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Big HMO Jolted By Email, System Failures
Posted by
Zonk
on Fri Apr 27, 2007 08:52 AM
from the so-proud-to-have-epic-systems-in-madison dept.
from the so-proud-to-have-epic-systems-in-madison dept.
JoanofAlaska writes "The Wall Street Journal is running a front page story about the internal mass e-mail that exposed the failing $4 billion dollar electronic medical record system at Kaiser Permanente, the biggest non-profit HMO in the country. When word of the system's meltdown quickly spread back in November, one reporter obtained a 722 page internal document that showed patient safety lapses as a result of the system's problems. Then in February, the Los Angeles Times had a front page story in which a systems analyst who worked on the project called it 'the worst [technology] project I have seen in my 25 years in the business.' They've created a website to try to rebuild confidence in the project, and they say their goal for system availability is 99.7% (they're currently at 99.2%)."
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Healthcare Giant Faces IT Nightmare 342 comments
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."
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Smoke, meet fire... (Score:5, Informative)
I don't know what to say about the first e-mail until I see more but the CEO sounds like a real jack ass in the second one. And if that 99.2% number is right then they got bigger problems than some email - that's all I can say!
ac
Re:Smoke, meet fire... (Score:4, Informative)
Parent
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Looks like things are getting better now; they have brought in several IT and facilities
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For instance, we stated having failures of refrigeration units in a new facility I helped build. Everything was going fine, until we stated getting calls regarding multiple equipment failures and risk to the product ins
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Re:Smoke, meet fire... (Score:5, Informative)
In all reality they are not the great evil. They certainly could do better, but by no means are they horrid (this assumes that you, as a patient, know what you need, and press for a second opinion &&|| a specialist when the initial diagnosis doesn't seem quite right).
-nB
Parent
Typical of medical and insurance businesses. (Score:2, Interesting)
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While the use of old technology at a physicians office may be true, I wouldn't generalize hospitals in that category. I have consulted at two different hospital systems in the past six years. At each location, the hospital was pushing to the forefront of technology. My last hospital was in the early stages of virtualizing all of their hardware environment and was using the most recent UNIX hardware
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There are several legacy, "green screen" apps in the insurance industry still kicking around out there. Some of these were initially developed as far back as the late 1970s. They are capable of high transaction rates in comparison to java-driven, web-based, "thin client" applications. Many of today's OLTP applictions would be better suited for ASCI-based interf
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I was involved in a project a few years back where a hospital's IT system ran on a bunch of OpenVMS systems, because the main application only ran on OpenVMS. (Which I concede is a capable operating system (logicals are even more powerful than symlinks, etc. etc.) but was outdated even in 2001.) They were also - by a factor of four or so - the largest deployment of the software, so they ran into all
My dentist... (Score:2)
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That's not being cheap. That's being a very conservative organization who can't really gamble on things suddenly not working.
I have seen numerous projects where a company with some older machines (say, mainframes) is being sold a piece of software to replace their 20 year old system -- and replace it with a Windows bo
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> hospital, insurance company or doctors offices. These places
> hate to spend money on IT and let old gear sit in place for
> almost ever.
Except that this article shows why that might be: true critical systems need to be reliable and understandable. Systems that have been in production for many many years often meet those requirements. That is why you often see 3270 green screen applications in large medical offices, and DOS or (old,
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Or option 3, has no choice but to be in an HMO because that's all their employer offers.
I'm in that situation and almost all medical expenses are taken care of. Then again, I'm a basic user. Twice a year dentist check is all I need.
Granted, I wish I could opt out of paying for any medical and get the money in hand and pay my own, rare, expenses but I don't have that option. It would be cheaper for me to get the money and
Young people are cheap to insure (Score:2)
Granted, I wish I could opt out of paying for any medical and get the money in hand and pay my own, rare, expenses but I don't have that option. It would be cheaper for me to get the money and pay when I go to a visit than it is to piss away money every paycheck and not use it.
Your message sounds to me as though you're fairly young. Have you ever checked insurance premium charts? The cost to cover a 20-something is about half the cost of someone in their late 40s and above. The whole idea of HMOs and group insurance was to spread the risk among huge patient pools so no one patient would ever face large medical bills for the unexpected. So while 20-somethings fuss over $400 monthly premiums deducted from their paycheck, keep in mind that the level amount deducted from all employe
Epic Systems? No wonder... (Score:5, Funny)
C'mon, it really can't be that bad, can it?
Oh, Epic Systems? No wonder. Dude, you're f****ed.
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Re:Epic Systems? No wonder... (Score:4, Informative)
*sigh* - too true. Epic requires a monumental effort just to get the off-the-shelf product to work properly. Kaiser is doing a massive amount of internal development in addition to trying to implement as Epics biggest customer.
Part of me wants to think that Justin is just fresh meat who hasn't put in the time to become as jaded as the rest of us in HIS. The other part of me thinks he might be right and that Kaiser has bitten off way more than it can chew. Failure to understand the effort involved is just as pervasive as the massive waste he's critiquing, and just as harmful.
Parent
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Did they perhaps build it in MUMPS? (Score:2, Funny)
$4billion for a failing healthcare system? (Score:3, Funny)
As someone going to a Kaiser appt. today... (Score:2, Interesting)
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I experience poor service whenever I deal with any organization in Health Care. Of course, where I live, Kaiser isn't a significant presence, so I can't blame them or their new software. I just blame it on the shitty system of Health Care we have here in the US.
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What's an HMO? (Score:2)
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Re:What's an HMO? (Score:4, Funny)
If only there was a way for someone to find information on the internet. Like a centralized tool or website that indexes other websites and allows people to search for it when they don't understand.
