Sunday, April 29, 2007

E-Medicine - Trouble In E-Paradise: Kaiser and Its EMR

Employee Fires Off EMail, Gets Himself Fired

George Halvorson, CEO and Chairman of Kaiser, is a friend and visionary. I often refer to his books; Strong Medicine(Random House, 1993, and Epidemic of Care (Jossey-Bass, 2003). In them, Halvorson says health care rests on a foundation of consumer engagement, doctor teamwork, collaboration, quality improvement, and accountability.

I feature Halvorson and Kaiser Permanente in a chapter, pages 103-111, in Innovation-Driven Health Care; 34 Key Concepts for Transformation (Jones and Bartlett, 2007). I lead off that chapter with this prelude:

Big health care organizations, such as Kaiser with its $30 billion in revenues, have bigger innovative levers to lift health care world, such as a comprehensive electronic system connecting all of its physicians.”

Kaiser’s EMR is widely considered the electronic medical records prototype of the future.

I’m not alone in admiring Halvorson. He is noted for plain talk. He is regularly featured as the keynote speaker at various national and international conclaves.

I was taken back when a Kaiser employee, 22 year old Justen Deal, dealt Kaiser a public relations blow with a Kaiser system-wide email lambasting HealthConnect – Kaiser’s ambitious $4 billion project to convert paper files into electronic records available at every doctor’s fingertips.

What upset me wasn’t so much Mr. Deal’s accusations (“We’re spending recklessly, to the tune of over $1.5 billion in waste every year, primarily on HealthConnect but also on other inefficient and ineffective information technology projects.”), but Deal’s lack of qualifications to judge Kaiser’s IT purported deficiencies.

Deal’s background, as outlined in a recent Wall Street Journal front-page piece (Rhonda Rundle, “Critical Case: How an Email Tirade Jolted a Big HMO,” April 24, 2007), were:

• dropped out of high school and college,
• served as a gay-rights activist in West Virginia,
• performed administrative chores for West Virginia Symphony and an Ottawa gay rights group,
• worked for a travel agency,
• developed patient-education booklets for Kaiser.

This is hardly a credible background for accusing Halvorson and other Kaiser executives of high level misconduct and for proclaiming HealthConnect as a “disastrous failure.”

Deal ignored the fact that since 2003 the Kaiser EMR has been developed and installed by the Epic Systems Corporation, a Madison, Wisconsin-based medical software systems corporation. Epic is widely considered as the premier EMR firm for large multispecialty organizations in the U.S.. Epic has won every award offered by the medical software industry raters – KLAS enterprises, College of Healthcare Information Managers, the HIMSS Davies, ASHP, and the Best in Texas.

Epic is, in short, considered in a class by itself, and has its systems installed and functioning in scores of large health care organizations across the country.

Mr. Deal didn’t try to hide what he was doing. He signed his email. It reached an estimated 120,000 employees of Kaiser. He didn’t think would be fired. But Kaiser dismissed him on January 11, two months after his November 2006 email blast. Now he’s helping friends with their computers, resting on his laurels as HIStalk’s (a popular IT website) Person of the Year, and looking for a new job.

Deal has become a Big Deal in the blogging world. He was asked to participate in a HealthCare Blogging Summit, and his accusations were featured in an interview by Matthew Holt, a well-known health care blogger with Dr. Andrew Wiesenthal, a physician overseeing the HealthConnect project.

Kaiser tale of electronic woe highlights three cyberspace dangers:

1) Hazards of off-the-cuff email remarks by employees of large organizations ( if you want confirmation of this danger, ask Alberto Gonzales, the current U.S. Attorney General)

2) Difficulties of controlling damage of electronic “whistle-blowers” of high-profile, high-target organizations (even if accusations don’t hold up under rational scrutiny)

3) Reputation injuries inflicted on individuals and organizations (The chief information officer of Kaiser resigned – said to be unrelated but the stigma remains - and the California watchdog agency overseeing managed care says it is monitoring HealthConnect’s performance, even though it finds no fault.)

George Halvorson and Kaiser don’t need me to defend them. George’s record and Kaiser’s performance speak for themselves. My father once told me, “Don’t start vast projects with half-vast ideas. Kaiser’s ideas – to connect all of its physician with one software system, to use software in its Archimedes Project for predictive modeling purposes, to run virtual clinical trials based on data from its 8.3 million members, to use a state-of-the art medical software company to make these ideas a reality – are truly vast and worthy of praise – not 0f off-handed half-vast condemnation by the ill-informed.


Darrell said...

Like it or not, this is empowerment in a flattened World. Jeff Jarvis set the precedent a couple of years ago with Dell Hell, a malevolent and very effective Internet assault on Dell Inc. Tomorrow’s whistleblowers are watching Justen Deal. And contrary to your desires that he be punished for the rest of his life as an example to other non-conformists, he will very likely be rewarded generously with a nice job where non-conformists are respected for enthusiastic innovation, especially if they can create content like Justen can.

He appears to have been a good employee. Anyone who reads the email of November 3rd, has to recognize immediately that Justen loved his work at KP. From the words of support he continues to receive from those who evidently know him from Kaiser, I imagine that he is the kind of person who remains a loyal friend to his co-workers. He was even loyal to the insensitive boss you defend.

If what Justen wrote is inaccurate, how come his arguments were not publicly shot down immediately by PR at Kaiser Permanente? This is Internet transparency. Silence is no longer an effective defense for slow-reacting, command-and-control business models. I would love to know more about the connection between management and a tanning solon. What is that about?

Justen Deal’s story will be included in tomorrow’s business school textbooks. If you have not noticed, he is also a folk-hero. You are one of the few who sides with executives at Kaiser. Like Justen Deal, you also show the courage of a non-conformist. Darrell Pruitt

Unknown said...

Your attempt to discredit this kid based on selected pieces of his background is blatant (the WSJ printed that he did IT but you excluded it and the LA Times confirmed that he did work on the HealthConnect project but you never read that story right?).

The governor of Delaware dropped out of high school. Bill Gates dropped out of college. Neither of them have any credibility either.

I read the CEO's e-mail response and (funny enough) it sounded just as arrogant and misleading as yours.

Richard L. Reece, MD said...

Wow! I see a struck the wrong nerve among some by siding with Kaiser rather than Justin Deal. I was not trying to discredit him, simply to question his judgment. He has talent and IT knowledge. I recognize he is a folk-hero among the whistle-blowers of this "flattened world," which is characterized by individualism and outspokenness. More power to them, but these traits carry risk. I'm all for mavericks. I'm a bit of a maverick myself, and I do not think of myself as arrogant. I wish Justin a successful future.