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TECH/HEALTH PLANS: more on KP

Well it’s coming thick and fast. First the podcast with Andrew Wiesenthal (previous post here). Then Gadlfy in her anti Kaiser site has some more about her take, including her commenters thinking that I’m just an apolgist being paid off by KP (and I’m still waiting for the check!).Finally MrHISTalk has much more on his site including this list of questions, which using what little I know and was told, I’ve tried to answer below (Questions have bullets; my answers are below)

  • On George Halvorson’s first day, he cancelled KP’s existing $442 million KP-CIS project to implement electronic health records.
According to Wiesenthal, Halvorson asked a big team to take a look at what the right solution was–postponing the CIS project at that time. Separately a senior KP doc who’s a tech expert, who I know and respect and has not been in the news, told me that the IBM code was the worst he’s ever seen, but that Epic’s was good (He also said Soarian might be better if it ever got into production!). CIS was considered as a potential option going forward.
  • Mr. Halvorson had also pushed through the selection of Epic at the health plan he previously had led, in Minnesota.
  • George Halvorson’s previous employer, HealthPartners of Minnesota, has faced significant problems with its Epic project, and, so far, the Epic software has only been able to completely cover about half of HealthPartners members. 
HealthPartners definitley selected Epic while Halvorson was CEO and it seems to be working OK there—according only to a patient that I know! Not clear who lead that selection or how badly things have gone there compared to what they hoped to achieve.
  • KP’s CEO and CIO ignored internal engineering reports which said Epic software would be unreliable for KP’s size and difficult to adapt to KP’s scope.
Unclear as to whether this is more than rumor. Wiesenthal said a large team looked at Epic, CIS and Cener (on Halverson’s request) and decided that Epic was the best option for what they were trying to do. He says the current problems are to do with Citrix (some thing to do with too big a server installation in one place) and power and UPS problems in their S. Cal data center. His quote "Epic is rock solid"
  • Mr. Dodd brought in a company called Tanning Technology to give an opinion on the viability of Epic within an organization as large as Kaiser Permanente. Mr. Dodd, while serving as an officer of Health Plan, also simultaneously served as a director for Tanning. Ignoring this significant conflict of interest, Mr. Dodd paid nearly $1 million dollars for Tanning Technology to give a favorable report on his and Mr. Halvorson’s predetermined plan to shift KP’s business to Epic.
Tanning apparently was brought in for a different task not related to HealthConnect, who’s selection Dodd was NOT part of. Wiesenthal claims not to know why Dodd resigned but claims it had nothing to do with the Deal email
  • A decision was made to replace almost all of the KP home grown systems … with one "integrated" system and do it in three years. Those making the decision had no concept of the real scope this project or the expertise required to do it. Epic is a good product whose average client was no bigger that 2,500 users running on one instance. Kaiser retooled it to scale to 150,000 users and 20 instances using the same building and configuring techniques as the average client, which is manually building and configuring again and again.
This is basically true. But only because no one had done anything this big before in health care and certainly not in the US (outside of the VA), so it’s likely that they didn’t know what they were getting into. The proof though will be in the pudding when it’s all up and running system wide in a year or so, and seeing whether it works as advertised. They’re clearly not turning back
  • KP-CIS (the homegrown system that Epic replaced) was not a $400 million loss for KP, it was much more. Somewhere around $4-5 billion. In 2000-2001, KP-CIS was spending between $500,000 and $750,000 a day.
Highly unlikely. In this period KP went from losing money in 1998ish to making big profits in the early part of this decade. How they would have hid a $4bn loss/write-off in 2002 is unlikely. If CIS was spending $500,000 a day from 1998 to 2002 that still way less than $1 billion ($500K x 365 = $182m. $182m x 5 <$1bn. So the $400m write off sounds much closer to the truth given back of the envelope math.  And according to one interview I read (I think with Halvorson) some of the money they paid IBM in that $400m, they got to transfer over for use of hardware, etc.
  • One of the major problems with KP-IT stems from the continuous turmoil in the organization.
And this makes them different to other large American corporate entities, how? In addition apparently HealthConnect and the KP-IT stack are not the same people (which of course may be part of the problem!!)
  • J. Clifford Dodd was soon discovered to be on the board of directors of one of the companies he was outsourcing to. He first resigned from Kaiser (in an e-mail) and then said that he really meant to resign from his outsourcing company.
Second part is rumor (unless someone kept that email). First part appears to be confirmed by Tanning’s SEC statements referenced elsewhere on HISTalk–he seems to have selected Tanning for work while he was both a director there and was their hirer at KP. I assume that this is why he resigned–on the presumtion that either this was kept from the board/management or ignored by them between April 2002 and last week.
  • Epic outages called "Code White" have increased from just over 9,000 user hours per month in June to over 59,000 last month. When the system is down, no paper or locally stored data is available, so treatment decisions are made without any previously recorded information.
Wiesenthal suggests that this is to do with the power and Citrix issues mentioned earlier and that the major problems were earlier this year. (More details in my interview with him). He claims more than 98–9% uptime since. Someone smart than me can work out how many user hours there are, and how many a single half hour failure adds to that total (as happened this week) and how much that relates to the 99% claimed uptime.
  • The 26,500 concurrent KP users figure isn’t anywhere near accurate – it’s more like 9,000 to 13,000, on average. Saying 24 hospitals are live on "several apps" means they’re live on check in and registration, and maybe a few people are echarting. Those two hospitals that are "completely rolled out" regularly (at least every few days) drop to Code White (back to paper).
More details are in the interview, but Wiesenthal says that the outpatient side of HealthConnect is up everywhere outside Calif and up for 30-40% of both California regions. (That’s were most of the users are of course). Only 2 hospitals in Cal are fully up on Inpatient Epic plus other apps in the suite, but others are coming on board over time. The concept that both hospitals are using paper seems unlikely as Wiesenthal stressed that outpatient clinics on Epic use no paper. Rationally, paper copies of everything for an EMR doesnt make sense. As with the Parkland experience discussed in HISTalk, a strong unbreakable contemporary electronic back up is what’s needed and what Yahoo, Ebay et al do for their businesses.
  • Bruce Turkstra is interim: as soon as they can find someone outside who will take the job, Bruce is gone, too.
Who knows. Certainly doesn’t seem that Dodd’s departure was planned. Wiesenthal stressed that HealthConnect is his baby on the Permanente side and Louise Liang’s on the plan side and Dodd had nothing much to do with it.

