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Healthcare Giant Faces IT Nightmare
Joan writes "Kaiser Permanente, the largest HMO in the U.S., has spent about $4 billion on an unreliable electronic medical record system that is impacting patient care, according to a 722-page internal report revealed by Computerworld. The CIO resigned after the news came out, and CEO George Halvorson is telling the media that the goal is an alarmingly low 99.5% uptime and that all the problems are really just power outages. Yesterday, Slashdot covered a story about the possibility that the NHS in the UK could now claim the 'biggest IT disaster' prize, but Americans, fear not: so far, the Brits are running a much more efficient failure at $24,000 per physician per year, while America's KP is spending $76,920 per physician, per year on its failing project."
Maybe they can merge the two projects (the Britain and the KP project) for greater efficiencies.
We always new that the US health service was expensive.
Take that Brits! oh... wait.
http://www.CelloFourteGroupie.net
It's a feature, not a bug.
ajf
See here for details.
"Sacrifice for the good of The State" - The State
We're Number 1! We're Number 1!
Huh?
You mean we're NOT in a competition to make health care unaffordable? Doh!
P.S. You'd think that a company selling healthcare (something on which people will spend any amount of theirs and others' money) could actually afford working generators and uninterruptible power supplies - if they can't afford it, then how does anyone else?
That's less than my desktop box here at home. Poor Americans ;-(
Another HMO bites the dust!
Wulfram II - Free Online Mutiplayer 3D Tank Shooting Gam
The free market is more efficient than some socialist government project. There must be some error in the article.
there is no need to sign your posts. this isn't usenet. your username is right there above your post. stop it.
Always got to do it bigger and better.
Basically what this means is there's a lot of completely incompetent management in the healthcare sector generally. Actually I think this is better because the US organisation being private can be bankrupted and replaced by someone who actually has a clue what they're doing. The NHS will simply continue sucking the taxpayer dry without the incompetent twits having any sanction against them at all.
Deleted
Take the you limey bastards! U.S.A!! U.S.A!!!
Honestly. I really did not know that any other health service organisation of any kind could fuck it up better than the NHS in the UK. Public spending goes up and lots of IT companies rub their hands together and con the incompetent civil servants.
;-). The mind boggles......
The government is now highly keen on national ID cards and biometric scanning, and are extremely keen to use it as a solution to everything from immigration to terrorism - except it won't solve anything and it will be broken in no time. Obviously many IT companies are very keen on the figures handed around of £30 billion, not that I'm suggesting they've been buttering up our politicians or anything
Don't get comfortable you Yanks. No one outdoes the UK Public Sector for very long in terms of utter incompetence!
FBI IT Department to Kaiser IT Department: "Amateurs."
I have used Citrix and it solved some problems for us, but why the shell would you use Citrix for a new application developed from scratch? To me Citrix is a system to run legacy applications. Any time in the last 10 years I would think you would choose a platform that does not require a hack (multi user ms windows) to run.
"We're the largest Citrix deployment in the world," Deal said. "We're using it in a way that's quite different from the way most organizations are using it. A lot of users use it to allow remote users to connect to the network. But we actually use it from inside the network. For every user who connects to HealthConnect, they connect via Citrix, and we're running into monumental problems in scaling the Citrix servers."
99.5% uptime means 7.2 minutes of downtime per day.
Meanwhile, the report that came out is 722 pages long.
You be the judge!
From the Epic Systems website (emphasis added):
Problem Solver / Technical Services
Are you interested in learning more about software development? Combine your problem solving skills and technical interest with our comprehensive training to support our nation-wide clients. You will have the opportunity to participate in many aspects of the software field, including analysis, training, quality assurance, troubleshooting, install, and implementation. Most importantly, you will help clients get the maximum benefit from their software.
Because we train internally, no prior technical experience is needed. Candidates must have a BS or BA, a history of academic and professional success, and a willingness to travel 10%.
Remember that we're talking application uptime, not server uptime. This means that for any multi-server and multi-tier application, application uptime is essentially the product of the uptime of all servers that make up the app. Factor in that windows makes up the bulk of application servers and that people often have weekly scheduled downtimes that are in the hours, and 99.5% is actually quite ambitious.
Those who can, do. Those who can't, sue.
Kaiser Permanente are clearly much more efficient at wasting money than the NHS, almost 3 times more efficient at it.
