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Call it HealthConnect, Take Two. Only this time, replace Kaiser Permanente with Sutter Health.

Tim, over at HIStalk, was the first to pick up a story by Chris Rauber covering Sutter’s Epic Systems implementation. The guy in charge over at Sutter, Jerry Padavano, wants to be clear: “I’ve learned from Kaiser’s missteps, and we’re all learning from one another.”

Indeed. They learned a lot. Sutter’s original project budget was $150 million. They’re, so far, up to $500 million. HealthConnect is going to wind up upwards of five times over budget. Sutter is pulling it in at just three times over!

Alright, that was a cheap shot. Cost is important, but as Tim points out in his Universal Rules for Big EMR Rollouts™, maybe the key goal for any electronic medical record project is to get it up and running, “hopefully without killing patients in the process.”

There’s no word from Sutter on reliability or downtime, although the six hospitals aren’t expected to all be live until 2011, so they may still be a bit aways from having any feeling about that. Maybe they will address downtime ahead of time, and maybe that’s one point they will have learned from Kaiser Permanente?

Speaking of HealthConnect… Kaiser Permanente, by my estimates, has now spent upwards of $5 billion on the project (according to Kaiser Permanente: $3.2 billion; according to the Los Angeles Times: $4 billion). Five of our nearly forty medical centers are now live, which, at this rate, means they’re rolling out about three new hospitals a year.

The project was supposed to be completed “nationally” by late 2006. (Don’t laugh.) The outpatient portion now won’t be finished until well into 2008. The inpatient portion now isn’t expected to be completed before 2012.

And that $5 billion spent so far? That’s primarily just for outpatient. Considerably more funding will be spent on the remainder of the inpatient portion. The nearly $100 million figure Sutter is seeing about matches what KP has spent so far to bring hospitals up on HealthConnect. That means an estimate of as much as $3.3 billion more in implementation costs, although the last actual amount budgeted to HealthConnect that I saw was over $4.2 billion from 2008 through 2012.

Assuming the largest figure is the more accurate one (it always is with HealthConnect), that would mean the total, almost ten-year cost of creating an electronic health record network for Kaiser Permanente will come out to over $9 billion. Ten years. $9 billion. The original estimate? Three years and $1.8 billion. (Why did Bruce Turkstra and Cliff Dodd leave Kaiser Permanente, again?)

So, back to Epic.

Let me say that I agree that Epic, today, has one of the best electronic medical record platforms out there when it comes to features. Many of the problems at Kaiser Permanente were infrastructure: poor desktop deployment planning, lousy network design, inadequate change management processes, and so forth, which led, in part, to the poor reliability of HealthConnect. The issue, as I alluded to in the post on IBM and KP getting back together, is that Epic either didn’t try or was ineffective when it came to helping Kaiser Permanente plan adequately for the project, let alone all the contingencies. You’ll find the same problems at Allina, and now at Sutter (both Epic installs), and at any number of other healthcare organizations and hospitals that are transitioning to electronic medical records, regardless of the vendor.

Yet, the key goal for KP, and it appears Sutter, has always been some elusive ability to “improve” billing. The article on Sutter, which has 26 hospitals, points out that the six chosen facilities for the Epic deployment were picked because they account for “roughly half of overall patient volume.” George Halvorson is on the record time and again saying KP desperately needed Epic for the tide of health savings account members that would be coming along any day (you’re not still holding your breath, are you?).

So, as these projects have their top priorities set in billing, the “ideal” of patient safety and the promise of preventing medical errors have taken a back seat. To this day, HealthConnect has only rudimentary procedures in place to track (let alone processes to actually deal with) potential medical errors. While there’s a lot of promise for intelligent diagnosis support and error detection, you won’t find hardly any of that promise in HealthConnect, and I doubt you’ll find much of it in Sutter, either.

Which, I think, means this phase of electronic medical record deployments in the United States will largely be eventually written off as a failure. Perhaps the only saving grace is that these deployments might, might be laying the groundwork for a better round yet to come (through workflow improvements, network infrastructure upgrades, and so forth).

Time (and lots of money) will tell.

This story was originally posted at justendeal.com.

