Slashdot Mirror
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."
For every user who connects to HealthConnect, they connect via Citrix, and we're running into monumental problems in scaling the Citrix servers.
I'm not surprised at all. I don't want to give details, but my former employer had as a customer a very large European hotel chain who insisted on using Citrix in its architecture. I saw trouble tickets almost every day related to the Citrix servers, which were always falling down and causing one sort of problem or another. I was really glad I didn't have to work on those problems and the only thing it taught me was that any business that relies on Citrix is foolish.
That's not as far-fetched as you might think. Many NHS Trusts go to the States to visit Kaiser and see how their methods can be used in the NHS: http://www.dearden.co.uk/kaiser.shtml
Because it effectively was a legacy app in the sense that it was running a legacy programming language/system MUMPS http://en.wikipedia.org/wiki/MUMPS. I haven't used MUMPS, but my brother-in-law was working on a project to add a web interface to a MUMPS application. The language was so unwieldy (see the previous link and note the user of abbreviations and [sometimes] syntactic meaning of spaces) that he recommended scrapping the conversion a rewriting from scratch in Java because it would be up and running sooner and be much easier to maintain. Unbeknownst to him, management set up another group to start a rewrite and they completed the rewrite in half the time the upgrade team had been working (at the point the upgrade was cancelled). From TFA it appears IT at Kaiser was similary concerned, but in their case management appears to have ignored IT.
Programmers in mirror are brighter than they appear
Oddly enough, yes.
Health care management systems are a royal pain to build. They need to (if you want to be inclusive) do all of the following: billing, insurance submission, pharmacy and supply ordering both provider and vendor side (including inventory management), lab work integration, patient record management, facility booking, scheduling, and or interfacing with all of the above. You're doing this in a highly distributed system (both logically and physically), where fault tolerant behavior is required (and the 99.5% uptime mentioned is drastically too low). You're trying to do this while gathering inputs from hundreds or thousands of different systems, both internal and external, all of which talk different protocols using different vocabulary, all of which need to be reconciled, and all of which have their own quirks. To operate this system you have your standard IT grunt that has no more than 2 years of ITT Tech training. All of this needs to be done in a high-security environment where information is compartmentalized, both at the functional and the individual level. The users of this system range from physicians who don't know how to use a keyboard to administrators who want customized reporting and statistics out of the thing. A large subset of the users are prima donnas who *are* essential to your operation and who *will* walk if you don't satisfy their whims. Now go up another level - you also want a system that's easy to customize and extend (medical science doesn't stand still). Without a doubt, due to the fragmentation of the health care provision in our country, the range of users and functions these systems have to cover, and the extension requirements in place, these systems are some of the most complex that are constructed. K-P actually had an easier time of it, because of their vertical nature where so much of their operations are internal, but even so they needed to interface with hundreds of external contractor's systems (they contract out specialty care like heart surgery).
So, no, it's not an easy job; no, you can't just buy one off the shelf; and, unless you want to go to a much more regimented and controlled health care system, it's not going to get any easier. There's a reason why there are hundreds of companies in this business and why multi-billion dollars worth of this type of work is being done each year.
That is all.