Deleted
Accenture.
Any time I hear of some massive project that goes way over budget, doesn't work, and fails to meet requirements, I usually find out that Accenture was the consulting company contracted to do the work.
What's this software called? SickPeopleSoft? :)
US consumers and companies can walk away from KP and find a competent HMO, whereas the poor saps in the UK are stuck with their NHS.
(Granted, I don't like having to let my employer choose my health plan, but if it gets egregious enough, I can choose another employer if I'm not satisfied with the benefits from the current one.)
Don't send a boy to make a mans job. AS/400!
How the hell do you spend 4 billion dollars on software?
I didnt see anything over what time frame that $4 billion was spent, but even if we assume 10 years, thats $400 million a year. Assume an insane $100 million a year spent on hardware and infrastructure, another $100 million a year for unspecified overhead and an insane salary strucutre with an average of $200k a year, thats still 500 developers, 400 testers and 100 managers working on this project every year for 10 years and they cant make it work?
I could have made it fail for a fraction of the cost with only one person on the payroll.
I am now taking bids for any other project doomed to failure.
Sadly, this story isn't a surprise at all. Having spent some time working in healthcare IT, the only thing about this that's moderately surprising is the scale, not that it's happened.
Many of the people I've talked to in the field have similar stories to my own experience. Executives making a decision based on either financial interest; a consultant's recommendation; or buying the sales rep's pitch, and contravening any internal IT objections. The result is almost always a disaster, with IT people having to try to make a square peg fit into a round hole. The blame then falls on everyone but the executive who made the decision in the first place. The solution always seems to be to try to fit a different square peg into a round hole.
The end result is a lot of money and time wasted. The only difference is the scale.
The dirty secret of the software industry is that if you need a complicated piece of custom software, you're going to pay *huge* amounts of cash to have it developed, and it's never going to work right.
Anyone who has worked in the IT industry for a while knows the sheer HORROR of most the "niche" software products that big businesses need. They're universally terrible. The people that make that stuff have no incentive to make their product GOOD. They only care about making it marginally functional, so they can make sure their customers have to pay them support fees for eternity.
The article says that Kaiser is spending about $1.5 billion a year on this plus other IT systems
That comes out to $15,000 per year per physician.
Bad summary or am I missing something?!
(This makes me want to check on those UK health system numbers too...)
Fortunately, we Americans have short attention spans; otherwise, come the next debate over rising health insurance costs being the result of high malpractice coverage and low/no income 'over usage' of US medical care, we would be pointing the proverbial evil-monkey finger at health care management debacles such as this.
SLR-
Congratulations,
Make a system to save money on efficiency to be totally inefficient.
Actually, what will be found out (in the near future) that consolidating medical records, precribing, admissions -or- billing on a large system will be so unwieldy that the organization will be hurt more if it's attempted then it could ever make things better. This is not to say that it is impossible, but the myriad of laws, policies, regulations, and over-lapping dependencies will set it up to fail.
I found it especially interesting that a mere power-outage grinds the system to a halt as apparently they don't appear to have any plans for that, but to blame Citrix for their implementation woes is going abit overboard. An organization that big should stick with regional datacenters then to put all its eggs in one basket.
God: When you do things right, people won't be sure you've done anything at all.
used Ubuntu instead.
"an IT employee .. said part of the problem .. is that the Citrix Application .. just can't handle the load .. we actually use it from inside the network .. and we're running into monumental problems in scaling the Citrix servers"
Technically speaking, how would connecting from 'inside' be any different that outside. it's just packets being moved around.
"Another issue is with the Epic software and its adaptability, according to Deal and the IT employee. They said the software was written in MUMPS (Massachusetts General Hospital Utility Multi-Programming System) -- a health care programming language originally developed in the 1960s"
I recall someone telling me about MUMPS. You ran it off 5 ¼ floppies and accessed the data through direct access to a b-tree.
"Using Citrix is something that defies common sense. It would be like trying to use a dial up modem for thousands of users. It's just not going to work, and it's not something anyone would tell you a dial-up modem should work for"
What if anything is Citrix designed for but for large scale remote access.
davecb5620@gmail.com
Citrix allows us to keep the application updated without having to touch all of the desktops. You shouldn't confuse Kaisers System with Epic Systems software.
