TECH/HEALTH PLANS: A Permanente Group Executive speaks

There continues to be much flack in about the “email heard around the health care IT world” about Kaiser Permanente’s HealthConnect program and its success or lack or it, and its contribution or lack of it to a potential massive shortfall or profit  in the organization’s finances. If you want to know what lots of insiders and outsiders think, go read these comments on KP in this HISTalk post. Suffice it to say that there’s a wide, wide divergence of views on whether Epic is scalable or not, or if anything else would or could work. Given that this is America’s largest health care EMR deployment, it’s not a trivial issue.

But in addition there are wider rumblings that something is going awry at Kaiser Permanente. Given that it’s just coming out the other side (bar the lawsuits) of a scandal where something went very badly wrong in its new kidney transplant program in Northern California, this latest brou-ha-ha is more grist for the mill for the anti-KP folks. I am not one of those, and in fact have been criticized for being too supportive of pre-paid medicine in the past. But I call things the way I see them, and I don’t get any money from Kaiser. So I’m trying to remain “neutral” in what is a highly emotional issue.

Today Andy Wiesenthal, an Executive Director with the Permanente Federation, the umbrella group for the regional PMGs emailed me offering to go on the record. I told him that I would ask about HealthConnect, the kidney transplant fiasco and how TPMG works with the health plan. This podcast is what he had to say when we spoke late Friday evening. It was via cell phone so the sound quality isn’t the greatest.

He was unable to comment on the kidney transplant story, claiming to only know what he read in the papers. But about everything else he had strong and I think relatively balanced opinions–especially as he was the physician executive in Colorado who was in charge of the CIS project that was being implemented system-wide when it was scrapped in favor of the Epic/HealthConnect software system–which he strongly defends.

Whatever your views, it’s very interesting stuff. I hope I asked him the tough questions and in general I think he gave very thoughtful answers. And it’s to his credit that he decided to get his and Permanente’s side of the story out, as they’ve been far too reticent to talk openly in the past. Here’s the interview. There’ll be a transcript as soon as it’s available.

