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HEALTH PLANS: A little more on KP

Here’s a piece from veteran SF Business Times health care reporter Chris Rauber on the Kaiser saga. I still basically stay where I was, but it’s worth noting that the presumed reason that Cliff Dodd resigned on such short notice (i.e. was canned) is not because HealthConnect (Epic) doesn’t work—it’s because the story that he was a director of the consulting company paid $1m in fees by KP while he was CIO is presumably true! That’s such a visible conflict of interest, it’s bizarre that he and the rest of the board thought they could get away with it. So I suspect that he never told them and no one bothered to ask until Justen Deal dug it out of various filings. Of course you may have your own opinions. I also just noticed that Dodd’s sole academic qualifications were that he has a BA in Sociology. I’ve got one of those (well, sort of)—perhaps they should give me the job!

However, there is no evidence that any other major EMR system works better than Epic, or is written on a more sophisticated, more modern code than MUMPS. The only real competitor in existence when the decision was made was Cerner’s Millenium—not known for its drop dead gorgeous implementations, and lacking an outpatient function at that time. The others, Soarian (Siemens), Eclipsys, McKesson did not have proven ambulatory and in-patient systems.

Why didn’t KP just buy Epic, as has been suggested? Perhaps you should ask the folks at Phillips about how easy Judy is to work with, and how willing she is to sell.

While we can all snipe from the sidelines, there is no question that getting clinicians to use process automation software of any type is really, really, hard. So I’m not surprised that this isn’t all smooth sailing.

Finally, the real scandal at Kaiser this year has not been about the IT system, or even about the pecadillos of various Kaiser executives. The real scandal has been the opaqueness of the management of the kidney transplant program’s collapse, even though that’s stayed out of the national press (beyond the LA Times and Chris Rauber’s work).

At a meeting about PR for blogging that I spoke about, Kaiser’s new press rep (didn’t catch her name) said that they were going to behave differently in the future. At least Halvorson wrote an email about this latest brou-ha-ha. We heard zip from him or TPMG about the kidney scandal.

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  4. I agree they get integrity/ethics and regulatory/compliance confused. I understand that there is an Ethics Officer – but that person reports to Garcia; and given the poor culture as evidenced by these blogs and news reports the ethics (not compliance) program is a sham.

  5. Garcia is actually on the Board of Directors and in the most highly compensated range. IMHO, Kaiser gets compliance and ethics confused. They think they will have an ethical business as long as everyone complies with organizational standards (though managers try to pose their personal goals as organizational standards, and if something goes wrong they will blame subordinates for not offering “pushback”).
    An organization can’t be ethical unless it allows its employees to act with integrity. Sometimes acting with integrity means dissenting, offering criticism, and raising concerns.

  6. KP may be in a better situation if they had an effective Ethics program. I suspect the ethics officer is unwilling to take on senior leadership and ensure the right things get done – such as ensuring there is no retaliation for reporting problems.
    By comparison, Hewlett-Packard might have avoided much of the pretexting scandal if its chief ethics officer, Kevin Hunsaker, had asked more questions and demanded more answers. See:
    http://www.forbes.com/2006/10/23/leadership-ethics-hp-lead-govern-cx_hc_1023ethics.html

  7. Regarding the Dodd conflict of interest and the lack of protection of whistleblowers, doesn’t Kaiser have a bloated ethics and compliance department? Last I heard there were upwards of over 60 people in the department and that’s not counting indirect reports and related network structures. That’s huge! And being headed by a member of the Board they still can’t instill a better corporate culture?! What have they been doing?

  8. Keep in mind that David Merlin was simply a high profile case. It will be even more demoralizing when the public realizes that Kaiser made a widespread practice of firing and otherwise retaliating against people who tried to point out problems. That’s what my own three years of blogging has been all about.

