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Healthcare Giant Faces IT Nightmare 342

Posted by Zonk from the awesome-rpg-character-name dept.
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."
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Healthcare Giant Faces IT Nightmare More

Healthcare Giant Faces IT Nightmare

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  • maybe they can merge (Score:5, Funny)

    by yagu ( 721525 ) * <yayagu@[ ]il.com ['gma' in gap]> on Thursday November 16, 2006 @02:10PM (#16872414) Journal

    Maybe they can merge the two projects (the Britain and the KP project) for greater efficiencies.

  • News came out (Score:4, Informative)

    by Hijacked Public ( 999535 ) on Thursday November 16, 2006 @02:13PM (#16872460)
    If by 'News' you mean an internal email that detailed all manner of underhanded dealings, sent by a project supervisor, implicating the CIO and CEO.


    See here [fixkp.org] for details.

    • Re: (Score:2, Offtopic)

      by stevesliva ( 648202 )

      See here [fixkp.org] for details.

      Sounds kind of personal-- straightforwardly asking the board to fire these guys:

      More explicitly, the decisions made by George Halvorson and J. Clifford Dodd since their joining this organization have fundamentally undermined our financial and market positions. Within two years, we will face the risk of a financial meltdown that would change the face of Kaiser Permanente as we know it. Instead of irresponsible cuts to our staffing, benefits, and care, we must take immedi

  • Woo-Hoo! (Score:2, Insightful)

    by Hap76 ( 995519 )
    We're Number 1! We're Number 1!

    Huh?

    You mean we're NOT in a competition to make health care unaffordable? Doh!

    P.S. You'd think that a company selling healthcare (something on which people will spend any amount of theirs and others' money) could actually afford working generators and uninterruptible power supplies - if they can't afford it, then how does anyone else?
    • You have things backwards. The purpose of a company selling healthcare is not to actually pay for services, but rather to drain the coffers of those who pay them.

      For example, my employer (the people of the Commonwealth actually), pays for the majority of my medical insurance with a small amount being deducted from my pay. I had to have wisdom teeth pulled earlier this year.

      My dental insurance would pay for the novacaine but not the nitrous oxide. Nor would they pay for me to be put comletely under. Over

      • Re: (Score:3, Insightful)

        by jbrader ( 697703 )
        My medical paid all but $10 to have my wisdoms pulled. Of course I'm not a baby that wants general anesthetic and NO2 either.

        • Re: (Score:3, Funny)

          by arth1 ( 260657 )
          jbrader (697703) wrote:
          My medical paid all but $10 to have my wisdoms pulled. Of course I'm not a baby that wants general anesthetic and NO2 either.

          You mean you transcend dental medication?

          Regards,
          --
          *Art

      • Re:Woo-Hoo! (Score:5, Insightful)

        by bfields ( 66644 ) on Thursday November 16, 2006 @02:43PM (#16872934) Homepage
        Medical insurance, unless you have some severe, traumatic injury, is a worthless investment.

        That's the way medical insurance is *designed* to work. It's a net loss as long as all we need is routine stuff (like wisdom tooth extractions). And we accept that in the understanding that in the case of a severe, traumatic injury--something we just wouldn't be able to pay for *at all* otherwise--we'll be covered.

        • Re:Woo-Hoo! (Score:5, Insightful)

          by John Newman ( 444192 ) on Thursday November 16, 2006 @03:37PM (#16874000)
          That's the way medical insurance is *designed* to work. It's a net loss as long as all we need is routine stuff (like wisdom tooth extractions). And we accept that in the understanding that in the case of a severe, traumatic injury--something we just wouldn't be able to pay for *at all* otherwise--we'll be covered.
          It may work that way for young, healthy, childless people, but the wheels fall off when you think about everyone else. Everyone will require significant medical care during their life. If not due to injury, then most certainly due to age or for routine care of children. The very idea of "medical insurance" starts to sound like an oxymoron when you realize that virtually every human being is guaranteed to have some sort of chronic and treatable - and therefore expensive - medical condition when they get older (and "older" may well mean 40s, not 80s). "Insurance" here acts less like true insurance - where the odds of having to redeem a claim are very low - and more like an investment plan where the bank can choose to seize your investment at any moment and pawn your needs off on the government instead.
        • That's not how all medical insurance is designed to work. There are expensive plans with low copays, and cheaper plans with higher copays. (And the guy did mention only a small amount is deducted from his pay). So which is better? Naively you might think catastrophic insurance is more efficient from a market standpoint because people are incentivized to avoid unnecessary health care for small problems. Problem is, many health care problems are progressive. If you avoid treating small problems now, you

          • Re: (Score:2)

            by bfields ( 66644 )

            That's not how all medical insurance is designed to work.

