California looks into Kaiser's EMR troubles

A California regulator is investigating purported problems with the installation of Kaiser Permanente's $4 billion electronic medical record system. But a leader of the HealthConnect project says progress is "spectacular."

Kaiser Permanente has been publicly vouching for its EMR ever since last fall, when a mass e-mail sent by a Southern California Permanente Medical Group employee claimed tests showed the system suffered frequent outages, claims backed up by an internal Kaiser document leaked to the media.

Also, the reported cost of the project has kept going up -- from an initial estimate of $1.8 billion in 2003, to an approved budget of $3.2 billion later that year, to a current estimate of $4 billion. In 2002, Kaiser had to write off a $442 million investment in an EMR system when it found the system could not accommodate the staff-model HMO's size.

With public reports showing the system available only 80% of the time -- a rate experts say makes it inoperable -- the California Dept. of Managed Care decided it wanted to look into the EMR's implementation.

There was concern that Kaiser "put a high premium on this electronic medical record system being its primary source for the exchange of information," department spokeswoman Lynne Randolph said.

In January, the department requested information as to how Kaiser handled the outages, what its back-up procedures are, and how it can ensure public safety in the event of future outages.

"It [the inquiry] could lead to a broader investigation, but at this point we don't have evidence that it will," Randolph said. "We were satisfied with their response, but we're still looking into it."

Despite the inquiry and the reports of troubles, Kaiser is confident in HealthConnect.

As evidence of how "spectacular" things are going, said Andrew M. Wiesenthal, MD, associate executive director for clinical information support for the Permanente Federation, the network's medical group division, Kaiser recently announced plans for large-scale research that wouldn't be possible without a functioning EMR system.

The $7 million project would look at the cause of common diseases, exploring genetics, environmental and lifestyle factors, and relying on information cross-referenced in patient databases. Dr. Wiesenthal said he's confident the organization, and the system, is ready. He acknowledges the 80% availability rate that has been reported. But he said the organization gauges availability differently than most in the technology field.

Dr. Wiesenthal said Kaiser only reports availability when the system is 100% operative, so even something as minor as a printer malfunction would be one less available user hour reported. He said for the past several months availability statistics have been in excess of 99%, since problems with a supplemental software system, which helps the data center communicate with the system's work stations, was fixed last fall.