Billions of dollars and millions of lives are serious business, but sometimes I wish, if for a moment, that I could laugh at the nightmare that is HealthConnect. Here’s an attempt (followed by the serious part)…

Oakland, California, December 17, 2007. Kaiser Permanente today sought federal disaster assistance for its HealthConnect electronic medical record project. Declaring a state of emergency covering all eight regions impacted by the project’s deployment, each of the regional Permanente medical directors called on the Department of Health and Human Services for help with the ongoing fallout from the ongoing rollout (casualties which include staff morale, patient waiting times, physician burnout, pharmacy overload, nurse exhaustion, and member dues swindling). Embattled and unshaven chairman George Halvorson, via satellite linkup from a rural village in Africa where he is working on his nineteenth book, continued to defend the years-late and billions-over budget project, claiming the system to be “robust” and the deployment to be “on track.”

That was enjoyable, but there is an actual story hiding behind that parody. Kaiser Permanente did apply for a grant from the Agency for Healthcare Research and Quality, which is part of the Department of Health and Human Services. Yes that would be the agency that has a 2007 budget of about $300 million. Kaiser Permanente, on the other hand, is on track to generate ten times that in profit this year (yes, somewhere around $3 billion in profit).

So KP obviously didn’t need the money. What it does need, however, is to restore a bit of the sheen that has been fleeing from HealthConnect since my email last year. With blistering exposés from the Los Angeles Times and the Wall Street Journal, there’s a lot of incentive to allude to an endorsement from the Federal “Agency for Healthcare Research and Quality.”

Sadly for Kaiser Permanente, there is no such endorsement. In fact, HealthConnect is barely involved in the grant at all. Of course, that certainly didn’t stop Kaiser Permanente from repeatedly mentioning the system in the press release announcing the grant. They even managed to slip in a flattering adjective, calling HealthConnect “robust.” Sadly, all signs point to… No. Nope. Nada.

In fact, I was able to take a closer look at the actual facts behind the grant. The vast majority of the grant is to assemble and analyze the data, most of which has already been collected (the data window is from 2003 to early 2008). Interestingly, the region selected for the study is Hawaii, which, yes, you guessed it, was using the pre-Epic, pre-HealthConnect KP-CIS system for a big chunk of that time. So, while HealthConnect might be the one spitting out (or otherwise ungainly expelling) the data, it’s hardly the heroic “robust” miracle worker George Halvorson is making it out to be.

Think about it. If much of the data being analyzed was collected just as well using a system that cost a fraction of what HealthConnect cost, doesn’t that expose the whole debacle for the naked (and damned expensive) emperor it really is?

Sorry, Mr. Halvorson. Just because you were able to convince a federal bureaucracy to hand over $600,000 isn’t all that impressive, and it says nothing about the quality or integrity of system itself. Now, if you’ll excuse me, I need to go write my senators and congresswoman about government waste…

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.

The much bigger story today is that George Halvorson is once again proving that he has destroyed accountability at Kaiser Permanente: instead of paying a $25,000 fine for an egregious medication error that led to the death of a baby, he’s ignoring the fine. Read the story over at Kaiser Thrive. I’ll have more on medication errors and HealthConnect shortly, though.

A source inside IBM confirmed to me that a comment on this morning’s HIStalk is accurate: Kaiser Permanente is moving rapidly towards outsourcing a significant portion of its information technology operations. I haven’t had a chance to really sit down and think through all the implications of the (fairly monumental) shift in strategy, but here are a few first thoughts:

