Bert Verhees wrote:
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This is how computer world put it:
Problems abound for Kaiser e-health records management system
Linda Rosencrance
November 13, 2006 (Computerworld) An electronic health records
management system being rolled out by Kaiser Foundation Health
Plan/Hospitals has been nothing short of an IT project gone awry,
according to sources at the company and an internal report detailing
problems with the HealthConnect system.
Questions about the project arose last week at about the same time Cliff
Dodd, the company's CIO, resigned. Dodd stepped down last Monday after
another Kaiser employee, Justen Deal, sent a memo to every company
worker warning of technological and financial repercussions related to
the rollout of the nearly $4 billion system from Epic Systems Corp.
Deal said he also sent letters to Kaiser management expressing his
concerns. But in internal memos, officials said they investigated those
concerns and denied that the implementation of the HealthConnect system
has been a failure.
"In the implementation of a new, large and complex system such as KP
HealthConnect, various technical problems are likely to arise, but none
that you mention are unknown to KP-IT nor were as insurmountable as you
imply," Mark Zemelman, one of Kaiser's attorneys, said in a letter to Deal.
Kaiser declined to offer specifics about Dodd's resignation and whether
questions about the project played a role in his departure. Deal, a
publication project supervisor in the Health Education and Training
Department at Kaiser Permanente's Los Angeles facility, was placed on
paid administrative leave after sending the memo. Deal is not an IT
employee, according to Kaiser.
A 722-page internal report obtained by Computerworld details hundreds of
technical problems with the system -- some affecting patient care --
that appear to bear out the concerns of Deal and others in the
organization that the system is a failure. The report also contains
suggestions on how to fix the problems.
In his memo to employees, Deal pointed to reliability and scalability
issues Kaiser faces with its HealthConnect system.
When fully implemented, it is supposed to give more than 100,000 of
Kaiser's physicians and employees instant access to the medical records
of some 8.6 million patients, along with e-messaging capability,
computerized order entry and electronic prescribing. In addition, the
system is supposed to integrate appointment scheduling, registration and
billing functions and will offer various features to Kaiser members
through KP.org.
But according to the report, that doesn't seem to be happening with any
degree of regularity.
For example, a power outage on May 9 at Kaiser's data center in Corona,
Calif., lasted for 55 hours and 7 minutes and affected the ability of
numerous health care facilities to access the HealthConnect system.
"This outage affected every Kaiser Permanente Region. ...
Providers/clinicians across KP would not have access to medical
information to treat members, process lab and pharmacy requests, and in
some cases were in full down-time modes compromising direct member
treatment, with the inability to access current medical information for
decision making," according to the report.
Deal and an IT employee, who spoke to Computerworld on the condition of
anonymity, said part of the problem with the HealthConnect system is
that the Citrix Application Delivery infrastructure implemented by
Kasier just can't handle the load of the Epic Systems.
"We're the largest Citrix deployment in the world," Deal said. "We're
using it in a way that's quite different from the way most organizations
are using it. A lot of users use it to allow remote users to connect to
the network. But we actually use it from inside the network. For every
user who connects to HealthConnect, they connect via Citrix, and we're
running into monumental problems in scaling the Citrix servers."
"Epic simply cannot scale to meet the size and needs of Kaiser
Permanente," Deal said. "And we're wasting billions of dollars trying to
make it. The big issues for me are the financial repercussions of trying
to launch such an ineffective and inefficient and unreliable system
across the organization."
According to Deal, Kaiser is wasting more than $1.5 billion a year,
primarily on HealthConnect as well as on other inefficient and
ineffective IT projects. Kaiser declined to provide financial details of
the HealthConnect system, which it has been working on since 2003.
Kaiser expects the outpatient portion of the project to be fully
implemented in 2008, with the in-patient portion done in 2009.
Another issue is with the Epic software and its adaptability, according
to Deal and the IT employee. They said the software was written in MUMPS
(Massachusetts General Hospital Utility Multi-Programming System) -- a
health care programming language originally developed in the 1960s.
"Basically, the problems really do follow the entire scope of the
platform in that we have these issues with the adaptability of Epic and
we have these issues with the information security of Epic -- so we
implemented Citrix to try and protect that, and we're facing the
scalability issues with that," Deal said. "Using Citrix is something
that defies common sense. It would be like trying to use a dial up modem
for thousands of users. It's just not going to work, and it's not
something anyone would tell you a dial-up modem should work for.
"I don't think that Citrix really appreciates what we're trying to do
with their software," Deal said. "I don't think ... we have any
[service-level agreement] from them because they would not guarantee
that this was going to work at all for this implementation."
