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Healthcare Giant Faces IT Nightmare
Posted by
Zonk
on Thu Nov 16, 2006 02:09 PM
from the awesome-rpg-character-name dept.
from the awesome-rpg-character-name dept.
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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Biggest IT Disaster Ever? 405 comments
lizzyben writes, "Baseline has a major story about a major IT disaster in the UK: 'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion, and two Members of Parliament say the project is "sleepwalking toward disaster"... In scale, the project... (NPfIT) is overwhelming. Initiated in 2002, the NPfIT is a 10-year project to build new computer systems that would connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals; allow for the electronic storage and retrieval of patient medical records; permit patients to set up appointments via their computers; and let doctors electronically transmit prescriptions to local pharmacies.'" An Infoworld article from earlier this year sketches some of the all-time greatest IT meltdowns.
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Big HMO Jolted By Email, System Failures 171 comments
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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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)
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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?
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Re:maybe they can merge (Score:4, Funny)
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News came out (Score:4, Informative)
See here [fixkp.org] for details.
well this obviously can't be right (Score:4, Funny)
Re: (Score:3, Insightful)
Re:well this obviously can't be right (Score:5, Insightful)
-nB
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Re:well this obviously can't be right (Score:5, Insightful)
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Re: (Score:3, Insightful)
Re:well this obviously can't be right (Score:5, Funny)
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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: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.
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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.
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99.5% availability is par for the course. (Score:4, Insightful)
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.
Funny thing. (Score:5, Informative)
Re: (Score:3, Insightful)
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.
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Re:Woo-Hoo! (Score:5, Insightful)
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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
Re:Probably not. (Score:5, Informative)
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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.
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Re:Go USA! (Score:4, Funny)
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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.
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