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killaDr. IntegrityMatthew HoltBloggerelliottg Recent comment authors
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killa
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killa

a lot of the content in this particular article is way, way off. Resignations were due to other ongoing missteps that had huge ramifications on cost. This is what happens when you report news based on emails and heresay from those partially in the know.

Dr. Integrity
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Dr. Integrity

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? 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… Read more »

Gadfly
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//If you dont think that lot is worth of comment, then the stories we hear of Epic only hiring naive rubes from the CS dept of Univ Wisconsin and indoctrinating them into a cult might actually be true!//
ROTFLMAO!!! You win the blogosphere, Matt.

Matthew Holt
Guest

Blogger. Let me see, we have
…strong statements that HealthConnect is going to take KP as an organization down,
internal scenarios of a $7 BILLION loss, and the resignation of the CIO at the same time,
insinuations that Halvorson and Epic are involved in financial improprietary
Significant challenges with downtime of HealthConnect,
oh and meanwhile KP having slight issues with its transplant unit in N.Cal
If you dont think that lot is worth of comment, then the stories we hear of Epic only hiring naive rubes from the CS dept of Univ Wisconsin and indoctrinating them into a cult might actually be true!

Blogger
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Blogger

As someone who has worked extensively with KP as an Epic employee, I don’t understand all the hubbub. This news is not new nor is it a reason for elevated concern by either organization. Isn’t there anything truly newsworthy to blog about?!?

Gadfly
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I’ve seen these, and I have a question – does anyone know if anything odd happened in the Ohio region during the first week of November?

elliottg
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elliottg

What I want to know is what the system uptime goals are for this project. I can’t imagine that an all-electronic integrated healthcare platform is not targetted at 99.99% uptime which makes the numbers being quoted by people defending Kaiser ridiculous. Claims of an acceptable goal of 99.5% by Halvorson made my BS detector peg. Nobody would take delivery on an IS project that promised over a day of downtime per year!

Gadfly
Guest

Lest I be considered your eternal nemesis, I have to agree that KP-CIS sucked. I’m not sure about the technical reasons (though you might be interested in this chart of CIS server costs – but I do know that IBM was, as usual, trying to hold on to their proprietary perch by imposing completely alien concepts and terminology on everyone. Does anyone here know what the hell a “baselet” is? Thought so. I call bullsh*t on the large consensus decision for Epic. Also, I don’t think you can say the regional prototyping effort had nothing to do with the national… Read more »