• IBM is obviously back in KP’s good graces. KP and IBM had a very close partnership on KP-CIS. But, after George Halvorson nixed the KP-CIS project in 2002, IBM and KP largely went their separate ways. Aside from legacy Big Iron, Tivoli, and Lotus Notes, KP went from being a huge IBM account to a pretty insignificant one. IBM Services, especially, was pretty much persona non grata in Oakland (and Pleasanton).
• Something like a quarter of IBM’s services workforce is in India. Which means lower costs for IBM and its clients. Lowering costs to help delay a financial meltdown at KP has been a critical mandate for the new leadership at KP-IT. A key component of Phil Fasano’s “plan” has been to outsource to lower costs, and an obvious opportunity to offshore work seems even more financially advantageous, if questionable for a non-profit.
• It’s no secret inside KP that the regions outside California are being undermined by the ridiculous amount of financial waste at KP-IT. (Remember Cynthia Finter?) In the near term, the arrangement with IBM could finally return the regions outside California to a reasonable level of operating financial health.
• Carol Rizzo, in particular, is playing a central role in the IBM relationship. You saw that one coming, right? I’m not clear yet on exactly what Diane Comer’s responsibilities have become, but I imagine she might have something to do with the (re)new(ed) IBM relationship. You saw that one coming, too, right?
• George Halvorson may not have been fond of KP-CIS, but it was nothing if not scalable. That was IBM’s big contribution. Going off with a vendor whose largest integrated install was less than a tenth of KP’s size might have been novel and good publicity for a while, but now IBM has to come in and clean up the mess.
• I don’t doubt their abilities, but IBM knows as well as anyone that KP’s a very bizarre client. For example, insisting on a single data centre for almost all its userbase was a very foolish move on KP’s part, and we knew better. I wonder if IBM might have guaranteed itself broad latitude to make decisions on KP’s behalf, perhaps with even some limited power to overrule the occasional KP ridiculousness?
• No matter the benefits for KP and IBM, this is most significantly a win for Epic. (Yes, I meant to write that.) HealthConnect’s failures aren’t as much the doing of Epic as they were the doing of poor planning and implementation on the part of KP. (Dr. Wiesenthal and Dr. Liang, still want to take credit for that?) IBM can get uptime up to par and help restore a bit of luster to HealthConnect, and a bit of glean to Epic. Plus, it can’t hurt Epic to have the likes of IBM familiarizing itself intimately with their products. Is that a clearing in the clouds over Madison, I see?

Lastly, the murmurs of a first round of layoffs in Pleasanton, at KP-IT headquarters, are not primarily the result of the growing IBM relationship. As HIStalk noted, these were cost cutting measures by sheer job elimination, not cost savings measures by outsourcing (or offshoring). Moving forward, though, I think a big question is whether a primarily California non-profit ought to be shipping hundreds (and eventually thousands) of jobs overseas. (I say no, but KP has been spending millions on offshoring for years, anyway, and nobody’s spoken up yet…)

Stay tuned.

This story was originally posted at justendeal.com.

Nary a mention of it’s been made in the California media, but Francis J. Crosson (you can call him Jay) is resigning as head of The Permanente Federation, effective September 30. Jack Cochran, a plastic surgeon who currently heads up the Permanente Medical Group in Colorado, will be “elevated to [the] national role” of executive director of the Federation.

I’m not sure if “elevated” is the right word. Dr. Crosson has seen the Federation become increasingly irrelevant since he started as its founding executive director about a decade or so ago. While Kaiser Permanente’s initial electronic health record was truly spearheaded by Dr. Crosson and the Federation, since George Halvorson took over KP, both the Federation and the (now barely existent) “Kaiser Permanente Partnership Group” have barely any power left.

Perhaps the Federation is best known for its funneling of Kaiser Foundation Health Plan’s not-for-profit dollars into its nice little investment firm, KP Ventures?

I still remember, back in November, Dr. Crosson’s frantic emails to Dr. Weisz about the HealthConnect problems finally making the news. I suppose we all want to have a decent legacy, by the time it’s all said and done. How horrific it must be to Jay Crosson that HealthConnect will probably be his.

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.

With governance at Kaiser Permanente in shambles, it is sad but not surprising to hear that the respected musical chair method of reorganization is now in full swing at KP-IT, under Phil Fasano. The new orgchart has been drawn up and distributed. The only trouble? Well, there aren’t any names. Simple math says there are now fewer positions than there were a few days ago, but nobody knows who’s out just yet.

The details of the brilliant reorganization plan don’t end there. Every year or so, KP hires an outside firm to gather opinions about KP-IT from a sampling of top executives from across the organization. Needless to say, last year’s results painted a bleak picture for KP-IT. In particular, concerns have reached the boiling point with regard to the amount of money being wasted by KP-IT: it’s killing the regions outside California. The solution? Put a new middleman between head CIO Fasano and the itty-bitty CIOs in each of the other regions. I’d hate to be that middleman. (His name is Garry Hurlbut. Pray for him, won’t you?) Just so you’re following me… Dodd: centralize everything! (Pendulum swinging…) Fasano: regionalize everything! (Sad inside joke: somewhere, off in the distance, I hear a Boeing crashing.)