            No, it is--but I think we actually agree here:

            There are expensive plans with low copays, and cheaper plans with higher copays.

            Right. And in either case, the insurance is a net loss in the case of routine work--that is to say, you'll spend more money with insurance than you would if you didn't buy the insurance and paid as you went instead. That's more obvious in the high-deductable case (where the insurance may pay out nothing, and hence be a

        • Which is the wrong way to look at it. Either you're paying the premiums to cover you for medical expenses, regardless of what that expense might be, or you're throwing money down the hole in the off chance that someday, somehow, you'll get hit crossing the street.

          I don't like paying for something and not getting anything in return. I especially don't like it when the taxpayers, already burdened with a high tax load, are paying for something and not getting anything in return.

          Either the medical insurance i
        • Obviously you have NO idea what you are talking about.

          The "list" price doctors give as their fees are often 100% MORE than the rate insurance companies negotiate with the doctors. And the doctors aren't going to sit there by the hospital bed and negotiate with YOU when you are sick. So if you have no insurance, you are getting raped in medical expenses, even assuming a high overhead cost for going through the insurance company.

          A physician friend of mine once told me a particular procedure is listed as being
        • Right, this is why people shouldn't be surprised when their insurance doesn't cover "forseeable" expenses like dental cleanings (or even pregnancy). Insurance means "risk spreading," not "free money." (except when it is used as camouflage for subsidies)...

      • Re: (Score:3, Informative)

        by Johnny5000 ( 451029 )
        Medical insurance, unless you have some severe, traumatic injury, is a worthless investment. You're better off investing what you would pay in premiums to a company in a good mutual fund and use the money when/if you need it.

        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 ins
        • Aren't most bankruptcies in the US caused by medical expenses, and involving people who do have insurance, no less?

          I doubt it. I bet there are more bankruptcies as a result of credit card overextension, or poorly managed home loans, than as a result of medical expenses.

          • Re:Probably not. (Score:5, Informative)

            by John Newman ( 444192 ) on Thursday November 16, 2006 @03:31PM (#16873878)
            I doubt it. I bet there are more bankruptcies as a result of credit card overextension, or poorly managed home loans, than as a result of medical expenses.
            A recent study [healthaffairs.org] that made some ripples in the media indeed found that half of all bankruptcies were due to medical bills. Most frighteningly, they found that 75% of families forced to declare bankrupcty for medical bills had health insurance.

            • Re: (Score:3, Informative)

              by R2.0 ( 532027 )
              Careful...

              (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 ho

            • Re:Probably not. (Score:5, Informative)

              by twotommylong ( 794494 ) on Thursday November 16, 2006 @06:31PM (#16877076)
              A true life story

              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.

  • well this obviously can't be right (Score:4, Funny)

    by bunions ( 970377 ) on Thursday November 16, 2006 @02:17PM (#16872530)
    The free market is more efficient than some socialist government project. There must be some error in the article.

    • Since when is the US health care system a free market?

      • Re: (Score:2)

        by bunions ( 970377 )
        what would you call it?

        • Re:well this obviously can't be right (Score:5, Insightful)

          by networkBoy ( 774728 ) on Thursday November 16, 2006 @02:34PM (#16872804) Journal
          The term clusterfuck comes to mind...
          -nB

        • Re:well this obviously can't be right (Score:5, Insightful)

          by Brandybuck ( 704397 ) on Thursday November 16, 2006 @02:41PM (#16872910) Homepage Journal
          The first word in "free market" is "free". That's free as in unhindered, unrestricted, unencumbered, etc. The US medical industry is not a free market, as there is a bewildering array of non-market forces hindering, restricting and encumbering it.

