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."
Maybe they can merge the two projects (the Britain and the KP project) for greater efficiencies.
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?
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.
Did you also no that the correct spelling of new that you want is knew?
Jim
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."
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.
What's this software called? SickPeopleSoft? :)
Don't send a boy to make a mans job. AS/400!
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.
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.
US health service is second only to our education!
Check out my lame java blog at www.javachopshop.com
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
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
How the hell do you spend 4 billion dollars on software?
A couple of their secretaries upgraded to Vista.
Thomas Galvin
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
>"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".
Careful...
(from the link)"We also used the questionnaire to estimate how frequently illness and medical bills contributed to bankruptcy. We developed two summary measures of medical bankruptcy. Under the rubric "Major Medical Bankruptcy" we included debtors who either (1) cited illness or injury as a specific reason for bankruptcy, or (2) reported uncovered medical bills exceeding $1,000 in the past years, or (3) lost at least two weeks of work-related income because of illness/injury, or (4) mortgaged a home to pay medical bills. Our more inclusive category, "Any Medical Bankruptcy," included debtors who cited any of the above, or addiction, or uncontrolled gambling, or birth, or the death of a family member.16"
In other words, their analysis included lost income from illness (not covered under medical insurance), self reporting, and addiction or gambling. So the study didn't show that "medical bills" per se waere the cause, only that there were "medical" factors involved.
"As God is my witness, I thought turkeys could fly." A. Carlson
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.
A true life story
I have a dependant, who became afflicted with a rare conditon about a year ago, and we ran up 207,000 (and counting) of medical bills this year. Tomorrow is their last day of therapy... at which point 'we hope' we're done. Therapy costs $2000 a day.
The day they were discharged from the hospital for the inpatient, my employer also saw fit to lay me off, with 11 weeks of severence, and, of course, no extension of company paid benefits beyond the end of the termination month. COBRA cost me 1000/month for what was in the industry know as 'high deductible health care' [basically it's medicare part d for healthcare.. with a huge 'donut hole']. My plan has a 10,000 out of pocket max, and then the insurance pays 100%
Couple this with the getting the 'best doctors' to deal with this meant going out of network... when you go out of network, you see "oh, I'm only going to pay $10,000, as that is my Out of Pocket Max" Err, no.. see health insurance companies have this 'usual and customary' valuation of procedures, saying that if doctor charges $4500 for a MRI, and Medicare only reimburses that at $2000, well, the insurnance will only pay 100% of the '$2000', leaving the 'insured' paying the $2500 that is 'not covered'. You'll be surprised that an insurance company will pay $100 to an innetwork physician, for an office visit, but only pay $35 for an out of network physician, because medicare has deemed that 'usual and customary.'
So the bill yesterday said, after insurance paid "their share" of all claims that I still owe 97,000 (remember that 10,000 'out of pocket Max'. This after the privilege of paying $9000 this year for insurance coverage.
Note We have depleted 20,000 for living expenses while I was looking for a new job, and now that I have a job we have dedicated 500 a month to pay off the debt, and I am spending 2 hours a day appealing most of the 'usual and customary' valuations, which I will probably whittle off about 50K (I have no problem paying the difference between the common 'negotiated' rate with in network providers and Mayo's bill, but Medicare just doesn't cut it).
This is not a sob story, I'm actually been in the health industry most of my adult life... but If I were 20 years younger, and all this happened, I'm certain I'd be bankrupt.