Epic itself is part of the puzzle. (And is a pile of crap that doesn't scale.) (Written in MUMPS etc on Cache with a Windows Front End -- all of the communication to the clients is done over Telnet!!!)
I rest my case.
99.5% uptime is phenominal... if you're using Windows. Windows is okay as a desktop system. But it does NOT scale up to being a reliable backbone for an enterprise network. But for some totally brain dead reason (probably because everyone else is doing it too), the medical industry as a whole has chosen Windows as its standard. To the point that a former employer of mine standardized on WinXP/C#/.NET as the mandatory framework for hard realtime embedded diagnostic and monitoring systems.
Perhaps this might make people start to question their choice of Windows as a one-size-fits-all solution.
Nah...
Don't blame me, I didn't vote for either of them!
Why the hell wouldn't they just use VistA CPRS instead of jacking off to the tune of 4 BILLION DOLLARS?!?!?!?!?
Seriously, commercial software in the ERP fild is a disaster.
Google 'ERP failure rates'. Depending on how you count over 50% fail. They replace systems that work with POS ERP systems. Having surved a couple of smaller installations the costs is huge in terms of burn out and staff churn as well.
People need to learn "if it aint' broke, don't fix it".
putting the 'B' in LGBTQ+
That is only one hospital. Epic Systems is run by MANY health care organizations.
You get what you pay for..
From 1999 to 2001 they applied for and were granted LCA's for 230 H-1B's..
Top H-1B wage 62,000 (2).. lowest wage 31,000(10) average wage ~38,000..
Add in another 56 LCA's for green cards(1999-2000).. top wage 60,500 average wage ~40,000.
Note: The Zazona.com database stopped collecting LCA records back in 2002..
Here is a link to Madison Wisconsin Blog about Epic Systems.. read it and be informed..
About 15 years ago, I worked in Denver for IBM watson lab on the KP system. It was actually a OS2 desktop with AIX backend and had been decent system over the last decade. Then talking to ppl at KP, they told me that higher ups wanted a windows system. Well, I guess they got exactly what they wanted.
I prefer the "u" in honour as it seems to be missing these days.
From the perspective of a patient, at least, "health care" IT is in the stone age. Can't set appointments over the Internet. Providers don't use email. Billing involves multiple pieces of paper. Getting a prescription filled involves shuttling a piece of paper with scribbles on it. Records retrieval depends of pieces of paper not getting lost. At first glance the KP system is promising and could ulimately lead to untold cost savings. Unfortunately, at least to an ignorant observer like me, it seems that only the big, integrated systems like Kaiser, the VA, and the military have any hope of ever getting some modern IT, at least as long as the US politicians keep their heads up their asses and refuse to do anything about this country's absolutely dysfunctional and outrageously expensive "health care system".
Penny - plain text accounting
Aren't most bankruptcies in the US caused by medical expenses, and involving people who do have insurance, no less?
I doubt it. I bet there are more bankruptcies as a result of credit card overextension, or poorly managed home loans, than as a result of medical expenses.
"Ladies and gentlemen, my killbot features Lotus Notes and a machine gun. It is the finest available."
Quoth the article:
When fully implemented, it is supposed to give more than 100,000 of Kaiser's physicians and employees instant access to the medical records...
That 100,000 includes Kaiser employees, so the actual number of physicians should be much lower.
Stop by my site where I write about ERP systems & more
That only works out to 2,628 minutes of downtime, on average, per year. Or just under 44 hours.
I mean, healthcare information doesn't have to be ready and available, like, every minute, does it?
Although from what I've seen of Kaiser healthcare in practice, making information available 99.5% of the time might be an improvement from the Hello-here's-your-new-doctor, don't-get-too-attached, whoops-there-they-go, Hello-here's-your-new-doctor standard they follow now.
"We can categorically state that we have not released man-eating badgers into the area." - Major Mike Shearer, UK
well there seam to be a lot of people that are upset . So how about this OPEN SOURCE THE WHOLE THING AND MAKE IT A SOURCE FORGE PROJECT
"I don't pitch OpenSUSE Linux to my friends, i let Microsoft do it for me
It's all about who is running the show. A smart guy running the show deflects questions to people that know the answer. Idiots that run the show try to answer the question they know nothing about and make decision based on what they think *should* be the right answer and ignore those in the know because they are intimidated by them.
This happens all the time.
