blog.fixkp.org

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.