Needless to say, all stop at KP-IT is about how things are going right now. Uptime has held fairly steady these past few months (after doubling every few months last year), but the amount of lost productivity by physicians, nurses, and pharmacists as the result of unavailable and malfunctioning systems is still an enormous (and growing) drain on Kaiser Permanente.

The cash spigot is being tightened to KP-IT, as the organization as a whole is beginning to feel the painful results of poor financial (mis)management. Fasano is bracing KP-IT for job cuts, but so far is coy about whether there will be net losses of positions.

It’s sad to see the wheels coming off the wagon. You know this organization can do better, you know these people, if given the right resources, can do more (well, except one or two of them).

I gave up, long ago, thinking the Kaiser Foundation Health Plan Board of Directors would do something about all of this. (There’s a reason, after all, that Halvorson felt such a strong need to defend his “rubber stamp” board, a term he chose himself, and an accusation I had never made.) But, when Halvorson is finally forced out, the pieces will not be easy to put back together. What a mess. What an unnecessary mess.

This story was originally posted at justendeal.com.

Kaiser Permanente reported its first quarter financial results late Friday. You’d be hard-pressed to find any actual coverage of the results, but if any newspaper cared enough to cover the financial health of the largest not-for-profit healthcare provider in the country, it would go something like…

Kaiser Foundation Health Plan and Hospitals, the largest not-for-profit healthcare provider in the country, on Friday reported first quarter financial results that showed revenue surging 9% to $9.4 billion from $8.6 billion one year ago, as membership growth plummeted over 60%. Profit, on a net income basis, came in at $698 million, compared to $448 million in the year-ago quarter, largely the result of the organization cutting $130 million from spending on medical equipment, hospitals and facilities, and other capital investments. HealthConnect, the controversial computer project to try to digitize patient records being pushed by Kaiser’s CEO, continued to consume a large portion of the healthcare provider’s resources, as critics say the unreliable project is both a threat to patient safety and a drain on the organization’s resources.

Perhaps unsurprisingly, the organization chose not to publicly report, at all, operating income or operating margin. My post last week pointed out that Kaiser Permanente’s growing reluctance to report results on an operating basis make discerning the organization’s true financial health difficult.

I suppose that’s the point.

This story was originally posted at justendeal.com.

If Kaiser Permanente was a for-profit, publicly traded company, it would come in at number 63, by revenue, on the 2007 Fortune 500 listing, just ahead of The Walt Disney Company.

In fact, as a not-for-profit organization, Kaiser Foundation Health Plan and Kaiser Foundation Hospitals raked in considerably more profit (on a net income basis) last year than Best Buy, Safeway, Medco, Costco, Kroger (which also owns Ralphs), Cardinal Health, and McKesson. Continuing the list, it made about as much as CVS/Caremark and Sprint Nextel, but just slightly less than Sears Holdings (which also owns Kmart).

If the concept of a not-for-profit making that much money worries you, the tale only gets worse for Kaiser Permanente members. Those sumptuous profits are coming at the expense of the future stability of the largest health insurer in California.

Kaiser Permanente is approaching its perfect storm, the coalescence of an expected deterioration in the rolls of traditional members, a rapid escalation in spending to try to repair the unreliable (and already enormously costly) HealthConnect project, and, at long last, the inability to raise member dues further (since payers simply can’t afford higher rates anymore).

When I learned, last year, that Kaiser Permanente could face losses of billions of dollars through 2009, I was shocked. (Kaiser Permanente later called those projections a “worst case scenario.”) Our organization had grown revenue and income by leaps and bounds for years: could that growth finally come to an end?

Right up to fiscal year 2007, those projections show that all financial signs should be pointing to healthy. By and large, they are. But the warning bells are sounding.

Under George Halvorson, Kaiser Permanente’s financial “transparency” has become murky, at best. Looking at the provided figures for 2006, you would probably notice that net income increased a whopping 30 percent last year. You’d even be pleased (or not) to know that our operating margin increased from 2.6 to 2.8 percent. But, in real numbers, that means our operating income likely only increased around 19 percent, far less than our reported net income increase of 30 percent.

While net income provides an important metric, it doesn’t provide a true picture of our organization’s health, and is more susceptible to one-time adjustments and transactions that could mask true financial changes or problems.

If Kaiser Permanente can’t report upfront, honest financial numbers to the public, you have to wonder why. Perhaps fortunately for Kaiser Permanente, there really isn’t any governmental entity that pays much attention to the truth in financial reporting of not-for-profits. That oversight (or, ironically, that lack of oversight) is quite unfortunate for the organization itself, and especially for our members.

