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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 www.jameslhollymd.com 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 www.jameslhollymd.com - 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 www.jameslhollymd.com 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 www.jameslhollymd.com. | 
 
	| 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 www.jameslhollymd.com. 
Kaizen 
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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