          • Re: (Score:3, Insightful)

            by bunions ( 970377 )
            there's no such thing as a completely free market. your argument is the free-marketers equivalent to the communist saying "oh, but there's never been a -real- communist government, so just pointing at the litany of the failures of communism doesn't mean anything."
          • You'll never see a truly free market for health care because the idea is absurd. What, if one incompetent unlicensed doctor kills me, I should vote with my walette and see a different one from now on?

            • Re:well this obviously can't be right (Score:5, Funny)

              by bunions ( 970377 ) on Thursday November 16, 2006 @03:25PM (#16873750)
              In a truly free market, incompetent doctors would put themselves out of business because all their patients would be dead - problem solved!
              • In a truly free market, incompetent doctors would put themselves out of business because all their patients would be dead - problem solved!

                Duh! Of course, patients being alive was the problem to be solved by the "free market" all along! Why didn't I think of that before?! It all makes perfect sense now.

      • Re: (Score:2)

        by spun ( 1352 )
        It's a free market in the sense that when CEOs of any large company whine about wanting a free market, this is what they actually want. You know, free to have the market all to themselves?

        But seriously, people can buy any healthcare they want here, right? So Kaiser Permanente is operating in a free market. And the labor market is a free market, right? If the labor market is not efficient at allocating talented individuals to companies willing to pay the big bucks for them, perhaps there is something wrong. [wikipedia.org]
    • Kaiser Permanente are clearly much more efficient at wasting money than the NHS, almost 3 times more efficient at it.

       

    • Re: (Score:3, Insightful)

      by Dr. Zowie ( 109983 )
      The efficiency is only over the long haul. The advantage of a free-market system is that, when large organizations get sufficiently bad, they fail and are replaced by other, presumably more efficient, ones. It is painful and takes years to happen, but they do. In a centralized economy, large, stultified, inefficient organizations are coded into law and can't fail until there is a revolution.

      • The advantage of a free-market system is that, when large organizations get sufficiently bad, they fail and are replaced by other, presumably more efficient, ones. It is painful and takes years to happen, but they do.

        Efficient == profitable. This does not necessarily mean a better quality of life for those affected (wrt healthcare, it usually means a lower standard of care).

        That 'painful' period of adjustment? How many of those periods will we get, and how long will they last? Decades?

        What about the c

        • That 'painful period of adjustment? How many of those periods will we get, and how long will they last? Decades?

          A lot. Forever.

          The problem is high expectation. Quasi-free-market capitalism simply doesn't work very well when organizations get large -- the individual peoples' incentives always tilt toward value hoarding (which translates to corporate behaviors like rent-seeking and personal behaviors like deception) rather than value creation.

          The only advantage capitalism has is that everything else seems

      • Re: (Score:2)

        by scheme ( 19778 )
        The efficiency is only over the long haul. The advantage of a free-market system is that, when large organizations get sufficiently bad, they fail and are replaced by other, presumably more efficient, ones. It is painful and takes years to happen, but they do.

        As a famous economist said, in the long run we're all dead. Increased efficiency 10 years down the line is all well and good but that doesn't help the people that need the services now.

    • The hazards are
      1. Size. Big organizations can't be efficient in human experience, except maybe at one single specialized activity, and that only with great effort and sacrifice.
      2. Misaligned incentives. Corporate managers get pay and perks for making their deparments larger and more expensive. Owners lose. Which brings us to the next point,
      3. Lack of oversight. If shareholders don't demand an active board of directors, they're making the same mistake as voters who don't demand representatives who will hold

      • Re: (Score:2)

        by bunions ( 970377 )
        Agreement. I am generally a big proponent of free market stuff, but sometimes it just doesn't work so well, and I happen to think that health care in the US is one of those areas.

        > 3. Lack of oversight. If shareholders don't demand an active board of directors, they're making the same mistake as voters who don't demand representatives who will hold hearings and issue subpoenas.

        Well, that's true. But:

        (a) increasing shareholder value and long-term performance are not necessarily linked. A good example of
  • Always got to do it bigger and better.

    Basically what this means is there's a lot of completely incompetent management in the healthcare sector generally. Actually I think this is better because the US organisation being private can be bankrupted and replaced by someone who actually has a clue what they're doing. The NHS will simply continue sucking the taxpayer dry without the incompetent twits having any sanction against them at all.

     
  • Honestly. I really did not know that any other health service organisation of any kind could fuck it up better than the NHS in the UK. Public spending goes up and lots of IT companies rub their hands together and con the incompetent civil servants.

