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HEALTH PLANS/TECH: Full text of Andrew Wiesenthal (Permanente Federation) interview

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Here’s the full text of my interview from last week with Andrew Wiesenthal of the Permanente Federation–mostly about the HealthConnect project and attendant controversies!

Matthew Holt: This is Matthew Holt at The Health Care Blog and tonight at rather short notice I am lucky to have an interview with Andrew Wiesenthal who is an executive director in the Permanent Federation which is the umbrella group that oversees the entire Permanente Medical Group in the different regions of Kaiser Permanente. Andrew contacted me this afternoon as he had seen a number of the postings on various blogs on some of the issues that have been going on with Kaiser. And I thought it would be a good chance to have a discussion with him about many of the issues, some of which have been raised in the last week about Health Connect and some others. So, Andrew, thanks a lot for agreeing to take the call. I know you are in the back of a cab there and hopefully we can have a decent conversation. So could you just give me a very brief thumbnail sketch of your role at Permanente and a little bit on how the Permanent Federation is organized.

Andrew Wiesenthal: Sure, I am a pediatrics infectious disease physician and I began my career as a member of Kaiser Permanente as a member of the Colorado Permanente Medical Group something over 20 years ago. I took care of patients and also had responsibility for quality improvement and other things in my medical group in Denver, Colorado. And, as part of that, almost 20 years ago I began to clearly see the need for an electronic health record in order to gather the kinds of information we want them to have so we could measure our quality and improve it. Ultimately I was the Physician leader for the development of what we called the CIS or Clinical Information Systems in Colorado. We finished that development and deployment work in 1998. Kaiser Permanente in Colorado does not own and operate Hospitals so the record was in the ambulatory setting. But this did serve at that time about 600 physicians and approximately 400,000 members of the Colorado regions. That was what it was doing at that particular point. Basically the physicians, nurses and staff of Kaiser Permanent in Colorado were essentially paperless from that point forward.

Continue reading…

POLICY: Maryland plan mandates coverage

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Maryland is considering a plan that would require residents to purchase health insurance. Very similar on the surface to the Massachusetts plan, but with a few key differences.  Via Balt Sun:

The plan would be a radical change from the current system of employers
choosing which health plans to offer to workers. It would set up an
insurance exchange where individuals could choose from any plans
offered by insurers and keep the same coverage when moving from job to
job.

The plan wouldn’t apply to large employers, but the cutoff on employer size hasn’t been set.Employers would pay much of the cost, with each employer setting a
dollar figure it would contribute toward the purchase. And the state
would provide a subsidy for lower-income workers.   

The Maryland Health plan doesn’t include any mandate on employers –
making it different from the Massachusetts law. But Cowdry said
"individual responsibility would put greater pressure on employers" to
"be in the game" by contributing to insurance coverage.

If the idea actually goes anywhere, Maryland would become the second state to embrace the idea of mandated coverage.  Given the amount of attention and credibility Romney has gained by taking credit for coming up with the idea, it seems inevitable that more states will launch similar experiments. So who will be next?  In California, Arnold’s office has been hinting that a major health care policy announcement of some kind is on the way. I wonder if they could be planning something along similar lines. — John Irvine

BLOGS/HEALTH PLANS: Why we love Roy Poses!

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Over at Health Care Renewal Roy Poses notes that the Annals of Internal Medicine has an article by a little known Columbia University public health professor (well, actually not one, but you’d never know) with the name J. Rowe which appears to promote pay for performance. Roy notices that a certain major national health plan until recently had a CEO with a very similar name which might possible benefit from P4P.

Roy wonders if they are, perchance, related?

HOPSITALS/HEALTH PLANS: You’d think Kaiser’s had enough bad publicity lately, but then again

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The city of  Los Angeles. is filing patient `dumping’ charges against Kaiser Permanente. Obviously there are plenty of hospitals dumping patients onto LA’s Skid Row, and obviously the way our society deals with elderly people with dementia, (and younger ones with other problems too)—by leaving them out on the streets—is a disaster. We clearly need a national health and social services system to deal with these issues,a nd Kaiser (and the rest of the health care system) should throw its weight behind us getting one. But given that we don’t the city is just picking the best example, which happens to be from an organization with deep pockets. 

And I’m sure that the Kaiser staff meant for the elderly patient still wearing a hospital gown to make it from the taxi into the Union Rescue Mission (rather than as the video shows literally wonder the wrong way down a busy road, not even on the sidewalk). But for KP, this is just a damning indictment:

The Los Angeles city attorney’s office filed false-imprisonment and dependent-care-endangerment charges against hospital giant Kaiser Permanente on Wednesday, the first criminal prosecution of a medical center accused of “dumping” patients on skid row. The charges stem from an incident earlier this year when a 63-year-old patient from Kaiser Permanente’s Bellflower hospital was videotaped as she left a taxi in gown and socks, and then wandered skid row streets.

<SNIP>

The day she was discharged, March 20, hospital staff members wrote on her chart that she was “non-talkative,” “forgetful” and “disoriented,” according to court documents.”Despite these findings,” prosecutors said, “the Kaiser Bellflower staff made no other efforts to assess or treat her medical condition.” Instead, the documents say, hospital staff “summoned a taxicab and directed the taxi driver to transport Ms. Reyes to skid row, approximately 16 miles away…. [She] was literally rushed out of the hospital and into the taxi even though the hospital staff could not locate her clothes…. [T]hey escorted her to the taxi without any pants, even though Ms. Reyes expressed concern about her clothes.” Court documents allege that Reyes was not told that she was being taken to skid row.After Reyes arrived at skid row, Union Rescue Mission staff members worked out a special arrangement so that she could remain in the facility during the day rather than check out the next morning and re-apply for a bed later in the day. But three days after her discharge from Bellflower, according to the documents, Reyes “lost consciousness in the bathroom of URM, falling and suffering head trauma.”Jeff Isaacs, head of the city attorney’s criminal division, said Reyes was subsequently hospitalized at Los Angeles County-USC Medical Center, where she was diagnosed with pneumonia, anemia and dementia, a progressive brain dysfunction, and remained in the hospital for at least 45 days. A guardian has been appointed to protect her interests, Isaacs said.

And the cynics would point out that if the patient had spent those 45 days at Kaiser rather than LA County, then they, not the taxpayer, would have paid for it.

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!

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