The IT industry is literally littered with these failures. You can find the relics of these monuments to failure all over the place.
$4 BILLION spent on establishing an open source foundation to manage these sorts of (slightly more sophisticated than average) CRM projects would resolve this problem indefinitely.
But you see, that would defeat the objective of this kind of government to corporate, and corporate to corporate welfare.
The objective is not to suceed. The objective is to spend money.
100,000 users is a lot, but not a vast number by any standards. They aren't exactly breaking new grounds here. Let's read the PR description:
When fully implemented, it is supposed to give more than 100,000 of Kaiser's physicians and employees instant access to the medical records of some 8.6 million patients, along with e-messaging capability, computerized order entry and electronic prescribing. In addition, the system is supposed to integrate appointment scheduling, registration and billing functions and will offer various features to Kaiser members through KP.org.
I would bet dollars to donuts that Google could implemenet such a system that would scale to _millions_ of physicians and _hundreds_ of millions of patients with few to no issues, and still fit well inside a $4 billion price tag.
The problem is that large companies keep wanting to reinvent the wheel, and I have no idea. Someone with 1/2 a brain should leverage the open source community to build this kind of software (after all, there's _tons_ of money to be made in this business, even in the open source realm. Who the heck but a few large companies has the hardware to run _any_ kind of software supporting this kind of infrastructure). Once that is done, an entire ecosystem could build around the central code, with companies providing service, support, and customization.
Kind of the way Linux works.
I would guess that Microsoft has it's hands in a lot of these implosive deployments.
WhiteWolf666 an exBush supporter. All you new-school,compassionate,save the children Republicans can rot in hell
As a general practitioner in the uk I'm not so far very impressed with the uptime and efficiency gains of the "Choose And Book" system. I feel that Uncle Bill bulldozed the UK government with a lot of money and a good line into trying to achieve a Microsoft based system. It's probably provided a lot of jobs and helped the economy, but I have reservations about a centralised database of an entire nation's healthcare records. I don't think there was a lot of input from clinicians at all, and we're the end users.
I like Apple. They make nice stuff which works most of the time.
Is this problem really so hard that nobody can write the software without a major cluster-f***k?
From my experiences with large IT consulting firms, I'd be willing to bet the politics between the health-care company & departments, state & federal regulators, IT company & departments etc is what screwed these projects up.
If someone could write a health care management system that is complete, functional, meets all regulations, and is easy to write legacy plug-ins to they would be able to grab a big chunk of the BILLIONS being otherwise wasted on these efforts, and help the healthcare industry to boot.
It would take someone with some resources to do it, but it would be worth the effort.
The key, I think, is the project has to be insulated from political interference, which probably means it will be written WITHOUT a specific customer in place to screw it up.
- For the complete works of Shakespeare: cat
Citrix offers one huge advantage in the world of healthcare IT: When the thin client is not connected, no patient data exists on a thin client machine.
The HIPAA Security regulations are good regs, as such things go. But one of their demands is that you know exactly which machines have Electronic Personally-identifiable Health Information (ePHI) on them. Any such data must be protected, backed up, and audited. Further, each machine containing ePHI is subject to the organization's media disposal policy.
Now, ideally an EMR system should not leave tracks on the client machine even with its fat client. But if the EMR's fat client does leave data on the client machine, then meeting HIPAA Security requirements would be one heck of a lot easier to accomplish if all you have is thin clients. I have no idea if the EPIC client does leave data on the client computers, but if it did there would be reason to be very interested in using Citrix to keep all ePHI off of all periphrial machines.
With reasonable men I will reason; with humane men I will plead; but to tyrants I will give no quarter. -- William Lloyd
Regarding Justin Deal, am I the only one who thinks the idea of a "25 year old project manager with a background in IT Management for Non profits" is a bit of an Oxymoron? At 25 you hardly have any background at all, especially in managing a large scale project such as this!
We should see news stories about large IT projects that aren't big boondoggles.
"Large New System, in development to replace working system foo, way over budget, doesn't work, no fixes in sight" isn't news, any more than "Airline flight arrives without crashing" isn't news.