"From what I've read, Epic [is] not very scalable and not very robust,
and when you're putting Citrix in front of that -- we have most the most
number of Citrix servers in the world -- you're going to have problems,"
said the IT employee.
Epic officials referred questions about the project to Kaiser.
Scott Herren, group vice president and general manager at Citrix Systems
Inc.'s Virtualization System Group said the issue isn't scalability,
it's really about the overall system architecture being set up to
accommodate loads of that size. Kaiser is using Citrix's Presentation
Server.
He said these issues do not stem from the Citrix product. "In fact, we
have many very large successful Epic deployments around the world.
However, in order to support large deployments, the Citrix
implementation must be architected accordingly," Herren said.
"Kaiser has expanded its user base very quickly over the last year, and
as such, Citrix is working with them, as well as other IT vendors, to
make sure that their IT infrastructure is 100% ready for that
expansion," he said. "Kaiser's IT infrastructure is robust with many
applications, server farms and data centers running 24/7. As it is
complex, we are confident in working with them to address any pain
points so that their needs are being met and that they can consistently
meet their customer and business demands."
The problems detailed in the Kaiser report include:
* On March 26, for 3 hours and 51 minutes, users in multiple
locations were "intermittently unable to access [HealthConnect] --
receiving Citrix error message and therefore unable to access any
patient info or update patient info in a timely manner," said the report.
* On April 10, for 1 hour and 23 minutes, users in the Baldwin Park
Medical Office were unable to place new orders for in-patients. "Drug
Database information is not populating for pharmacist and technicians,"
the report said. "New orders will have to be manually done. In the
manual process, the nurses cannot see patient updates for new orders for
new medications or changes in meds, such as stopping orders. The manual
process will create significant delays in patient care."
* On May 10, a power outage that lasted for 37 hours and 9 minutes
affected multiple facilities. "Pharmacists must handle medication orders
on these patients manually because one cannot enter medication orders
into the system on patients that have not been admitted," the report
said. "Also, if a patient were transferred during this time, they would
need to track their location manually. In addition, the [users] are
reporting that multiple patients are showing in the wrong beds. Patient
Care Impact: The [users] reported that the potential for patients to not
get the treatments they need and the possibility of patients receiving
the incorrect medications."
* On May 23, for 1 hour and 57 minutes users in the Glendale
Medical Office could not dispense medication because the billing
application was down.
* On June 7, for 6 hours and 34 minutes, labs were unable to
collect data, run tests and provide test results.
* On Sept. 15, for 48 minutes, users in multiple locations were
unable to check patients in for their appointments. "As a result," the
report said, "this causes delays at the front desk for the members to be
checked in and seen by their providers. In addition, the departments are
not made aware that the member has arrived for their appointment, which
can cause delays in the workflow of the department."
* On Sept. 28, for 2 hours and 35 minutes, users in one facility
were unable to release lab orders through HealthConnect. "This issue is
a hindrance to the diagnosis," said the report.
* On Oct. 10, for 3 hours and 24 minutes, doctors and nurses in
several facilities were unable to retrieve critical medical information
to treat patients.
* On Oct. 11, for 1 hour and 47 minutes, multiple users in one
facility were unable to access the network.
"The dedication of this organization is to quality outputs and system
availability," said Henry Neidermeier, vice president and quality leader
for KP-IT. "The complexity of the challenge here, with the links in the
availability chain, is significant."
Kaiser spokesman Matthew Schiffgens said any issues that have come up
should not be surprising, given the complexity of the project. He
acknowledged that a report had been compiled to track problems.
"As you move out with a very large deployment like this, you encounter
challenges along the way, and we have a process to systematically
identify and address challenges as they arise," Schiffgens said. "The
problem at the Corona data center was a good one. It came up, we
addressed it, and we feel confident that we made the proper
infrastructure to manage that. That is the fundamental practice of
running a good business. Does that mean there are systematic and ongoing
problems? No. You identify issues and address them as they go along.
You're seeing a robust process in terms of those reports."
Neidermeier said Kaiser is focused on managing the problems detailed in
the report and working to make sure it has backup procedures in place so
that patient care isn't compromised.
But Kaiser workers are still concerned, according to the IT employee.
"People out in the field are frustrated, and the people in IT are just
as frustrated because this was a solution forced upon us and was not an
IT solution," said the IT employee. "I know in conversations I've had
with my superiors there was a big push back in selecting Epic, and it
was not a choice made by IT simply because of the large infrastructure
needed to support it."
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