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  1. Suggested reading:
    The Circus of Medicine. Lima, OH: Wyndham Hall Press.
    by Richard Dean Smith
    Medical practice received uncharacteristic sanction and public approval during the middle decades of the 20th century. For centuries before and decades since, medicine has been the focus of criticism and distrust. Throngs, droves, herds, flocks, legions of self-appointed critics, pricey ‘healthcare’ consultants, economists (academic and otherwise), on-the-run politicians, and promoters of the healthcare insurance industrial complex brought bizarre exaggerated claims against the medical profession. Nearly everyone has opinions on ‘what’s wrong’ with doctors, hospitals, and medicine—a new / old breed of hangers-on surround medicine; such as, some rabble healthcare consultants throwing dice on a blanket in the hospital parking lot, some misguided influential academic healthcare economists dealing three-card monte on the front sidewalk, some less than objective medical journalists hustling a shell game in the hospital foyer, that is, a pervasive new form of healthcare quackery. A result was the managed care mass medical movement.
    Literature of past centuries shows that medicine has always been surrounded by a circus: promoters, jugglers, swindlers, con-men and women, charlatans, imposters, poseurs, humbug artists in the School of Indictment opposed to ethical practicing physicians. Purveyors of not just bad advice, but worse. Robert Morris says: “Some of the most responsible doctors will always be in the hands of financial fakers, and some of the most responsible business men will always be in the hands of medical fakers,” and healthcare consultant fakers. In the 19th century, Worthington Hooker said, “It is folly for the physician to boast that he worships in a temple, upon whose altars no strange fires ever burn, while he looks out with contempt upon what he regards as the almost heathenish observances and worship of the unscientific and unlearned people.”
    The “intellectual underpinnings” of managed care form a Noodle’s Oration: a superficially plausible argument consisting entirely of fallacies and logical errors. Oliver Wendell Holmes said, “There is a class of minds much more ready to believe that which is at first sight incredible, and because it is incredible, than what is generally thought reasonable: Credo quia impossibile est.” Historian James Harvey Young says: “The quack has been adept at erecting a beautifully logical structure on the basis of a single false but plausible premise. Numerous educated men have missed the premise, admired the logic, and been trapped.”
    In the presence of woodenheadedness that permitted rapid adoption and excited growth of managed care, the mass medical movement of managed care flourished unrestrained. Failure of the popular press, failure of ‘learned’ journals, the fallacy of self-assumed authority of the healthcare consulting industrial complex, and lack of responsible inquiry by the academic community (whose tenure intended to prevent such atrocities against human reason) supported the irrational, foolish movement into managed care: “Knaves there will always be, and fools—whatever the justification for their folly—and, therefore, pseudo-medical deception.” The self-trumpeter’s fallacy became the creed and modus operandi of the managed care mass medical movement.
    While medical practice is solemn and serious, humor and satire may neutralize madness of the mass movement of managed care: satire consists: “not of mirth, but of the intense and even painful sense of the absurd.…where it is vice rather than folly that is the target, or folly so noxious as to amount to vice—and provoking reactions that vice engenders but not mere folly—we are in the presence of Satire,” and thus, the modern Circus of Medicine.
    1. Scheider’s Brew
    2. HealthCare Amateurs
    3. Medicine in the Gaseous State
    4. Free Beer
    5. The Lightning-Rod Man, Updated
    6. Zeal!
    7. It’s Déjà Vu All Over Again, Revisited, Reiterated, Reprised, Rehashed, Recapitulated, Recounted, Reasserted, Restated, Regurgitated, Reechoed, Repetended, Retautologized, Reduxed
    8. In the Absence of Absolute Truth
    9. Doctour of Physic: His Modern Peer
    10. The New Medicine Show
    11. All the Wonders of Africa
    12. Chronic Pain
    13. The Trap
    14. Gold’s a Dollar, the Expert’s Free
    15. Springtime for a Frog
    16. Managed Care: From Miracle to Madness to Myth
    17. A Classification of the Unknown
    18. Get on Board–The Hindenberg Plan
    19. Don’t Look Now, but It’s a ‘Revolution’: Is Quality a ‘Given’?
    20. Game Theory and the Managed Care Mass Movement
    21. Cabbage Systems International: Annual Report. Eleven O’Clockish 1995ish
    22. The Delivery of BeansCare at Konga Beansanente. by Dr. Syckley Moult
    23. Dr. Huffahuff’s ManagedBeans Strategy by Dr. Suffin Huffahuff
    24. An Old Heart’s Appeal: Her Confession
    25. Professor Bray and the Beans of Competition
    26. The Celebrated Jumpin Frog of All the County of the Piney Wilderness
    27. The U.S. Alti-Thronus Court and the Hobgoblin Decision: Concurring
    28. Modern Behavior Economics and the Circus of Medicine
    End Page

  2. Matt, thank you for the podcast with Dr. Wiesenthal. I just wish you had asked him to respond to Justen Deal’s allegations about cost overruns associated with HealthConnect. In 2004, George Halvorsohn said KP’s internal analysis showed that HealthConnect would generate savings of $500 million per year (see Fall 2004 issue of The Permanente Journal). Is this estimate still valid?

  3. Hi, Matt – great score for an interview! Wiesenthal is the one who was pimping HealthConnect to the Ways and Means committee. I also find it’s interesting that he comes out of Colorado – known for spilling it’s Intranet onto Google, including the PR plans for Thrive. (See http://www.kpthrive.org)
    I’m interested in Wiesenthal’s comment that “everyone preferred” Epic when there are comments on HISTalk that say there was an original team that panned Epic, but they were replaced by a team that would play ball (Tanning?). From what I remember when I was there, the decision was portrayed as a unilateral one by Halvorson. All the CTO of TPMG knew in December 2002 was that Halvorson was choosing between Epic and Cerner – I know because I was asked to add a “rumor control” piece to his newsletter.
    I wonder how Wiesenthal thinks employees learn about the “only Halvorson gets to send a broadcast email” policy. I never saw any policy like that, and I’m holding a couple of Kaiser’s email policies right now (just added to my most recent post).
    Otherwise, I didn’t learn much except Wiesenthal thinks dealing with Justen is a waste of his super-valuable time.
    In speaking of interesting comments on Kaiser’s financial condition, I just posted some insider remarks on http://corphq.livejournal.com