Call it HealthConnect, Take Two. Only this time, replace Kaiser Permanente with Sutter Health.
Tim, over at HIStalk, was the first to pick up a story by Chris Rauber covering Sutter’s Epic Systems implementation. The guy in charge over at Sutter, Jerry Padavano, wants to be clear: “I’ve learned from Kaiser’s missteps, and we’re all learning from one another.”
Indeed. They learned a lot. Sutter’s original project budget was $150 million. They’re, so far, up to $500 million. HealthConnect is going to wind up upwards of five times over budget. Sutter is pulling it in at just three times over!
Alright, that was a cheap shot. Cost is important, but as Tim points out in his Universal Rules for Big EMR Rollouts™, maybe the key goal for any electronic medical record project is to get it up and running, “hopefully without killing patients in the process.”
There’s no word from Sutter on reliability or downtime, although the six hospitals aren’t expected to all be live until 2011, so they may still be a bit aways from having any feeling about that. Maybe they will address downtime ahead of time, and maybe that’s one point they will have learned from Kaiser Permanente?
Speaking of HealthConnect… Kaiser Permanente, by my estimates, has now spent upwards of $5 billion on the project (according to Kaiser Permanente: $3.2 billion; according to the Los Angeles Times: $4 billion). Five of our nearly forty medical centers are now live, which, at this rate, means they’re rolling out about three new hospitals a year.
The project was supposed to be completed “nationally” by late 2006. (Don’t laugh.) The outpatient portion now won’t be finished until well into 2008. The inpatient portion now isn’t expected to be completed before 2012.
And that $5 billion spent so far? That’s primarily just for outpatient. Considerably more funding will be spent on the remainder of the inpatient portion. The nearly $100 million figure Sutter is seeing about matches what KP has spent so far to bring hospitals up on HealthConnect. That means an estimate of as much as $3.3 billion more in implementation costs, although the last actual amount budgeted to HealthConnect that I saw was over $4.2 billion from 2008 through 2012.
Assuming the largest figure is the more accurate one (it always is with HealthConnect), that would mean the total, almost ten-year cost of creating an electronic health record network for Kaiser Permanente will come out to over $9 billion. Ten years. $9 billion. The original estimate? Three years and $1.8 billion. (Why did Bruce Turkstra and Cliff Dodd leave Kaiser Permanente, again?)
So, back to Epic.
Let me say that I agree that Epic, today, has one of the best electronic medical record platforms out there when it comes to features. Many of the problems at Kaiser Permanente were infrastructure: poor desktop deployment planning, lousy network design, inadequate change management processes, and so forth, which led, in part, to the poor reliability of HealthConnect. The issue, as I alluded to in the post on IBM and KP getting back together, is that Epic either didn’t try or was ineffective when it came to helping Kaiser Permanente plan adequately for the project, let alone all the contingencies. You’ll find the same problems at Allina, and now at Sutter (both Epic installs), and at any number of other healthcare organizations and hospitals that are transitioning to electronic medical records, regardless of the vendor.
Yet, the key goal for KP, and it appears Sutter, has always been some elusive ability to “improve” billing. The article on Sutter, which has 26 hospitals, points out that the six chosen facilities for the Epic deployment were picked because they account for “roughly half of overall patient volume.” George Halvorson is on the record time and again saying KP desperately needed Epic for the tide of health savings account members that would be coming along any day (you’re not still holding your breath, are you?).
So, as these projects have their top priorities set in billing, the “ideal” of patient safety and the promise of preventing medical errors have taken a back seat. To this day, HealthConnect has only rudimentary procedures in place to track (let alone processes to actually deal with) potential medical errors. While there’s a lot of promise for intelligent diagnosis support and error detection, you won’t find hardly any of that promise in HealthConnect, and I doubt you’ll find much of it in Sutter, either.
Which, I think, means this phase of electronic medical record deployments in the United States will largely be eventually written off as a failure. Perhaps the only saving grace is that these deployments might, might be laying the groundwork for a better round yet to come (through workflow improvements, network infrastructure upgrades, and so forth).