I work for a large metropolitan multi-hospital system that just rolled-out Citrix for their switch to the electronic medical record. In my experience using it as a provider, its functionality is very limited. For example, ideally I should be able to search in a patient's chart for any instance of a word (ex: penecillin). I should also be able to search physican dictation for various key words or phrases (bone fracture, overdose, etc.). At present, such functionality isn't available, and I don't see it happening any time soon. But they need to do it, as records can get quite large, spanning several decades of office visits and hospitalizations. Also, views of information are only customizable to a certain extent - and the system loses those preferences after logging out. Compared to certain other applications, the functions in Citrix are very concrete-operational. What's worse, is that since Citrix is rolled out via web sign-in (using remote thin clients and such) the provider has to effectively sign-in with password TWICE. Once to sign in to the Citrix Metaframe, and again to invoke CIS. It's a pain in the damn ass. If Google wrapped their efforts around the various problems, I think things would be far better.
The problem is that all large scale databases are doomed by stupidity from the start. The inputs are widely variable and the outputs change based on who you ask. Doctors need one set of information, accounting need something completely different and management wants to know when the client has exceeded they allotment of care. Also the parameters of the project keep changing, privacy issues arise, connectivity problems show up and the government adds legislation that adds a new level of complexity. Under current project design specification and best practices we couldn't get a network protocol designed in 20 years with a $20Billion budget. I guess I don't quite understand how billions of dollars can be wasted on something that doesn't work. If I spend money on something I expect it to perform the task for which it was designed. If it doesn't then I expect the manufacture, builder or employees to fix it. I realize that large projects mean large headaches and there are times when the problems happen. But if I contract to a company or hire employees to complete the job and they don't or are way over budget, its firing time. I understand hundreds and thousands and even hundreds of thousands, but billions! Lets use that money and hire filing clerks, filing cabinets and do the whole thing by hand. It almost sounds like it might cost less. I guess if you have no defined project with no defined timeline and a virtually unlimited budget then spending a few billion is not a problem (I know this sounds an awful like a current war). Lets define the problem, define the solution, create and timeline and budget and stick to it. If you change the parameters in the middle everything downstream changes and what you already have done may need to be scrapped. Let everything be completed and then start the change process. Just because you can make changes does not mean you have to. There are a few things I have missed here and some ideas may have been simplified for illustration so if you don't get it you probably work for large organizations with unlimited budgets or the military.
We're not happy 'til you're not happy.
Friends don't help friends install M$ junk.
The hazards are
1. Size. Big organizations can't be efficient in human experience, except maybe at one single specialized activity, and that only with great effort and sacrifice.
2. Misaligned incentives. Corporate managers get pay and perks for making their deparments larger and more expensive. Owners lose. Which brings us to the next point,
3. Lack of oversight. If shareholders don't demand an active board of directors, they're making the same mistake as voters who don't demand representatives who will hold hearings and issue subpoenas.
>"We're the largest Citrix deployment in the world," Deal said.
Alarm bells should have gone off.
>"We're using it in a way that's quite different from the way most organizations are using it"
When you make a pair of statements like that, you're really saying "We've just taken on more technical risk that we understand".
for some totally brain dead reason (probably because everyone else is doing it too), the medical industry as a whole has chosen Windows as its standard.
That is changing. GE's new CT runs Red Hat. Files are moved to and from it and other institutions by sftp. People don't stick with losers forever and change is on the way. A few more poster children like this is all it takes.
Friends don't help friends install M$ junk.
Yes, but if you count the Computer Aided Dispatch system for the London Ambulance Service back in 1992, the brits certainly get the prize.
The biggest reason for software failure is institutional: In this bussiness, there is a binary measure of quality; Works/doesn't work. The threshold for "works" is abysmally low. But anyone who writes code can tell you that how it's written will make all the difference. Unfortunately, there is NO way to sort out the wheat from the chaffe. Seriously, a recruiter looks at your resume, compares it to 300 other applicants with 5-7 years experience with "J2EE" (they have no idea what it means, just that they need to find people with it) and says I can afford to pay X. There is no way to distinguish the candidates by quality. This industry desperately needs a quality rubric and one that is followed. Perhaps if vendors were made liable for their product they would have incentive to improve.
That's probably about right.
My wife worked for a community health center that had about 15 providers and they payed something like $20,000 a year for their EMR.
They're a rather poor organization, so I suspect they got a serious discount.
And that didn't include any of the IT support or equipment, just the software.
mod'd.. offtopic??? Huh???
I don't see it..
