of Japanese businesses that have been seen as a part of their success. Quality circles, automation, suggestion systems, just-in-time delivery, Kanban and 5S are all included within the Kaizen system of running a business.

Kaizen involves setting standards and then continually improving those standards. To support the higher standards Kaizen also involves providing the training, materials and supervision that is needed for employees to achieve the higher standards and maintain their ability to meet those standards on an on-going basis.”

This is a good place from which for SETMA to begin our march to our 25th and our 50th anniversaries. Welcome to the journey.

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