Healthcare Giant Faces IT Nightmare 342
Joan writes "Kaiser Permanente, the largest HMO in the U.S., has spent about $4 billion on an unreliable electronic medical record system that is impacting patient care, according to a 722-page internal report revealed by Computerworld. The CIO resigned after the news came out, and CEO George Halvorson is telling the media that the goal is an alarmingly low 99.5% uptime and that all the problems are really just power outages. Yesterday, Slashdot covered a story about the possibility that the NHS in the UK could now claim the 'biggest IT disaster' prize, but Americans, fear not: so far, the Brits are running a much more efficient failure at $24,000 per physician per year, while America's KP is spending $76,920 per physician, per year on its failing project."
News came out (Score:4, Informative)
See here [fixkp.org] for details.
Re:Woo-Hoo! (Score:3, Informative)
And in the case of the severe, traumatic injury, chances are the medical insurance will still only cover a fraction of that, and you'll end up declaring bankruptcy if you can't pay for it.
Aren't most bankruptcies in the US caused by medical expenses, and involving people who do have insurance, no less?
Re:well this obviously can't be right (Score:3, Informative)
Funny thing. (Score:5, Informative)
Re:Why the hell do they use Citrix? (Score:2, Informative)
Deployment: Hospitals, Physician Offices, etc., often have diverse locations and diverse applications needed to run on all of their systems: you wouldn't put a radiology system on a Patient Care floor (you'd want to see the results, not the actual application). Using Citrix, a hospital can buy some beefy hardware for their servers and run cheaper hardware in these offices.
Lack of IT staff: Many hospitals either have a small amount of IT staff, or they grew from that type of an environment. This smaller staff can easily manage an upgrade when upgrading a dozen or more servers in a few locations, as opposed to thousands of computers in a large amount of places. And since hospitals are always working, they don't always have the luxury of upgrading in a few hours of downtime, even if they want to hire temp workers to install applications locally. (Sure, there are other ways around this, but my experience is that they refuse to use it.
Case in point: One hospital I used to work for had a home-grown VB5 application (and still used it as of 2004, last time I was there) for all deployment on Windows NT workstations. They would use a SysDiff on a workstation before an install and after an install and see what changes needed to happen. As a result, they had to maintain a monstrous amount of permutations of registry settings, hardware configurations, etc. because not every workstation should have the same thing installed --and-- physicians would need their settings carried over if they signed into a new terminal, regardless of where they signed in. Citrix would have saved these people tons of headaches, man hours, etc.
Re:Bad Math?! where does 77k/(year*doctor) come fr (Score:3, Informative)
When fully implemented, it is supposed to give more than 100,000 of Kaiser's physicians and employees instant access to the medical records...
That 100,000 includes Kaiser employees, so the actual number of physicians should be much lower.
Re:Why the hell do they use Citrix? (Score:1, Informative)
I work in healthcare IT supporting the exact application KP is having problems with. While I won't get in to our own issues with it, DelawareBoy has nicely illustrated the main reasons we use Citrix with Epic.
Epic has very frequent patches and modifications, in addition to all the customized programming requests we put in. Many of them require either server downtime, or client updates. And because many of the patches address patient safety issues, we don't have the luxury of doing them on a quarterly or extended schedule.
Given the absolute need for as close to 100% uptime as possible, we don't have the staffing to touch or troubleshoot 2000+ client installs during a one hour downtime. And we cannot run different client versions at the same time, even for a short time. Ugly things happen. Citrix, despite it's many faults, makes it possible to upgrade every client in a very short time frame. Patient care is affected minimally. At least when it works.
Not using Citrix would certainly have many benefits. But it would make the frequent updates needed by Epic almost impossible to manage with our small staff.
Re:Probably not. (Score:5, Informative)
HIPAA may be the answer (Score:5, Informative)
The HIPAA Security regulations are good regs, as such things go. But one of their demands is that you know exactly which machines have Electronic Personally-identifiable Health Information (ePHI) on them. Any such data must be protected, backed up, and audited. Further, each machine containing ePHI is subject to the organization's media disposal policy.