Michael Moore is ruffling more than a few feathers with SiCKO, his new movie which shines a (camera) spotlight on what’s wrong with healthcare in America. The movie doesn’t even open until Friday, but guess which healthcare organization already has its press release ready to go, saying its “portrayal” in SiCKO “must be addressed.” Yes, sadly, it’s Kaiser Permanente:

Voices that recently have joined the health care reform debate have incorrectly portrayed Kaiser Permanente and its history of championing health care excellence and availability in the United States. Kaiser Permanente has been a strong and steady proponent of high-quality, not-for-profit health care for 65 years. In this context, Kaiser Permanente’s portrayal in a new movie, “SiCKO,” must be addressed.

Now, before I actually get to Michael Moore’s lashing of Kaiser Permanente, I want to take this opportunity to advertise George Halvorson’s new book, Health Care Reform Now. It’s rather ironic. Think about it: George Halvorson wastes ridiculous amounts of non-profit member healthcare money in promoting his book. So it goes, naturally, that Mr. Halvorson is directing KP to use all its PR resources to promote his book, all the while claiming SiCKO is just all wrong when it comes to KP.

The irony, or honesty, depending on how you see it, continues on the website created especially for the book, where Halvorson is called “a thought leader on health care reform.” I guess you can’t call him an “action” leader, given Mr. Halvorson’s track record at HealthPartners in Minnesota, or at Kaiser Permanente. So, “thought leader”? Think of it as Mr. Halvorson’s way of saying “do as I think, not as I do.”

If George Halvorson’s abuse of his position at Kaiser Permanente isn’t enough to make you sick, the sad stories of Kaiser Permanente members in Michael Moore’s new movie will.

The horrific story of Mychelle Williams is a focus of the movie. Baby Mychelle, who was eighteen months old, “died of a treatable infection that a simple blood test would have detected.” The Foundation for Taxpayer and Consumer Rights continues the story:

The facts in Mychelle’s case are harrowing: An ambulance picked the little girl up from her grandmother’s Compton home in May 1993 and took her to Martin Luther King Jr./Drew Medical Center, the nearest hospital.

Dr. Trach Phoung Dang then gave Mychelle medication for her fever and other ailments and intravenous liquids for dehydration. He wanted to run blood tests to determine why the feverish, limp girl, who her mother said had been fine just hours earlier, was now so desperately ill. But the girl’s family belonged to the Kaiser health maintenance organization, and Kaiser’s Dr. Brian Thompson repeatedly told King/Drew that the tests should be done at Kaiser.

The telephone conversations between the doctors were tape-recorded by Kaiser, and according to a petition filed with the high court, Dang suggested three times that King do the tests before a transfer.

As the little girl’s condition deteriorated, her mother, Dawnelle Keys, now 37, pleaded with doctors for more aggressive treatment. But the child could not be given antibiotics until after a blood test, and wasn’t given the blood test because Kaiser wanted to do the tests…

By the time the toddler reached Kaiser — four hours after she arrived at King — she was near death. Her heart stopped about 20 minutes later, and she could not be revived.

Kaiser Permanente’s defense? Mychelle died “14 years ago. [Her death] was not [as a result of] the denial of coverage for necessary medical care, as the movie claims.”

The jury said the evidence showed otherwise, and found Kaiser Permanente liable for $338,250.

You can’t help but feel heartbroken for this poor little girl’s family. Well, unless you’re George Halvorson. You can’t help but feel disgusted that Mr. Halvorson would try to use (a fabrication) of this little girl’s story to sell his book. What a truly respectable “thought leader” Kaiser Permanente has in George Halvorson.

This story was originally posted at justendeal.com.

Marie-Anne Hogarth, with the East Bay Business Times, has what I believe is the first interview with Phil Fasano since he joined Kaiser Permanente back in February. In the first dose of honesty in a while, Fasano admits KP is falling far short on reliability when it comes to HealthConnect:

The first goal, Fasano says, is to get KP HealthConnect up and running at least “five nines” – 99.999 percent of the time.

“(Kaiser CEO) George Halvorson and I have come together on that and believe very, very passionately that has got to be our goal,” Fasano said.

That’s a different message from what [former KP CIO and HealthConnect architect, Bruce] Turkstra related to East Bay Business Times in an interview in December, when he said the goal was an up-time of 99.7 percent. That would mean the system would be down about four minutes a day.

In the first quarter of 2007 – according to Fasano – the system has been up 99.57 percent of the time.