    The government is now highly keen on national ID cards and biometric scanning, and are extremely keen to use it as a solution to everything from immigration to terrorism - except it won't solve anything and it will be broken in no time. Obviously many IT compan

  • Why the hell do they use Citrix? (Score:4, Insightful)

    by jmyers ( 208878 ) on Thursday November 16, 2006 @02:22PM (#16872596)
    I have used Citrix and it solved some problems for us, but why the shell would you use Citrix for a new application developed from scratch? To me Citrix is a system to run legacy applications. Any time in the last 10 years I would think you would choose a platform that does not require a hack (multi user ms windows) to run.

    "We're the largest Citrix deployment in the world," Deal said. "We're using it in a way that's quite different from the way most organizations are using it. A lot of users use it to allow remote users to connect to the network. But we actually use it from inside the network. For every user who connects to HealthConnect, they connect via Citrix, and we're running into monumental problems in scaling the Citrix servers."
    • They're using Citrix? No wonder they have issues. Citrix is a pain to implement, to use and to monitor. It's nice that people don't have to install anything locally anymore, but that also means that the local processing power is lost. If they're planning on having some 50000 odd users run heavy duty apps through the same citrix cluster.... no wonder they're hosed.

    • Re:Why the hell do they use Citrix? (Score:4, Interesting)

      by Zontar_Thing_From_Ve ( 949321 ) on Thursday November 16, 2006 @02:35PM (#16872820)
      For every user who connects to HealthConnect, they connect via Citrix, and we're running into monumental problems in scaling the Citrix servers.

      I'm not surprised at all. I don't want to give details, but my former employer had as a customer a very large European hotel chain who insisted on using Citrix in its architecture. I saw trouble tickets almost every day related to the Citrix servers, which were always falling down and causing one sort of problem or another. I was really glad I didn't have to work on those problems and the only thing it taught me was that any business that relies on Citrix is foolish.

    • Re: (Score:2, Informative)

      by DelawareBoy ( 757170 )
      There are at least two of reasons.

      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 t

    • Re: (Score:2, Interesting)

      by javaxjb ( 931766 )
      Because it effectively was a legacy app in the sense that it was running a legacy programming language/system MUMPS http://en.wikipedia.org/wiki/MUMPS [wikipedia.org]. I haven't used MUMPS, but my brother-in-law was working on a project to add a web interface to a MUMPS application. The language was so unwieldy (see the previous link and note the user of abbreviations and [sometimes] syntactic meaning of spaces) that he recommended scrapping the conversion a rewriting from scratch in Java because it would be up and running

    • Re: (Score:2)

      by AK Marc ( 707885 )
      I have used Citrix and it solved some problems for us, but why the shell would you use Citrix for a new application developed from scratch?

      For one, the application was probably the worst of both worlds. They probably took an unusable off-the-shelf program and modified it poorly. They were left with something that required too much bandwidth for a direct client connection at the scale they were looking. Citrix is a good fix for that. Also, mention "health care" and people go insane over HIPAA. I've ha

    • HIPAA may be the answer (Score:5, Informative)

      by peacefinder ( 469349 ) * <alan.dewitt@gmAA ... inus threevowels> on Thursday November 16, 2006 @03:54PM (#16874318) Journal
      Citrix offers one huge advantage in the world of healthcare IT: When the thin client is not connected, no patient data exists on a thin client machine.

      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.
    • >"We're the largest Citrix deployment in the world," Deal said.

      Alarm bells should have gone off.

      >"We're using it in a way that's quite different from the way most organizations are using it"

      When you make a pair of statements like that, you're really saying "We've just taken on more technical risk that we understand".

  • 99.5% availability is par for the course. (Score:4, Insightful)

    by NeutronCowboy ( 896098 ) on Thursday November 16, 2006 @02:26PM (#16872660)
    Remember that we're talking application uptime, not server uptime. This means that for any multi-server and multi-tier application, application uptime is essentially the product of the uptime of all servers that make up the app. Factor in that windows makes up the bulk of application servers and that people often have weekly scheduled downtimes that are in the hours, and 99.5% is actually quite ambitious.