"Epic Systems" is the principle vendor at the center of this multibillion dollar fiasco..
Epic employees are the one's who selected Citrix(against the vendors advice).
Same goes for the VB and MUMPS languages and all subsequent programming.
No, the paper age. We gave up on hammering stone tablets a while ago. Give us some sort of credit...
Can't set appointments over the Internet
I hope to Bog not. People would either underbook or overbook times. While theoretically possible, the decision tree on how to set up an appointment for a given patient is scarily complex. We pay people good money to understand patient's needs and doctor's times.
Providers don't use email.
That's right, email is not suitable for private communication and doctor-patient discussions really don't need to be broadcast all over the world. Yes, I know there are "secure" systems for this, but then you have to get patients to use THAT system. Then you have to get patients to actually come in occasionally. Then you have to get insurers to pay for it. Something like this will happen eventually, but it's not quite set up in most places for most things.
Getting a prescription filled involves shuttling a piece of paper with scribbles on
You've got a point there - handwritten paper prescriptions should be relegated to the trash bin^H^H^H^Hshredder, but you don't need a multibillion dollar system to do this. A simple database / prescription writer and the old fax machine works fine and dandy.
TFA shows that, although all of these ideas (except the patient scheduling) can work and would Just Be Great if they did for everyone, scaling IT systems to these sizes is daunting and fraught with all manners of pitfalls. I'm sure that management will be pilloried for various and sundry (retrospectively poor) decisions, but it's interesting that these problems happen more often than not.
Perhaps our ability to manage enormous amounts of complicated information isn't as good as we think it is.
Faster! Faster! Faster would be better!
This is an interesting piece of news considering the announcement from SCALE this morning. SCALE 5x will be hosting the first Open Source Health Care Summit. Maybe we should invite the Kaiser IT folks to attend? :)
KP made their own, free, unencumbered, unregulated stupid decisions. That's why they're having the meltdown and other healthcare providers aren't. Anyone who thinks that the government somehow has a monopoly on IT mismanagement simply hasn't seen what goes on in large corporations. And in the small ones, for that matter.
They inflated their own importance for years until such time as they garnered sufficient funding to fuck up whole companies. But in fact "IT" is not anyone's core competency - unless you are an outsourcer or service provider. That's the MBA factoid all these CIO's miss - technological glorification for its own sake. I don't care how large your company is, there is no such thing as a patient records DB system that costs billions of dollars. It simply can't happen. So when they embark on these grand missions to the new world in the name of Empire of Spain or whatever the hell they think they're doing, they're just creating a messy boondoggle.
I am not surperised, most of these large shops, end up with a halfway decent 'programmer' who is very policly savy incharge of these kinds of mess's. not only that: this person usally is very poor at design and architure. more of a manager, inaddition i will bet poor design and interenal polics really is what crashed this beast. you Have to have a design/architect who is really techincal.
and a project manager who understands the project working together, other wise you see the results.
That's not too bad considering a 5-minute "check up" costs $200, it's done by a nurse that gets paid $12/hour and the "doctor" does 50+ of them a day.
The problem isn't really the system, it's the high value we place on human life here in America. We spend trillions keeping vegetables alive while the middle class pays for it in higher premiums. It's never a problem for the rich as they are always "ahead of the curve" and this always will have enough money to pay the more expensive health care. But the system is designed so a poor uneducated illegal immigrant is treated the same as the multimillionaire who obviously contributes a lot more to the economy, taxes, etc. Yes, they are charged accordingly. And you know, it's nice to know that I can get treatment no matter what, rich poor etc. The problem is that in a free market that drives prices up. Which means the vocal middle section of society who is right on the edge of being able to be honest and actually pay for it suffers by not being able to pay for it.
Cool! Amazing Toys.
As an insider, I can say that this incident is really the result of a Perfect Storm of incompetence, fear and cronyism.... and it came from the Top:
But.... believe it or not... Kaiser Permanente is not a "Bad" or "Evil" company. They are structured primarily as a non-profit, and as such are required to plow any profits back into the business rather than pay them out to shareholders. Even more importantly, Kaiser is BOTH a Health Care Provider AND an Insurance Provider. This acts as a positive feed-back loop. Where as, in other health systems the Health Care Provider and Insurance Company are separate and motivated to spend as little as possible, in the case of Kaiser, any money saved in Preventative Medicine pays for itself 100 times over as Kaiser's members get older. Kaiser has a built-in incentive to spend on preventive medicine, which benifits them monetarily but also benifits their members in the form of a healthier life.
