Employee stirs controversy over EMR project at Kaiser

A widely distributed e-mail questions whether HeathConnect will work, but the large health system says implementation is on track.

By Tyler Chin — Posted Dec. 4, 2006

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An employee of the Kaiser Foundation Health Plans and Hospitals distributed a mass e-mail to all the organization's employees Nov. 3, saying the organization's implementation of a $3 billion electronic medical records is going very wrong.

So wrong, that the employee, Justen Deal, writing on his personal blog (link), likened himself to whistle-blowers at famously scandal-plagued companies such as Enron and WorldCom.

On Nov. 13, Computerworld reported it had obtained a 722-page report that detailed hundreds of technical problems with the HealthConnect system, which is up and running in a few Kaiser facilities. The report appeared to support some of the claims Deal made in his e-mail.

But Kaiser said its EMR implementation, the largest any system has ever attempted, is not in trouble.

"We're taking on a project that no one else in this country has ever attempted and you're going to run into challenges as you go along the way," said Kaiser spokesman Matthew Schiffgens.

The implementation -- involving eight regions across the country, more than 12,000 physicians and 8.6 million health plan members -- has experienced problems but remains on track, Schiffgens said. Kaiser expects to complete its rollout of the EMR to the outpatient side in 2008 and the inpatient side in 2009.

Still, the controversy has some observers wondering if Kaiser's EMR implementation will be successful.

"I wouldn't say they are in trouble, but I think the unique environment of a staff-model HMO combined with the size requirements cause concern," said John Osberg, president of Informed Partners LLC, a Marietta, Ga., health care technology consulting firm.

Part of Kaiser's concern is not only implementing the system, whose technology is from Epic Systems, but beating back bad publicity generated by Deal's e-mail.

In his e-mail, Deal, a 25-year-old Kaiser Permanente employee in Los Angeles, claimed that Kaiser's system was not working well and would not be able to reach the goal of being operable systemwide. He wrote that Kaiser was going to lose $7 billion over the next two years, with $3 billion of that -- $1.5 billion each in 2007 and 2008 -- directly as a result of the EMR project.

As for the project itself, Deal wrote that system outages increased from about 9,000 user hours in June to more than 59,000 user hours in October. A user hour is defined as one user active for one hour; since there are multiple users of the system, this does not reflect the actual clock time the system was down.

Deal did not respond to AMNews' attempts to reach him for comment. However, in a Nov. 13 exchange with the health information technology blog HIStalk (link), he said he was motivated to send the e-mail because he likes working for Kaiser and didn't want to see it get wrapped up in a project that would not succeed. (See correction)

Schiffgens identified Deal as a publication projects supervisor who has no involvement with information systems or the EMR project. The company said he has access to documents about the HealthConnect project through the company's intranet system, but that he, and outside sources, are misinterpreting them.

For example, the $7 billion figure is accurate, but is from an old financial-planning document that assumed the worst-case scenario if Kaiser did not do anything to address its cost structure, Schiffgens said. As for Deal's claim that Kaiser will lose $1.5 billion on the project each of the next two years, that is the amount Kaiser has budgeted to support its entire information technology infrastructure, he said.

Also, the company said system down time was caused by internal power outages, or software configuration issues in old data centers.

"Overall, the e-mail was an unfortunate combination of partial facts, old data, incomplete data, conspiracy thinking and naiveté," wrote George Halvorson, CEO of Oakland, Calif.-based Kaiser Permanente, in an e-mail to employees.

He wrote that the system availability rate -- the amount of time HealthConnect is working -- is at 99.5%, up from 98% last year.

The HMO has placed Deal on paid administrative leave, pending an investigation into whether he violated its e-mail policy.

Four days after Deal's e-mail, Clifford Dodd resigned, without giving a reason, as senior vice president and chief information officer of Kaiser Permanente. Dodd's resignation compounded the project's image problem.

But Dodd was not involved in the implementation of the EMR, said Andrew Wiesenthal, MD, a pediatric infectious disease specialist and associate director at The Permanente Federation, which is composed of the Kaiser physician groups. Dr. Wiesenthal said he and Louise Liang, MD, senior vice president of quality and clinical systems support at Kaiser Foundation Health Plans, have overseen the implementation of the EMR since its inception in 2003.

"This is not an information technology project," Dr. Wiesenthal said. "This is a clinical operational and business operational project. This is stuff for the people who do the work."

Any EMR implementation is bound to raise challenges, perhaps even more so at Kaiser because "it's a tremendously complex organization," said Michael Mytych, principal of Health Information Consulting in Menomonee Falls, Wis.

Regardless of the ultimate outcome at Kaiser, Mytych doesn't expect to see any impact on physician or hospital adoption of EMRs.

"There are too many successful sites out that we can look and point to that the systems do work. Is it easy to do? No," Mytych said. "I think each organization and how they approach their physicians, how they educate them, how they train them, how they support them, that's where the rubber meets the road and that's where the differences are."

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Editor's note: This story incorrectly identifies Justen Deal as an employee of Kaiser Foundation Health Plan and Hospitals. Deal is employed by Southern California Permanente Medical Group, a physician group that has a contract to provide care to members of Kaiser Foundation Health Plans in Southern California. The article also refers to "attempts" to reach Deal for comment. AMNews tried to reach Deal once. American Medical News regrets the error.

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