Healthcare Giant Faces IT Nightmare 342
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 (Score:5, Funny)
Maybe they can merge the two projects (the Britain and the KP project) for greater efficiencies.
Re:maybe they can merge (Score:5, Insightful)
Re:maybe they can merge (Score:5, Funny)
He didn't mention the synergies that merging the two products would bring to the core competenancies of both organizations.
Now that I have, can I get the job?
Re: (Score:3, Funny)
In other words, it will suck. I should get the job.
Re:maybe they can merge (Score:4, Funny)
Re: (Score:3, Funny)
How is that different from how we do it now?
Re: (Score:2)
Re: (Score:3, Interesting)
News came out (Score:4, Informative)
See here [fixkp.org] for details.
Re: (Score:2, Offtopic)
Sounds kind of personal-- straightforwardly asking the board to fire these guys:
Woo-Hoo! (Score:2, Insightful)
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?
Re: (Score:2)
For example, my employer (the people of the Commonwealth actually), pays for the majority of my medical insurance with a small amount being deducted from my pay. I had to have wisdom teeth pulled earlier this year.
My dental insurance would pay for the novacaine but not the nitrous oxide. Nor would they pay for me to be put comletely under. Over
Re: (Score:3, Insightful)
Re: (Score:3, Funny)
You mean you transcend dental medication?
Regards,
--
*Art
Re:Woo-Hoo! (Score:5, Insightful)
That's the way medical insurance is *designed* to work. It's a net loss as long as all we need is routine stuff (like wisdom tooth extractions). And we accept that in the understanding that in the case of a severe, traumatic injury--something we just wouldn't be able to pay for *at all* otherwise--we'll be covered.
Re:Woo-Hoo! (Score:5, Insightful)
Re: (Score:2)
Re: (Score:2)
No, it is--but I think we actually agree here:
Right. And in either case, the insurance is a net loss in the case of routine work--that is to say, you'll spend more money with insurance than you would if you didn't buy the insurance and paid as you went instead. That's more obvious in the high-deductable case (where the insurance may pay out nothing, and hence be a
Re: (Score:2)
I don't like paying for something and not getting anything in return. I especially don't like it when the taxpayers, already burdened with a high tax load, are paying for something and not getting anything in return.
Either the medical insurance i
Re: (Score:2)
The "list" price doctors give as their fees are often 100% MORE than the rate insurance companies negotiate with the doctors. And the doctors aren't going to sit there by the hospital bed and negotiate with YOU when you are sick. So if you have no insurance, you are getting raped in medical expenses, even assuming a high overhead cost for going through the insurance company.
A physician friend of mine once told me a particular procedure is listed as being
Re: (Score:2)
Re: (Score:3, Informative)
And in the case of the severe, traumatic injury, chances are the medical insurance will still only cover a fraction of that, and you'll end up declaring bankruptcy if you can't pay for it.
Aren't most bankruptcies in the US caused by medical expenses, and involving people who do have ins
Probably not. (Score:2)
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.
Re:Probably not. (Score:5, Informative)
Re: (Score:3, Informative)
(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 ho
Re:Probably not. (Score:5, Informative)
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.
well this obviously can't be right (Score:4, Funny)
Re: (Score:2)
Since when is the US health care system a free market?
Re: (Score:2)
Re:well this obviously can't be right (Score:5, Insightful)
-nB
Re:well this obviously can't be right (Score:5, Insightful)
Re: (Score:3, Insightful)
Re: (Score:2)
Re: (Score:2)
Re: (Score:3, Informative)
Ah, but that is your opinion, and something you believe, not something you can have any proof of since such a thing never existed.
2. The more capitalist a nation is, the more prosperous it is (you don't need to have a completely capitalist nation to see it's effects).
Well yes, most countries in northern Europe, and especially Scandinavia are doing quite badly indeed.. I bet this is due to the socialist nature of their governments also.
Not to mention that c
Re: (Score:2)
Re:well this obviously can't be right (Score:5, Funny)
Re: (Score:2)
Duh! Of course, patients being alive was the problem to be solved by the "free market" all along! Why didn't I think of that before?! It all makes perfect sense now.
Re: (Score:3, Insightful)
And many who argue that also ignore the tiny detail that many western countries have a healthcare system that is at least as good and is upto 50% cheaper.
Re: (Score:3, Insightful)
Then I'd be interested in this premise of a free market healthcare system.
Re: (Score:2)
> The private sector (capitalism) offers insurance.
And so KP is where in that spectrum?
Re: (Score:2)
In general, unfunded mandates kind of suck.
Re: (Score:2)
Man, the free market [i]is[/i] efficient!
Re: (Score:3, Insightful)
Re: (Score:2)
http://www.kaiserpapershawaii.org/kaiserwatch.htm [kaiserpapershawaii.org]
the world is a nutty place.
Re: (Score:3, Insightful)
I know that, on the surface, it seems like no big deal that poor people get free medical care at the expense of big companies. The problem is that these big companies are starting to close their hospitals in poor areas - reducing the overall healthcare availability for poor people.
Like I said, unfunded mandates are gener
Re: (Score:2)
But seriously, people can buy any healthcare they want here, right? So Kaiser Permanente is operating in a free market. And the labor market is a free market, right? If the labor market is not efficient at allocating talented individuals to companies willing to pay the big bucks for them, perhaps there is something wrong. [wikipedia.org]
Re: (Score:2)
Actually the main problem the silly "Free Marketeers" fail to observe is that Adam Smith's ideas are not universally applicable to everythin. However since the "Free Market" is now to some of these individuals pretty much a religion, they of course attempt to apply it just about anywhere.