The source of most of Kaiser's IT woes are no different than at any other large (150,000+ employees), old (founded during WWII), complex (8-million members) company. Don't get me wrong, heads definately need to roll at KPIT but overall, the company is structured such that eventually it will straighten itself out. Just make sure you check the name at the top of your Lab results...
On the other hand, it's been a great industry to work in as an IT guy. Employment is definitely not a problem. And if you can get away from having to deal with providers (like into pharma or medical supply/products), it won't drive you too crazy.
"the Brits are running a much more efficient failure at $24,000 per physician per year, while America's KP is spending $76,920 per physician, per year on its failing project"
:(
Was this comparision done by one of those techno idiots? hehe
Seeing as how this a 'medical records system' not an office accounting system shouldn't one compare the number of medical records/patients not doctors involved?? Does an American doctor see 3 times the number of patients? Not likely but not inconceivable either.
Not that KP has ever been a model of effiency...
Oh well, we have a $50,000 system that can't remember check numbers between batches
The tragedy is, you don't actually have to be "Bad" or "Evil" to commit "Bad" or "Evil" acts. If somebody dies because of KP's IT screwups, you can't just say, "Well, its okay because they have their heart in the right place."
Companies are nothing more than a collection of people acting in the name of the few who run them. As such, the few who run the company need to be liable for their own screwups. The buck has to stop somewhere..
-S
Healthcare IT is like any other big industry environment: your critical product (i.e. life support systems for instance) is always on a different and independent grid, where your IT stuff is on another [compromised] grid. And with Healthcare being one of the cheapest buyers of IT--they skimp because the budgets goto the Physicians' salaries. This needs to change.
And having 99.5% uptime on mission critical systems with non-technical savvy users is a asking for a disaster to happen.
I don't think the parent is supposed to be offtopic. Kaiser's disaster is due to their software from Epic Systems a.k.a Healthconnect.. as an ex-Epic-burnout I know it is true and agree with most of the things stated in the link posted on the parent.
Am I the only one scared by the "Giant Faces" in the article title?
In my word application uptime should be better than any singe server uptime.
A single point of failure in a large critical system should not be allowed.
Any one of the application tiers can be clustered or load balanced in a way that provide near 100% application uptime.
We shoot for 99.95% SERVER uptime.. Application level outages are rare
If you think it's expensive to hire a professional to do the job, wait until you hire an amateur. --Red Adair
KeepItSimpleStupid
Google or Amazon need to get into the healthcare biz. Don't put the application logic in the centeralized database. Make a simple authentication protocol. Don't try to structure it in any way. Just allow clients to upload new files with a timestamp and a unique medical practicioner ID.
Thus, if doctor A is using medical software A and doctor B is using medical software B they can store data in whatever format they want. Hopefully they will use some sort of XML and upload images in standard formats, but if they don't want to they don't have to. Same thing for the pharmacy. Same thing for the insurance company.
If there is something super-private a doctor could even upload some encrypted records, no problem.
Once the ceneralized database is in place writing the applications on top if it would be a lot easier.
bash-2.04$
bash-2.04$yes "Don't you hate dialup connections?"| write USERNAME
Based on your compaints, I think your confusing Citrix with the actual EMR Application. Citrix provides the framework for remotely deploying an app, but the functionallity of the system, like searching for Penicillin, or keyword search is a function of the Application itself. Also Citrix does offer single sign in features, but it sounds like your implementer chose not to use those. Fault the EMR Developer or the impleneter, not Citrix in this case.
Think of Citrix as a waiter in the restaurant, they bring the food to you, but the bad taste of it is the fault of the chef.
I er, um, know someone who works at KP, that's it a friend of mine works there, and there are bigger problems than the IT issues.
This is management problem - my friend does patient care, and her boss isn't even in the office but about a few hours a week. This boss is the one forcing her team to implement this IT system - without it having been TESTED.
"We'll work it out" the boss says. Then isn't around to lift a finger to help. And the boss used up one of three 'super user' logins that can fix/correct chart entries.
Even worse, the boss sets the specs on the software - AND NOT ONE TIME USED THE OLD SOFTWARE. None of the staff who actually use the software had ANY input into what it does/how it works.