Here’s an interesting snippet from Erik Sherman’s blog.

Ironically, Mr. Deal first sent his complaints to Kaiser’s compliance officer and to the board of directors:

Kaiser’s assistant general counsel sent Mr. Deal a letter saying that “a thorough investigation” found no evidence of misconduct by the executives, nor of a “disastrous failure” of the HealthConnect project.

And yet there was this internal report. In either case it’s clear that the board has some problems. Either it knew of the system issues and ignored them – which would seem like criminal negligence if patient health was affected – or it was incapable of unearthing this report. In either case, this would seem a clear issue of board dysfunction.

This story was originally posted at justendeal.com.

Today, the Charleston Gazette is printing, on their front page, a story based on an interview I did with Tara Tuckwiller, along with a reprint of Rhonda Rundle’s Wall Street Journal article. From the Gazette article:

In a telephone interview with the Gazette Wednesday from his home in Los Angeles, Deal said he still thinks Kaiser Permanente is a good organization.

“For me, there were these problems that were threatening patient safety and the financial stability of the organization,” he said.

“It was not within me to just ignore that or be quiet about it.”

Ignore the Problems

The Kaiser Permanente Responds page has no actual response to the Wall Street Journal article, and, unfortunately, our Board of Directors has not yet addressed the Minnesota Attorney General report, the Dodd SEC filings, or the other inaccuracies in George Halvorson’s initial response. In fact, our Board has never commented whatsoever on any of these serious issues.

As if the continued complete lack of responsibility by our Board wasn’t enough, the organization now has officially adopted Mr. Halvorson’s “just give me more time to hide the problems” mantra:

“The value and merit of the various KP systems and strategies will be validated by time and actual performance.”

Halvorson’s original plea:

“[We] will prove the point beyond debate of whether or not [HealthConnect] can handle our total volume. I am confident that those results will be entirely satisfactory. All signs are that the careful work we did to guarantee scalability of the system have succeeded.”

That’s not what the 722-page document obtained the Los Angeles Time said.

Finally, the “official response” continues the attempt to say that the few features of KP Online are an integral part of HealthConnect and indicative of the total project’s “success.” KP Online is not KP HealthConnect. Requesting an appointment online is convenient. Your physician having access to accurate, reliable medical records can be critical. The system’s reliability has not drastically improved since November, and instead of talking honestly about that fact, Mr. Halvorson ordered that the downtime figures stop being published internally.

The project and the system can be pushed along, but that doesn’t mean it’s truly functioning, and that certainly doesn’t mean it’s ever going to be a success. Instead, we’re throwing more money at what will ultimately be another multi-billion dollar write-off — to shield, as long as possible, the comfortable position of George Halvorson and the reputation of our absent Board members.

Many Discussions

Meanwhile, around the web, folks are talking. I’ll try to list here some of the comments forwarded on to me.

From Rick Nelson, at Taking the Measure:

“Interestingly, Deal’s mass mailing wasn’t a rash, spur of the moment action. His message is a carefully edited 2000-word indictment alleging conflict of interest among Kaiser Permanente officials and outside organizations as well as mismanagement of the document-conversion program.”

You can see my original message here.

From the Wall Street Journal Health Blog:

“Mr. Deal’s email has the ring of truth. Mr. Halvorson’s email has the ring of arrogant corporate vengeance.”

You can read Mr. Halvorson’s response here.

From a lively discussion at MetaFilter:

“I want to say that I was struck at the quality of this man’s email; it does a better job of representing the issue than I’ve come to expect from investigative journalists these days. He may not have a future in IT any more (debatable), but he would make a fine reporter.”

Professor Bailey and Professor Hollis would be proud.

“By definition, a nonprofit has been deemed to be an organization serving a public good. In exchange for this public service, their obligation to pay income tax gets waived. Every nonprofit organization is a taxpayer-subsidized organization. As a nonprofit they also become eligible for public subsidies in the form of grants. A nonprofit’s profligate waste better be a matter of public interest. We’re all its stock holders. [...] If you think a massive nonprofit’s screwups or corruption are none of your business, go right on ignoring it. It’s your investment to flush away if you want. The rest of us stakeholders will be over there, giving a damn.”

Exactly. I hope you will join me in telling our Board of Directors that you care about the future of Kaiser Permanente.

This story was originally posted at justendeal.com.

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