Free market, the real kind, excells in allocation of resources and growth of wealth in only one specific scenario: a very large number of small businesses competing in products about which the consumer is perfectly inform
What're you talking about? (Score:2)
Re: (Score:3, Insightful)
Re: (Score:2)
Efficient == profitable. This does not necessarily mean a better quality of life for those affected (wrt healthcare, it usually means a lower standard of care).
That 'painful' period of adjustment? How many of those periods will we get, and how long will they last? Decades?
What about the c
Re: (Score:2)
A lot. Forever.
The problem is high expectation. Quasi-free-market capitalism simply doesn't work very well when organizations get large -- the individual peoples' incentives always tilt toward value hoarding (which translates to corporate behaviors like rent-seeking and personal behaviors like deception) rather than value creation.
The only advantage capitalism has is that everything else seems
Re: (Score:2)
As a famous economist said, in the long run we're all dead. Increased efficiency 10 years down the line is all well and good but that doesn't help the people that need the services now.
Causes in common (Score:2)
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
Re: (Score:2)
> 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.
Well, that's true. But:
(a) increasing shareholder value and long-term performance are not necessarily linked. A good example of
Re: (Score:3, Informative)
Bloody Yanks (Score:2)
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.
Wow. We Are Not Alone (Score:2)
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 compan
Why the hell do they use Citrix? (Score:4, Insightful)
"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."
Re: (Score:2)
Re:Why the hell do they use Citrix? (Score:4, Interesting)
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.
Re: (Score:2, Informative)
Deployment: Hospitals, Physician Offices, etc., often have diverse locations and diverse applications needed to run on all of their systems: you wouldn't put a radiology system on a Patient Care floor (you'd want to see the results, not the actual application). Using Citrix, a hospital can buy some beefy hardware for their servers and run cheaper hardware in these offices.
Lack of IT staff: Many hospitals either have a small amount of IT staff, or they grew from that t
Re: (Score:2, Interesting)
Re: (Score:2)
For one, the application was probably the worst of both worlds. They probably took an unusable off-the-shelf program and modified it poorly. They were left with something that required too much bandwidth for a direct client connection at the scale they were looking. Citrix is a good fix for that. Also, mention "health care" and people go insane over HIPAA. I've ha
HIPAA may be the answer (Score:5, Informative)
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.
Citrix or anything else (Score:3, Insightful)
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".
99.5% availability is par for the course. (Score:4, Insightful)
Re: (Score:2, Insightful)
Name of the software? (Score:2, Funny)
Citrix? (Score:2, Insightful)
Only the scale is a surprise. (Score:2)
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 hav
Not surprising at all (Score:3, Insightful)
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.
Re: (Score:2)
Of course, the developer's goal is to make the system as complicated and proprietary as possible, because, again, they want to keep that support/update money coming for as long as possible.
Bad Math?! where does 77k/(year*doctor) come from? (Score:2)
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...)
Re: (Score:3, Informative)
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.
Re:Bad Math?! where does 77k/(year*doctor) come fr (Score:2)
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.
Evil Monkey (Score:2)
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-
Get used to IT (Score:2, Insightful)
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 i
Re: (Score:2)
In military terms, if your chosen plan requires more men to be landed on beaches than you have ships to land them...think again.
It is a refusal, despite experience, to acknowledge that the issues with large custom IT projects are as real as materi
Re: (Score:2)
Says who? These programs are awfully expensive, but it's still entirely possible that they'll create huge savings over the long run. The UK program is particularly expensive, but also ambitious - a complete, unified, nationwide patient records s
hospital IT system gets case of the MUMPS .. (Score:2)
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 (Mas
Re: (Score:2)
It was an interpreted language with only about 20 keywords, each of which was typically abbreviated with a single letter. As you might imagine, code l
Re: (Score:2)
The honest answer is probably none of us have anywhere near the information to know what wrong much less how to fix it.
If you use MUMPS under windows is it WMUMPS?
99.5% uptime (Score:2)
Perhaps this might m
No one knows how to do commercial software (Score:2)
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".
Funny thing. (Score:5, Informative)
I hope they get this thing right (Score:3, Insightful)
Gee, 2 and 1/2 nines ain't so bad (Score:2)
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.
Ego vs In the know (Score:2)
This happens all the time.
Insert Open Source Development Plug Here (Score:2)
$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 i
Huge Opportunity (Score:2)
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 bi
Re: (Score:2)
While it's inexcusable that they spent $4B and got such a poor product, I can see how the regs and data partitioning could make the specs for such a system very difficult to implement in a user friendly way. There are a lot of safeguards for medical data that need to be in place by law, and a new set of regs in the middle of development (I don't know that this happened), along with the 50 different state law sets must have created quite the nightmare.
Re:Huge Opportunity (Score:5, Interesting)
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.
Not Newsworthy (Score:2)
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.
Re: (Score:2, Funny)
Jim
Re:Go USA! (Score:4, Funny)
Re: (Score:2)
Re: (Score:3, Funny)
A couple of their secretaries upgraded to Vista.
Re: (Score:2)
Re: (Score:2)