So even if the IT team can fix the technology issues, the delivered product is unlikely to actually provide proper health-care functions for this direct patient care team.
And no I, er, she can't go over the bosses head, as that boss is even more absentee and worthless than the immediate boss. And whistle blowers get 'suspended' and then fired, with their names nationally know for years.
The Department of Veterans Affairs uses two systems, CPRS (Computerized Patient Record System) and VISTA (Veterans Integrated something something something) to manage all of their patient records and scheduling, and has been since at least 2001. These systems work pretty damned well, particularly in light of the VA being the largest health care provider in the nation.
I was just a lowly recreation therapy aide, but from what I can tell, each VISN (Veterans Integrated Service Network, VA-speak for "region") had its own server which kept all the CPRS and VISTA information, but you could hook into another VISN's system to pull up their records. Seemed to be a pretty good system.
Not sure why Kaiser is having so many frigging problems. If the government can manage to implement a pretty damned good computerized record system, why not a for-profit entity?
-Jenn
bah. will they ever learn? i guess we will see the prez of epic running for prez of US sometime soon as well.
From the article: "On Oct. 10, for 3 hours and 24 minutes, doctors and nurses in several facilities were unable to retrieve critical medical information to treat patients." I'm a doctor, (not at Kaiser) and at most hospitals I've worked in (University, private, non-profit), it would be a minor miracle if we actually could HAVE instant access to critical patient info at all! Most of the medical world still uses hand-scribbled paper notes about critical patient info, which are in some basement storage, often just plain lost, never mind having it available in an emergency. Even if you can find the actual chart, the info you need is often buried under reams of useless garbage that can take hours to wade through to find the results of some obscure test done long ago. So having access to this info for only 21 hrs and 36 minutes a day would be a huge boon to medicine in many places!
As an actual physician working at KP, I can tell you the system actually works. From my end the downtime has been truly minimal, and it is proving to be powerful despite intial misgivings. I don't doubt our IT has messed part of this up, but the system does actually work and I am already seeing some significant advantages when treating my patients....
Elian Paiuk
I worked for a hospital chain (that's now been gobbled up by another).
The CIO of the hospital chain was a VP at Cerner. Somehow the hospital chain happened to sign up to run Cerner's Millenium application - and this place I worked at was an "Alpha" site. In other words, they compiled the app, sent it over to see if it would run. If anything (and I mean, anything) was wrong with the code, they'd immediately blame (in this order)
1. The Netware server (which only had the app code on it, not the Oracle DB which is what the app could not connect to).
2. The network transport.
3. Invalid app install
Not to mention that the thing had like 20mb of WINDOWS registry settings...
We constantly had to PROVE to Cerner why it was THEIR problem, and not ours.
I jumped ship finally..
The United States military empire began using an electronic medical record system which makes the British system look good. The USA system is buggy, rarely works, and - of course - costs a fortune. This puts $800 hammers to shame.
Sometimes I wonder who comes with bullshit sentences like this, and then you guys, the editors, don't question this gratuitous use of language.
The downtime on such a situation comes at a shocking 1.8 days/years
That is less than 45 minutes a week.
Quite standard to be perfectly honest.
IANAL but write like a drunk one.
No responsible physician sees 50 patients a day.
30 is the max and is pushing it.
If you are routinely seen for 5 minutes, get another doctor.
I've heard that Kaiser doctors have see patients in that amount of time, which is pretty irresponsible.
www.worldvista.org
OSCAR McMaster is in service, for a different variety of health service, in Canada.
GNUmed is not ready yet, but shows plausible promise. It needs a lot of work, but the team have committed themselves to doing it right rather than soon.
The US Veterans Administration system, which has been called VISTA for 10-30 years and is a distributed hospital information system is mostly (except for some imaging applications (PACS for radiology) public domain software, WorldVista's version is GPL'd and being developed, and runs on the GPL'd version of M, which is also being developed and has big brothers on big computers in banking.
KP's system is probably better than paper (I've not seen it), but the outages are more visible than the low level failures to have notes for patients who are involved with two doctors.
Prescribing is actually the larger benefit than notes, for the patient. Hand-written prescriptions are a bad idea, I'm trying to write no more than one a month now.
UK population.
We cover them all.
It seems a socially useful activity.