blog.fixkp.org

The Los Angeles Times is running a story by reporter Daniel Costello today confirming that George Halvorson has unexpectedly replaced interim chief information officer Bruce Turkstra. Philip Fasano has now taken over as the third chief information officer to attempt to get the HealthConnect project back on track.

The choice of Fasano seems as unusual as his background. Since 2004, Fasano has been self-employed as a consultant, apparently trying to help companies secure business with the federal government. The official press release, somewhat understandably, magnified his last three years as a consultant, naming him as “president and CEO of Capital Sourcing Group, Inc., based in McLean, Va.”

Curiously, according to the Commonwealth of Virginia State Corporation Commission, Capital Sourcing Group’s business license was terminated on January 2, for non-payment of state debts totaling $1,529.

The quirks of Fasano’s history are interesting, but the most significant question is glaring: Why would America’s largest healthcare organization hire someone with no healthcare experience to manage the “largest civilian” healthcare information technology project?

The press release seems to have, again, understandably, highlighted the more impressive parts of his career. Although he did spend two decades in the financial sector, as best as I can tell, only a handful of those years were as a chief information officer. During one brief period, he swiftly moved from Deutsche Financial Services to American Financial Group to JPMorgan Chase. The quick succession does not appear to have been conventional career advancement. According to a spokeswoman for American Financial, at the time, Fasano was asked to leave the company due to “differences in philosophy.” (Nevertheless, a situation I can personally appreciate.)

Fasano’s bizarre hiring, coupled with Turkstra’s unexpectedly brief tenure as chief information officer (and expected quick complete departure after Fasano has “transitioned” in) are just two more puzzling chapters in the story of Kaiser Permanente under George Halvorson.

Cliff Dodd was the main coordinator for HealthConnect. Bruce Turkstra was its chief architect. Both are now gone. But the man who put this trainwreck into motion, has yet to speak honestly about why he made the decisions he made, against the guidance of the Kaiser Permanente Partnership Group and against the advice of our internal information technology engineers.

These are questions George Halvorson may never answer. The most important question, though, is why has the Kaiser Foundation Health Plan Board of Directors completely abandoned its legal responsibilities to our members? That’s a significant question, and they should know that many people are waiting for an answer.

Chief Information Officer History at Kaiser Permanente

Philip Fasano
from early 2007
formerly finance (JPMorgan Chase, CapitalOne), defense contracting
(hiring)

Bruce Turkstra
from late 2006 to early 2007
formerly finance (Merrill Lynch)
(promotion, continued problems, replacement)

J. Clifford Dodd
from early 2002 to late 2006
formerly finance (American Express), telecommunications (Qwest)
(hiring, resignation)

Timothy Sullivan
from late 1996 to early 2002
formerly finance (First Interstate Bank, acquired by Wells Fargo)
(appointment, progress, replacement)

This story was originally posted at justendeal.com.

The East Bay Business Times recently ran an interesting article, by Marie-Anne Hogarth, on the first forays into “social media” by Kaiser Permanente. The article quotes Dmitriy Kruglyak, (link via Google) who heads up Trusted.MD, and who is moderating a discussion at the upcoming Consumer Health World conference, “Open Healthcare: Learning to Live in the Brave New World.”

As the moderator of the panel, Dmitriy, understandably, tells the Business Times that he wanted to provide an “open, fair forum” for each of the panelists participating in the discussion. The article mentions that officials at KP, after considering an invitation to join the discussion, declined to make anyone available for the panel. The Business Times was, nevertheless, excited about the opportunity: “It would have been a debate that many would have paid to see: Kaiser Permanente CEO George Halvorson on the same panel as Justen Deal, the IT employee who was placed on administrative leave after sending a mass e-mail detailing his concerns about the company’s emergency medical records system.“

Unfortunately, I will not be able to join the discussion at the conference. However, the panel assembled represents a very experienced, very diverse spectrum of folks from across healthcare. I hope to be there to hear what, I imagine, will be an interesting, open, and informative discussion.

In fact, the conversation leading up to the actual discussion itself, is turning out to be a good one, as well. Dmitriy posted yesterday a very honest critique of how Kaiser Permanente has tried to “handle” the HealthConnect concerns: “Control of the message is so 20th century. The name of the 21st century game is trust. The only way to earn it is through openness.“

Prior to my November 3 message, Cliff Dodd had embarked on an effort to promote “transparency” in KP-IT’s successes (and failures). One particular move under that initiative was to make HealthConnect system reliability information widely available to clinicians, managers, and engineers. The statistics were startlingly negative, and, unfortunately, they were an accurate reflection of the health of the HealthConnect system: it was failing. Within a week or so of Cliff Dodd abruptly leaving on November 6, the so-called “commitment to transparency” followed him out the door.

