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PODCAST/TECH: Health2.0 Communities

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Moving on from the Health2.0 conversation about search and transactions, this week I’ve moved into the really new, new thing. Both the companies on this podcast are at the cusp of health and communities, and both have offerings whose age can be measured in the weeks rather than years. One, Sermo represented by founder & CEO Daniel Palestrant, is for physicians. The other, Organized Wisdom respresented by Co-Founder and President Unity Stoakes, is for patients.

Both are getting at something that was never really made accessible before. Collecting, rating, codifying, ranking and making available the informal but very important experiences, wisdoms and discoveries of doctors and patients. Again really interesting stuff. The Podcast is about 60 minutes long and has good sound quality. (Transcript will be up in a few days).

POLICY: What Would Dubya Do?

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So I’m up at Spot-on asking if you really wanted to get to universal care and reward your base, what type of political moves would you have to make. In other words, What Would Dubya Do?

Comment back here if you like.

In the last week the Democrats must have gotten sick of being told that they are supposed to be moderates. The New York Times tells them that populism should trump ideology, the nut jobs on the right still think that they are the second coming of Lenin,
and the corporate-friendly Emmanuel faction is already starting the
fight with the Dean "net roots". Which is why I’m on the record as
saying that no radical health-care reform will happen in the balance of
this decade.

When you look at domestic issues, of course, health care is by
a mile the most important, and the party’s presumptive 2008
presidential candidate Sen. Hillary Rodham Clinton, has, shall we say, a history in the area.
But realistically all that will happen in the next two years is for
Congress to give the administration the right – but presumably not the
obligation – to directly negotiate with drug companies about Medicare
prescription drug pricing. There’s also the likelihood that Congress
will approve a reduction in the bonus profits currently offered to
private insurance plans by the 2003 Medicare Act. But it’s just as
likely that the drug pricing measure will be vetoed by President Bush,
although the cuts in Medicare private insurer reimbursement will likely
be part of a budget act which the President will probably sign. Continue

TECH/HEALTH PLANS: Perhaps the last word on KP (for now at least)

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Here’s a stack more comments on Kaiser HealthConnect at HISTalk (go down) and then Mr HISTalk’s conclusions, (again read down) which are very sensible and basically mirror mine! (surprise surprise!).

As I said in comments over there and here—openness for KP would be good. But regarding HealthConnect, the real question is how will it operate when it’s deployed and all the power problems have been sorted out. And what does Health Care have to learn from Google, Ebay et al which manage to have millions of users bang on them without going down. I’m not a techie, so I don’t know, but I suspect that the answer lies there.

TECH/HEALTH PLAN: HISTalk nabs Justen Deal

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HISTalk has an interview with Justen Deal (of Kaiser Permanente although probably not for long, my guess)! It seems to me that we’re now coming down to degrees as to how to interpret the same facts. There isn’t too much that he says that directly contradicts my interview with Permanente Federation Exec, Andrew Wiesenthal on Friday. The basic “he said, he said” conflict is over how deep the agreement to go with Epic + Citrix was at the time and whether Dodd was in charge of HealthConnect or a peripheral figure. A time, it’s worth noting when Deal didn’t yet work for KP! Otherwise they agree that power outages have been a big problem, that the Citrix installation is bigger than Citrix can handle so far, and that Epic is written in a 30 year old programming language. Although Deal continually suggests that they shouldn’t use Epic alone, none of the complaints in the internal documents in the ComputerWorld article seems to relate to Epic’s software not working as far as I can tell. And let’s face it, it’s not as if any alternative vendor strategy would have had no issues (Pain free Cerner installations, anyone?).

This is a bit like Kremlin-watchers in the 1960s trying to figure out which warring internal camp who had control over who the Soviets would invade next. It really smacks of the HealthConnect people not trusting the KP-IT staff and vice versa. Frankly, it almost makes little difference. The question is whether HealthConnect genuinely can be scaled to the whole KP organization and made reliable. We’re just not going to know until it gets rolled out, and that won’t either be stopped now (as it’s too far in and not working badly enough to be junked) nor will we know how well it works will the whole thing is rolled out in 2007–8.

That’s not to say that there isn’t some good to come out of all this and from Justen Deal’s email heard around the health IT world. Kaiser has failed to be as open as it should be about a range of issues—especially as a non-profit it has responsibilities to more than just its executives and members. This is a brave new world for it and many other HC organizations to deal with (pun not exactly not intended). Getting the truth and the facts out there is something that they all need to do. Dimitriy is right about that. Prodded by Deal, Kaiser appears to be slowly doing so.

BTW: For some reason I got a lot of hits Monday from Madison, Wisconsin. Can’t imagine why!

HEALTH PLANS/POLICY: Would you buy a used health care policy solution from this association?

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Here it is. AHIP’s Proposal — because they didn’t obviously didn’t get enough at the MMA trough in the last go around, they figure another $30 Billion a year for ten years will get us all the way to 95% coverage in 10 years.

Um, how about getting to 100% coverage for no more money than we’re spending now? I could do that. Of course that might piss some people off along the way, including those AHIP members with their snouts deepest in the trough. But fear not, that’ll come too because no way that this coalition can seriously hold together given the discrepancy of interests and moral values amongst their membership—even with its leader’s skill in believing her own prevariactions. Because eventually the shysters and those who genuinely believe that they add value to the care process will not be able to hang together.

TECH/HEALTH PLANS: Chris Rauber pokes more into KP

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For those of you who can’t get enough, Chris Rauber, health care reporter from the SF Business Times has discovered that the investigations into the KP Kidney transplant fiasco are getting wider. And if anyone from KP wants to go on the record about that, as did Andrew Wiesenthal about the HealthConnect issues, I’ll be happy to give a full and fair interview.

Meanwhile I’d missed this, but he also caught this one from July—Kaiser was trimming costs in its outsourcing for IT staff  by asking vendors to cut their rates. If you looked at HotJobs for tech jobs in San Francisco this year, you’d have noticed that KP was on a hiring binge for HealthConnect, so this all fits with the desire to cut costs.

Meanwhile even more gossip about Epic and whether running the future of health care on a 30 year old obscure programming language is a good idea or not here.

Oh, and at DiabetesMine, Amy Tenderich finally has her interview with KP’s PR guy in charge of promoting their HealthySolutions DM outsourcing group, who explains a little more about how their internal DM processes work. You get the impression Amy wishes that she’s done this interview a little later!

I’m sure there’ll be more, whether or not Epic employees think this is newsworthy!

 

POLICY: This is just brutal

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Ugly truth: no health insurance, no liver transplant.  Lose your health insurance in your 50s for a brief time period and your reward is death and bankruptcy. You cannot read this story without going “that’s not fair”. There may be a rational way to decide who gets a liver transplant, but this is not it.

And as more and more of these stories get out, the pressure for change will continue to bubble. (Hat-tip FierceHealthcare).

TECH/HEALTH PLANS: more on KP

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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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