Now, ideally an EMR system should not leave tracks on the client machine even with its fat client. But if the EMR's fat client does leave data on the client machine, then meeting HIPAA Security requirements would be one heck of a lot easier to accomplish if all you have is thin clients. I have no idea if the EPIC client does leave data on the client computers, but if it did there would be reason to be very interested in using Citrix to keep all ePHI off of all periphrial machines.
Re:Probably not. (Score:3, Informative)
(from the link)"We also used the questionnaire to estimate how frequently illness and medical bills contributed to bankruptcy. We developed two summary measures of medical bankruptcy. Under the rubric "Major Medical Bankruptcy" we included debtors who either (1) cited illness or injury as a specific reason for bankruptcy, or (2) reported uncovered medical bills exceeding $1,000 in the past years, or (3) lost at least two weeks of work-related income because of illness/injury, or (4) mortgaged a home to pay medical bills. Our more inclusive category, "Any Medical Bankruptcy," included debtors who cited any of the above, or addiction, or uncontrolled gambling, or birth, or the death of a family member.16"
In other words, their analysis included lost income from illness (not covered under medical insurance), self reporting, and addiction or gambling. So the study didn't show that "medical bills" per se waere the cause, only that there were "medical" factors involved.
Re:well this obviously can't be right (Score:3, Informative)
Ah, but that is your opinion, and something you believe, not something you can have any proof of since such a thing never existed.
2. The more capitalist a nation is, the more prosperous it is (you don't need to have a completely capitalist nation to see it's effects).
Well yes, most countries in northern Europe, and especially Scandinavia are doing quite badly indeed.. I bet this is due to the socialist nature of their governments also.
Not to mention that capitalism is not the same as 'free market', and I'm pretty sure that Europe has seen some extremely capitalist governments that brought their citizens an extreme amount of missery.
Re:Probably not. (Score:5, Informative)
I have a dependant, who became afflicted with a rare conditon about a year ago, and we ran up 207,000 (and counting) of medical bills this year. Tomorrow is their last day of therapy... at which point 'we hope' we're done. Therapy costs $2000 a day.
The day they were discharged from the hospital for the inpatient, my employer also saw fit to lay me off, with 11 weeks of severence, and, of course, no extension of company paid benefits beyond the end of the termination month. COBRA cost me 1000/month for what was in the industry know as 'high deductible health care' [basically it's medicare part d for healthcare.. with a huge 'donut hole']. My plan has a 10,000 out of pocket max, and then the insurance pays 100%
Couple this with the getting the 'best doctors' to deal with this meant going out of network... when you go out of network, you see "oh, I'm only going to pay $10,000, as that is my Out of Pocket Max" Err, no.. see health insurance companies have this 'usual and customary' valuation of procedures, saying that if doctor charges $4500 for a MRI, and Medicare only reimburses that at $2000, well, the insurnance will only pay 100% of the '$2000', leaving the 'insured' paying the $2500 that is 'not covered'. You'll be surprised that an insurance company will pay $100 to an innetwork physician, for an office visit, but only pay $35 for an out of network physician, because medicare has deemed that 'usual and customary.'
So the bill yesterday said, after insurance paid "their share" of all claims that I still owe 97,000 (remember that 10,000 'out of pocket Max'. This after the privilege of paying $9000 this year for insurance coverage.
Note We have depleted 20,000 for living expenses while I was looking for a new job, and now that I have a job we have dedicated 500 a month to pay off the debt, and I am spending 2 hours a day appealing most of the 'usual and customary' valuations, which I will probably whittle off about 50K (I have no problem paying the difference between the common 'negotiated' rate with in network providers and Mayo's bill, but Medicare just doesn't cut it).
This is not a sob story, I'm actually been in the health industry most of my adult life... but If I were 20 years younger, and all this happened, I'm certain I'd be bankrupt.