Or wait, even better - how about an encyclopedia like website that could contain vast amounts of knowledge.
Ah, that would be grand.
Parent
So what? (Score:3, Insightful)
Private incompetence pales in comparison to government incompetence.
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Actually, the oposite is true. For example, the US Medicare system spends about 98% of its funding on patient care. Even the largest and most efficient private insurers only can manage about 90%. The radical right-wing wants to preserve the profits of private insurers and so they spend a great deal of their propaganda efforts highlighting mistakes in the public sector so it appears that government is less efficient than it actually is.
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For example, the US Medicare system spends about 98% of its funding on patient care.
Administrative overhead is just about the worst possible measure of efficiency. What you want to measure is amount of needed services delivered for the cost. Medicare's low administrative overhead means that it doesn't have the administrative capacity to avoid paying for unnecessary procedures or to catch providers upcoding visits or procedures or outright inventing them. Even ignoring the question of how much of the services Medicare pays for are actually necessary, Medicare has a huge rate of outrigh
Long-term Kaiser patient disputes wild claims (Score:5, Informative)
Let me tell you of my experience visiting my doctor yesterday (Thursday). During my visit, my doctor pulled up recent lab results on the exam room console. He was able to prescribe new medication and schedule follow-up lab test through the system (no paper). I went down the hall to get a tetanus booster, then walk downstairs to pick up my prescription. All with no paperwork. I believe their system is phenomenally successful. I won't dispute the cost of this project.
I've undergone a number of procedures and consumed considerable medical resources during the past year. All of my records are computerized and information is easily shared among their medical professionals. The doctors, nurses, lab technicians have access to information required to deliver quality medical care to me.
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Does the "pain" I feel really matter when there are actual sick people up in that building relying on providers who need up-to-date and accurate informati
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It really pains me every-time I see one of these large organiz
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A previous article... (Score:5, Interesting)
As someone who has been frustrated by a variety of Electronic Medical Records systems in different medical settings, I must say that my "favorite" has been VistA [vistasoftware.org] (the medical records software used by the Veteran's Administration, and no relation to Microsoft Vista). Currently, I'm using GE's Centricity [gehealthcare.com] at my work site and have had some minor problems that have resulted in delays in entering my data. (Problems with VistA were more related to the entire network being down - problems with Centricty have been with database connectivity... I wish I could say more about it, but I'm not an IT person, I'm just a lowly end-user).
This all could have been avoided... (Score:4, Funny)
Hyperion: If it's good enough for Google, it's good enough for you.
Percentages and Marketing speak (Score:4, Informative)
It's also why many companies can say 99% uptime as that's close to 88 hours of downtime out of a year.
Hours in a year 8760
99% = 87.6 hours
99.2% = 70.08 hours
99.7% = 26.28 hours
If they are at 99.2% right now, I wonder how the heck they are going to get that extra 0.5% percentage points with all the problems they have now.
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The worst? (Score:2)
'the worst [technology] project I have seen in my 25 years in the business.'
Yikes. If his 25 years of experience are anything like my 10 years, then that's saying a LOT.
The State of Maine fails: (Score:2)
http://www.cio.com/article/20133/Maine_s_Medicaid_ Mistakes [cio.com]
Windows system doesn't scale. What a shock. (Score:5, Insightful)
From the ComputerWorld article: Deal and an IT employee, who spoke to Computerworld on the condition of anonymity, said part of the problem with the HealthConnect system is that the Citrix Application Delivery infrastructure implemented by Kasier just can't handle the load of the Epic Systems.
"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."
So instead of deploying the app on N thousands Windows desktop, they deciced to use Citrix to remotely connect to a pool of servers. The Citrix server and the Windows machine at the other end could not stand the load. Big surprise.
The way normal people would do it is use an X11 graphic application (X11 is available for Win32), or use a Java webstart client, or even do everything within a browser, or... But there are many, many way to architect a distributed app these days.
The ONE thing you shouldn't do is deploy lots of Windows servers, use the half-baked ICA protocol, and expect everything to be peachy.
Remember, CIO boys and girls: Uncle Bill's broken OS just cost lil' Cliff Dodd his job. Don't be the next one. Keep Win32 where it belongs, outside the server room.
Kaiser Permanente has significant problems (Score:3, Informative)
Add to this the reports of KP dumping homeless patients on the streets. There was the kidney transplant scandal. The patient information becoming available online scandal. And all of this in just the past 2 years. Kaiser is clearly flawed from top to bottom. They are the poster-child for real health care reform in this country.
Epic Systems (Score:3, Funny)
Interesting website .. (Score:2)
Kaiser sub-standard care. (Score:3, Informative)
For me the biggest issue came when it was time for discharge. The handed me a hand written sheet with about 12 different medications scribbled in "Doctorese" cursive writing. I couldn't read half of the sheet, and only the briefest of notes for each medication was listed. I was shocked that I didn't receive a computer printout with the medication instructions, especially for medications needed to be taken in the case of quadruple bypass heart surgery.
After many hours of sorting through the medications, trying to figure out if he had already been given a dose at the hospital or not, etc... I realized that when I had visited a non-Kaiser emergency room for a sprained ankle I got a multi-page printout with very thorough instructions for the medication and aftercare. On another visit when I had 107 temperature it was the same thing. I was very certain of the doctors orders for post-visit care.
With Kaiser though I was left confused with short hand written notes about a dozen medications. Confusion is not a state I wanted to be in when I'm charged with the care of one of the most important people in the world (to me) who has a life threatening condition!