Wednesday, November 15, 2006

Kaiser Permanente's New EMR - An Alternative View

MedInformaticsMD has posted recently about allegations of major troubles with Kaiser Permanente's new electronic medical record, and the management of its development (see here and here).

A physician correspondent at Kaiser, and someone whose judgment I trust, had an alternative view:

I want you to know that the Epic product for KP, HealthConnect, is a fully integrated and very highly functional software that interfaces with Pharmacy, Inpatient & Outpatient records, imaging,'s unbelievably useful. Not absolutely perfect, but really extraordinary nevertheless. I personally can research referrals with an ability to track diagnostic images, consults, labs, professional notes including progress notes all on one platform. It has been rolled out to most of the Northern California region where we serve well over 3 Million people, and there is nothing that competes with its usefulness. The down time quoted is a gross exaggeration. It has helped me enormously provide fast, accurate decisions in settings in which, in the old work, I would have otherwise wasted precious time getting the right, important information.
The KP CIS system to which some reference was made by JD is to Epic as the Conestoga wagon was to a Ferrari. The fact that he thinks it was a satisfactory system either reflects a lack of understanding or a willful blindness to the needs of clinicians. Furthermore, KP is a nonprofit in the best sense of the word - its margin is used to build new hospitals as mandated by State law to make hospitals earthquake safe and to improve care by doing things like rolling out KP HealthConnect [the Epic product]. These are spectacularly expensive projects in the best of all possible worlds, and are intended to provide advances in improving access to care for vulnerable patients.
This does not address all the issues in our previous posts, but at least makes clear that there was some reasonable rationale for trying to adapt the system to the Kaiser setting.

I would also note that Kaiser has a reputation as one of the best managed care organizations, and one that has remained not-for-profit and generally tried to maintain its focus on its primary mission. It's goood to see that Kaiser physicians are continuing to adhere to its traditions. We will stay tuned to see what turns out about the other issues raised about Kaiser's expensive EMR project.


kaiserfraud said...

I have to agree that KP-CIS was pretty rotten - and I'm not sure that anyone has pointed out that Justen started working at KP after it was already gone. The only thing he could have really known about it was that it was mind-boggling write-off.

If you've been reading the comments on HISTalk or my blog - it's pretty clear that the range of opinion can be sorted into various usergroups. While the "powerusers" may enjoy tuning up the Ferrari, the "boots on the ground" have been frustrated by noticeable downtimes. The project leaders have a vested interest in declaring how well everything is going while IT support staff seem to be stressed out by the "boots on the ground" issues.

I don't think these points of view conflict. There's obviously some communication problems between the project evangelists and the choir, and that places the issue squarely where I've always placed it: project management.

Ps. Is it me, or is there a coordinated "Kaiser key messages" campaign afoot tonight?

Anonymous said...

I would also note that Kaiser has a reputation as one of the best managed care organizations, and one that has remained not-for-profit and generally tried to maintain its focus on its primary mission.

Then there's this article:

Friday, November 17, 2006

Hospital chain accused of abandoning homeless woman in L.A.

By Andrew Glazer

The Associated Press

LOS ANGELES — In an unprecedented crackdown on a practice experts say is shamefully common around the country, prosecutors accused a major hospital chain Thursday of ridding itself of a homeless patient by dumping her on crime-plagued Skid Row.

A surveillance camera at a rescue mission recorded the demented 63-year-old woman wandering around the streets in a hospital gown and slippers last March.

In announcing the criminal and civil charges, City Attorney Rocky Delgadillo said a Kaiser Permanente hospital put the woman in a taxi and sent her to the neighborhood even though she had serious, untreated health problems.

"Kaiser Foundation Hospitals, part of Kaiser Permanente, the largest HMO in the nation, will be held accountable for violating state law, its commitment to its patients, its obligations under the Hippocratic oath, and perhaps most importantly, principles of common decency," Delgadillo said.