    • Re: (Score:2, Insightful)

      by CodeMasterPhilzar ( 978639 )
      When I worked at IBM in 90s we had several clients that rebooted their servers once a quarter. A couple were asking for once a year reboots... Even then, they complained about a 45 min reboot cycle. That's roughly 99.966% uptime for the server. Just about all our operating system, application, even hardware updates had to be set up such that they could go into a running system without halting it. There are probably systems out there that would consider that downtime budget lavish...
  • What's this software called? SickPeopleSoft? :)

  • Citrix? (Score:2, Insightful)

    by McNihil ( 612243 )
    Don't send a boy to make a mans job. AS/400!

  • Sadly, this story isn't a surprise at all. Having spent some time working in healthcare IT, the only thing about this that's moderately surprising is the scale, not that it's happened.

    Many of the people I've talked to in the field have similar stories to my own experience. Executives making a decision based on either financial interest; a consultant's recommendation; or buying the sales rep's pitch, and contravening any internal IT objections. The result is almost always a disaster, with IT people hav

  • Not surprising at all (Score:3, Insightful)

    by realmolo ( 574068 ) on Thursday November 16, 2006 @02:32PM (#16872758)
    The dirty secret of the software industry is that if you need a complicated piece of custom software, you're going to pay *huge* amounts of cash to have it developed, and it's never going to work right.

    Anyone who has worked in the IT industry for a while knows the sheer HORROR of most the "niche" software products that big businesses need. They're universally terrible. The people that make that stuff have no incentive to make their product GOOD. They only care about making it marginally functional, so they can make sure their customers have to pay them support fees for eternity.

  • From the article, Kaiser has more than 100,000 physicians...

    The article says that Kaiser is spending about $1.5 billion a year on this plus other IT systems

    That comes out to $15,000 per year per physician.

    Bad summary or am I missing something?!

    (This makes me want to check on those UK health system numbers too...)

    • Re: (Score:3, Informative)

      by TopShelf ( 92521 )
      Quoth the article:

      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.
    • That's probably about right.

      My wife worked for a community health center that had about 15 providers and they payed something like $20,000 a year for their EMR.

      They're a rather poor organization, so I suspect they got a serious discount.

      And that didn't include any of the IT support or equipment, just the software.

  • Fortunately, we Americans have short attention spans; otherwise, come the next debate over rising health insurance costs being the result of high malpractice coverage and low/no income 'over usage' of US medical care, we would be pointing the proverbial evil-monkey finger at health care management debacles such as this.

    SLR-

  • Get used to IT (Score:2, Insightful)

    by phorest ( 877315 ) *

    Congratulations,

    Make a system to save money on efficiency to be totally inefficient.

    Actually, what will be found out (in the near future) that consolidating medical records, precribing, admissions -or- billing on a large system will be so unwieldy that the organization will be hurt more if it's attempted then it could ever make things better. This is not to say that it is impossible, but the myriad of laws, policies, regulations, and over-lapping dependencies will set it up to fail.

    I found it especially i

    • Re: (Score:2)

      by Budenny ( 888916 )
      Yes this is right. If you find your chosen organizational/management structure requires IT projects of this size, and using custom components, you have the wrong organization/management structure. Think again, find a way to make it smaller and more decentralized.

      In military terms, if your chosen plan requires more men to be landed on beaches than you have ships to land them...think again.

      It is a refusal, despite experience, to acknowledge that the issues with large custom IT projects are as real as materi

      • Yes this is right. If you find your chosen organizational/management structure requires IT projects of this size, and using custom components, you have the wrong organization/management structure. Think again, find a way to make it smaller and more decentralized.

        Says who? These programs are awfully expensive, but it's still entirely possible that they'll create huge savings over the long run. The UK program is particularly expensive, but also ambitious - a complete, unified, nationwide patient records s

  • "an IT employee .. said part of the problem .. is that the Citrix Application .. just can't handle the load .. we actually use it from inside the network .. and we're running into monumental problems in scaling the Citrix servers"

    Technically speaking, how would connecting from 'inside' be any different that outside. it's just packets being moved around.