Time (and lots of money) will tell.
on Nov 16th, 2007 at 14:19
This explains why Sutter has been hiring ex Kaiser HealthConnect employees.
on Nov 16th, 2007 at 20:12
Very interesting. Sutter and Kaiser have a long relationship. Epic’s good and all but I wonder if Sutter was thinking longer term? Sutter could turn the Kaiser spigot back on in Nor Cal whenever they want. Could an interoperable EMR help grease the wheels?
on Nov 17th, 2007 at 14:13
You think all of the current EMR rollouts are going to be failures? UPMC had some rough going but it looks like their heads are above water now. Evanston Northwestern gets heaps of praise.
on Nov 17th, 2007 at 15:07
Jon has a point. Kaiser and Sutter are giving Epic and EMRs a bad name just because they’re big and slow.
Change this big takes time — especially in health care.
on Nov 17th, 2007 at 16:36
I actually wrote:
“Which, I think, means this phase of electronic medical record deployments in the United States will largely be eventually written off as a failure.”
I believe there will be fleeting glimpses of success in this round. But, largely, we’ll eventually recognize this “phase” was overhyped and vastly under delivered. The big installs, like Kaiser Permanente and Sutter Health, will eventually come in so massively over budget that every MD and healthcare CEO will have such a nasty taste in their mouth that getting money for HcIT will be damned near impossible.
Phase one: money comes very easy, very painful lessons learned, rudimentary groundwork laid.
Phase two: money is much harder to come by, painful lessons learned turn into decent implementation plans, and we see some smart folks come out with strong diagnosis support and error prevention intelligence software.
As I said, though, time will tell.
justen
on Nov 19th, 2007 at 11:52
Is there a site where useful screen shots of Epic’s current EHR products can be viewed, in enough detail and in enough quantity to get a sense of the overall “feel” of the application?
on Nov 19th, 2007 at 11:59
Justen wrote:
“I believe there will be fleeting glimpses of success in this round. But, largely, we’ll eventually recognize this “phase” was overhyped and vastly under delivered. The big installs, like Kaiser Permanente and Sutter Health, will eventually come in so massively over budget that every MD and healthcare CEO will have such a nasty taste in their mouth that getting money for HcIT will be damned near impossible.”
I’ll go a step further.
I believe this phase will be seen as a time when the Management Information Systems Religion is seen as inadequate in complex environments such as clinical medicine, where its practitioners are simply out of their league. This is largely due to advancements in biomedical information science and applications, requiring cross-disciplinary expertise to manage effectively.
Difficulties in “this phase” may cause this important question to finally be asked:
“What qualifies most hospital CIO’s and IT workers to put their feet in the door of actual clinical medicine interactions, and have authority over same?”
More on this at my site http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm .
on Nov 20th, 2007 at 01:07
Justen,
You are providing important information and opinion…all US Congresspeople should read it as they, and our President, have declared that there is not to be health information technology regulation…no matter how many deaths are caused by and dollars wasted on these flawed and ill conceived CPOE devices. S. Silverstein’s site should be required reading for the lawmakers. No one who has invested millions of dollars in dysfunctional CPOE devices is willing to admit their mistakes and those who criticize may find themselves the object of retaliation, as did Justen. Hospital administrators and CPOE manufacturer CEO’s with their paid booth bunnies will always blame human error and not the EHR device for an EHR/CPOE related death. The fact remains that these EHR and CPOE devices have not been subject to scientific scrutiny and their use is not based on sound (any?) scientific principles, and thus, all are experimental and the patients are guinea pigs. This is nothing but a costly experiment on patients with big bucks for CPOE manufacturers and hospital administrators (?kickbacks).
What can be done? Complain to the HHS OHRP (office of human research protection), and report all deaths, patient injury, and near misses related to CPOE and EHR dysfunction to the FDA, the Joint Commission, and your state’s health department patient safety division.
Best regards and go Justen,
Menoalittle