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.

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!

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!

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.

• 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. 

• 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.

• 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.

• 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.

• 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.

• One of the major problems with KP-IT stems from the continuous turmoil in the organization.

• 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.

• 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.

• 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).

• Bruce Turkstra is interim: as soon as they can find someone outside who will take the job, Bruce is gone, too.