  9. I’m glad to see there’s some recognition that the current Kaiser IT “crisis” pales in comparison to its failed kidney transplant program. Re accountability, if anyone doubts TMPG’s central role in managing clinical care at Kaiser (including designing and running this program), they should read a recent Health Affairs letter to the editor written in part by Dr. Robbie Pearl (TPMG Medical Director).
    See: http://content.healthaffairs.org/cgi/reprint/25/2/569-a?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=pearl&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
    See page 569.
    Perhaps Kaiser has learned something re negative PR. At least George Halvorson did internally respond to Justen Deal’s accusations and now, since he is apparently on paid administrative leave, they are treating him (relatively) with “kid gloves.” What a contrast with how transplant program administrator David Merlin was treated – he was fired for suggesting to his TPMG superiors that patients’ health and even lives might be at risk, claims that were substantiated within a few months by both CMS and the California DMHC.
    But the negative implications are not just for this whistleblower – they affect Kaiser as whole. I expect to see continued erosion of trust, not only related to the steadfast silence of TPMG, but also re the unequivocal “message” that firing David Merlin sends to other employees and members. It should now be clear to other employees that if they ever find themselves in a similar situation, they should keep their heads down and mouths shut. And as a result, the message to members (at least obvious to this member) is that you simply cannot rely on Kaiser staff to look out for your best interests, even where there are life-or-death consequences.

  10. I can see there’s no shortage of hostility on this board… “artistic” IT punks, capitalistic-pig physicians, and monday morning QB ex-CEOs are certainly convenient punching bags.
    Truth is the current market players (Epic, Siemens-SMS, McKesson-HBOC, GE-IDX, the list goes on) are falling well short of any reasonable person’s expectations. No one I know in the industry is happy with the complexity of systems that have wasted tons of our valuable time and money.
    The pace of moving information in healthcare to useful electronic formats is pathetic. We’re practically in the same place we were in 1960. You and I can withdraw money from our banks at an ATM in Paris, but we have to fill out a name and address at a physician’s office everytime we go for a visit. And drug histories are unavailable to an ER physician treating us with life and death decisions.
    What’s so controversial about wanting the industry to get even BASIC systems in place to make our lives easier and safer?
    I can count on one hand how many disruptive technologies have happened in healthcare. Zero.
    So before we preach more of the status quo and conveniently blame the IT minions, docs (users), and entrepreneurs, let’s take a long hard look at the state of the industry, and ask ourselves if it’s high time we think differnt(ly).
    I don’t pretend to have the silver-bullet answer, but maybe K.I.S.S. is not such a terrible approach to consider.

  11. Andy Grove should stick with semiconductors.
    What will speed the adoption curve for HIT will be a business case for the docs. Right now they get nothing out of making their notes available over the web.
    t

  12. Dodd’s sociology degree cracks me up because he doesn’t seem to be playing very well with others. Maybe the degree was actually in sociopathy?
    Anyway, I chalk this up to what I’ve been saying all along: Kaiser hires bullsh*t artists for IT project management.

  13. “I also just noticed that Dodd’s sole academic qualifications were that he has a BA in Sociology.”
    OK John Kerry, I don’t know the first thing about this guy Dodd, but let’s not presume anyone without academic credentials should just be over in Iraq fighting for your right to accumulate degrees (snickering).
    Andy Grove is making much of the same criticisms of companies like Epic. He believes these vendors are a failure, and we need a fresh approach (he personally advoctates systems with less structured information, and more ‘vanilla’ presentation of clinical information over the web, such as word doc formats – this would greatly speed the adoption curve and lower the cost to get information in electronic format. Innovation can spread from there; today rather, we have solutions (bad ones) looking for problems.
    I presume then you value a CEO’s “qualifications” to comment on this?

  14. Hi, Matt –
    Thanks for following up on your “fisking”, lol. I haven’t seen anything “changing” about Kaiser PR yet. As their response to Justen shows, they’re still playing “block and tackle.” Moreover, their top PR flaks obviously haven’t gotten the message of “above all, be honest.”
    Ps. Sorry it took me so long to approve your comment on LiveJournal (you have to have your own LJ account and be my “friend” to skip moderation). I’m at that Web 2.2 conference in SF, and I’m having trouble with the wireless connection.

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