Thinking about this step by step, now… Four of Kaiser Permanente’s 37 hospitals depend on HealthConnect. And that system is currently down for several hours every month. In case you were wondering, those four hospitals are South Sacramento and Baldwin Park (since last fall) and West Los Angeles and Santa Rosa (since earlier this month). Some might suggest you avoid those four facilities especially if unless you have a critical emergency.

Despite the alarmingly high downtime HealthConnect is still experiencing, Fasano is setting his sights on more glittery concepts (sure to tie in with the for-profit KP subsidiary, Aviva Health):

In particular, Fasano said that in the next 12, 24 or 36 months, Kaiser will be coming out with a suite of products allowing doctors to follow patients more closely. Patients in their homes could step on a scale – for instance – and their weight would be automatically uploaded electronically onto their electronic charts for doctor to see.

“Every bit of information that we expect to gather, we expect members to have access to what is appropriate for them,” Fasano said. “And do that in any format that they will like.”

Translation: Well, we might not be able to pull up your medical information in a critical emergency, since the system could very well be down, but whenever HealthConnect is back up, we’ll at least know how much you weighed yesterday! And that’ll be in…12…24…or…maybe 36 months? Something like that, right? Yeah. Sometime. Soon. Then we’ll fix HealthConnect.

Lastly, the article says that Carol Rizzo, who specializes in “establishing offshore business processing operations and IT development,” has (apparently) replaced poor David Watson as chief technology officer. Indeed, Ms. Rizzo, like Mr. Fasano, has a nifty LinkedIn profile. Like Fasano, she also has held a bunch of quick jobs over the past few years, and she also comes from the financial sector.

Is there anybody out there who can actually fix KP-IT, instead of harp on about Internet-enabled toothbrushes weight scales? Or, for that matter, is there a woman or man out there who can fix KP? (We could start with an actually accountable board of directors, and then a honest decent chief executive officer would be great.)

Preferably we’re looking for somebody who knows at least something about healthcare…

Reorganization: musical chairs. Hiring: recruit from LinkedIn. I thought things were bad last November. I had no idea. I just had no idea.

(Full disclosure: I have nothing against LinkedIn or musical chairs.)

This story was originally posted at justendeal.com.

The New York Times is wondering out loud whether the electronic health “cost savings” emperor has an empty wardrobe:

Saving money can be expensive.

Indeed, the quest to save dollars in the nation’s $2.1 trillion annual health care bill is becoming a lucrative market of its own. Thousands of companies, large and small, are pitching cost-saving ideas that range from electronic patient records to new medical devices.

It’s not all marketing hype. Experts in health policy agree that there is a real opportunity to curb health spending, which last year was the equivalent of $7,000 for every man, woman and child in the country. Studies predict a gain of as much as 30 percent in efficiency, mostly through reducing unnecessary tests and prescriptions, paperwork and medical mistakes.

It’s a really interesting article, from a viewpoint that hasn’t been heard much… Is healthcare information technology spending based on realistic expectations? The article cites the case of Dr. Richard Baron, of Philadelphia. His small practice (four physicians total) computerized their health records and processes. While the investment has “not paid off in actual dollars and cents,” it has helped “streamline the workflow.”

One of the key issues I have with HealthConnect is that it was never genuinely approached from any perspective other than being a better revenue-capturing system. Time after time, when I saw internal and external implementation and deployment teams canvass Kaiser Permanente facilities and departments, the general sentiment I heard once they went on their way was that they didn’t listen, didn’t hear, or didn’t care about “how things work” for that particular department.

For an organization that has had such tremendous local autonomy (until very recently), that’s a cardinal sin in the minds of most KP folks.

The need to break away from broken workflows (if there even is a consistent workflow) is pretty apparent across all of healthcare. But simply switching to a formalized (but still) broken process, or transitioning to a “new and improved” (but still broken) workflow doesn’t help anyone (except the well-paid implementation and deployment folks).

In an office of four physicians, there will usually be only very temporary tolerance for ineffective workflows. Things get fixed quickly. Processes are truly improved.

In an organization where one man is (recklessly) driving a project to help him sell books and repair his legacy, you see horrible tragedies like this.

I think, when you promote electronic health records looking solely at (supposed) additional revenue collection, or looking solely at (more realistic) cost efficiencies, you’re taking an easy road, and you ultimately lose sight of the possibilities for reducing preventable medical errors. Helping save lives was never a sincere part of HealthConnect. You don’t have to look far to see that. And that, I’m afraid, is its biggest failure.

This story was originally posted at justendeal.com.