Since mid-November, HealthConnect system reliability and availability reports have become highly restricted. In a meeting I had with Dr. Jeffrey Weisz and Thomas Williamson just before Thanksgiving, they both indicated even their access to the reports had been restricted. Dr. Weisz is the medical director for Southern California, and he is responsible for making decisions that affect the care of millions of our members. He told me that he had previously made the decision to slow further HealthConnect inpatient deployments in Southern California (beyond Baldwin Park). Now even he no longer has direct access to the reports that should be a critical factor in his decision making.

The truth is that severely limiting access to accurate information, inside and outside the organization, has not, and will not fix HealthConnect or its problems. The final reports that were made available indicated uptime had continued to severely deteriorate, month-over-month, well into November. The patient safety issues are serious, they do exist, and they must be addressed. Dmitriy pointed out the importance of “openness,” but, in this case, it’s not just important. Kaiser Permanente members are depending on an open, honest process to fix HealthConnect. That process is important, and it’s essential.

Update: A kind soul was kind enough to point out to me that there actually is a vision and set of principles for the “business” of healthcare in today’s world. Important folks from the Stanford University School of Medicine and Evanston Northwestern Healthcare have signed on, to name just two. Take a look.

This story was originally posted at justendeal.com.

For the third year, Tim has given HIStalk readers a chance to nominate and vote on companies, issues, and people who are important or notable in healthcare information technology. The coverage of the issues surrounding the Kaiser Permanente HealthConnect project was voted story of the year. Tim makes the revealing of the top vote getters an affair, and he asked me to write something about the recognition. Here’s what I wrote…

Story of the Year: KP HealthConnect Issues

In 1970, Dr. Sidney Garfield, the founding physician of Kaiser Permanente, wrote: “Continuing total health care requires a continuing life record for each individual… The content of that life record, now made possible by computer information technology, will chart the course to be taken by each individual for optimal health.”

It has actually taken nearly forty years for healthcare and technology to catch up to Dr. Garfield’s vision, but we are so close today. Dr. Garfield was uncompromising and passionate about efficiency, safety, and prevention. I believe he would have wholeheartedly supported an electronic health information system for Kaiser Permanente that was affordable, reliable, and safe. I imagine he would have absolutely embraced technology that would have intelligently helped his physicians improve diagnoses and prevent medical errors.

I regret that we still have not achieved Dr. Garifield’s vision, and that, unfortunately, is the reason that the Kaiser Permanente HealthConnect project is being mentioned here. We haven’t yet had a truly honest, truly open discussion inside Kaiser Permanente about how to achieve Dr. Garfield’s vision, but we will. In a few years, experts say we could see $80 billion dollars in cost savings because of the efficiency made possible by electronic health records. They also say those same systems could help prevent as many as 200,000 deaths that occur as the result of preventable medical errors. Kaiser Permanente has been a key driver forward in healthcare information technology, going back almost forty years to when Dr. Garfield first wrote about his vision. We will overcome the challenges we see now, and like many of the advancements Kaiser Permanente has pioneered, the benefits will be seen across healthcare, not only in America, but around the world.

The past year was not a good year for Kaiser Permanente, but I know that there are 163,000 physicians, nurses, and other caregivers who believe in what Kaiser Permanente stands for, and who also believe in the power of Dr. Garfield’s vision for the future of healthcare. We will get there. And, I hope, next year, you will be able to choose the “Turnaround of Kaiser Permanente’s Healthcare Information Technology Project” as your top story.

This story was originally posted at justendeal.com.

]]>

My BlackBerry woke me shortly after midnight with an alert that the Los Angeles Times had posted a front page story on the challenges the Kaiser Permanente HealthConnect problem is facing. The article is an amazing, honest insight into a project that has serious implications with regard to the health of Kaiser Permanente, and the safety of our patients.

The past few months have been more difficult than I could ever have imagined. I did not expect everyone to immediately appreciate the significance of the situation at Kaiser Permanente, yet the response from individuals inside and outside the organization has been overwhelmingly affirmative. Our physicians, our nurses, and people from across healthcare are extremely concerned with the future of Kaiser Permanente, under its current leadership.

I hope that, finally, the Kaiser Foundation Health Plan Board of Directors and physicians from across our Permanente medical groups will begin to frankly and honestly address the status and future of the HealthConnect project. It is time that a discussion take place that puts patient safety first, with a keen eye to the financial stability of our organization.

It is regrettably clear to me that George Halvorson and others within the organization have placed their personal interests far above the interests of our members. Over the past several weeks, I have come face to face with a terrible side of our organization, one in which retaliation and daunting threats of attack on my personal and professional integrity have nearly completely undermined my determination to continue to “fight to protect the future of our organization, the future of Kaiser Permanente.”

I had to remind myself this morning, of why I took the steps I did, beginning in August, and essentially culminating on November 3. I, like each of my colleagues at Kaiser Permanente, promised to protect our organization and our members. That’s a promise I intend to keep.

This story was originally posted at justendeal.com.

]]>