    "Another issue is with the Epic software and its adaptability, according to Deal and the IT employee. They said the software was written in MUMPS (Mas
    • In the early 90s, I spent about a year programming MUMPS on DEC VAX minis for a large healthcare company - they ran a huge medical records and billing system implemented entirely in MUMPS. The language was unlike anything else I've used (not in a good way). It's been a long time since I did any work on it (so my apologies if my recollections are incorrect):

      It was an interpreted language with only about 20 keywords, each of which was typically abbreviated with a single letter. As you might imagine, code l

    • Re: (Score:2)

      by LWATCDR ( 28044 )
      Lots of good software is written in MUMPS. The problem is this software seems to have lots of issues. What is the solution?
      The honest answer is probably none of us have anywhere near the information to know what wrong much less how to fix it.
      If you use MUMPS under windows is it WMUMPS?
  • 99.5% uptime is phenominal... if you're using Windows. Windows is okay as a desktop system. But it does NOT scale up to being a reliable backbone for an enterprise network. But for some totally brain dead reason (probably because everyone else is doing it too), the medical industry as a whole has chosen Windows as its standard. To the point that a former employer of mine standardized on WinXP/C#/.NET as the mandatory framework for hard realtime embedded diagnostic and monitoring systems.

    Perhaps this might m
  • Seriously, commercial software in the ERP fild is a disaster.

    Google 'ERP failure rates'. Depending on how you count over 50% fail. They replace systems that work with POS ERP systems. Having surved a couple of smaller installations the costs is huge in terms of burn out and staff churn as well.

    People need to learn "if it aint' broke, don't fix it".

  • Funny thing. (Score:5, Informative)

    by WindBourne ( 631190 ) on Thursday November 16, 2006 @03:04PM (#16873348) Journal
    About 15 years ago, I worked in Denver for IBM watson lab on the KP system. It was actually a OS2 desktop with AIX backend and had been decent system over the last decade. Then talking to ppl at KP, they told me that higher ups wanted a windows system. Well, I guess they got exactly what they wanted.

  • I hope they get this thing right (Score:3, Insightful)

    by massysett ( 910130 ) on Thursday November 16, 2006 @03:05PM (#16873368) Homepage
    From the perspective of a patient, at least, "health care" IT is in the stone age. Can't set appointments over the Internet. Providers don't use email. Billing involves multiple pieces of paper. Getting a prescription filled involves shuttling a piece of paper with scribbles on it. Records retrieval depends of pieces of paper not getting lost. At first glance the KP system is promising and could ulimately lead to untold cost savings. Unfortunately, at least to an ignorant observer like me, it seems that only the big, integrated systems like Kaiser, the VA, and the military have any hope of ever getting some modern IT, at least as long as the US politicians keep their heads up their asses and refuse to do anything about this country's absolutely dysfunctional and outrageously expensive "health care system".
  • That only works out to 2,628 minutes of downtime, on average, per year. Or just under 44 hours.

    I mean, healthcare information doesn't have to be ready and available, like, every minute, does it?

    Although from what I've seen of Kaiser healthcare in practice, making information available 99.5% of the time might be an improvement from the Hello-here's-your-new-doctor, don't-get-too-attached, whoops-there-they-go, Hello-here's-your-new-doctor standard they follow now.
  • It's all about who is running the show. A smart guy running the show deflects questions to people that know the answer. Idiots that run the show try to answer the question they know nothing about and make decision based on what they think *should* be the right answer and ignore those in the know because they are intimidated by them.

    This happens all the time.
  • The IT industry is literally littered with these failures. You can find the relics of these monuments to failure all over the place.

    $4 BILLION spent on establishing an open source foundation to manage these sorts of (slightly more sophisticated than average) CRM projects would resolve this problem indefinitely.

    But you see, that would defeat the objective of this kind of government to corporate, and corporate to corporate welfare.

    The objective is not to suceed. The objective is to spend money.

    100,000 users i
  • Is this problem really so hard that nobody can write the software without a major cluster-f***k?

    From my experiences with large IT consulting firms, I'd be willing to bet the politics between the health-care company & departments, state & federal regulators, IT company & departments etc is what screwed these projects up.

    If someone could write a health care management system that is complete, functional, meets all regulations, and is easy to write legacy plug-ins to they would be able to grab a bi
    • state & federal regulators

      While it's inexcusable that they spent $4B and got such a poor product, I can see how the regs and data partitioning could make the specs for such a system very difficult to implement in a user friendly way. There are a lot of safeguards for medical data that need to be in place by law, and a new set of regs in the middle of development (I don't know that this happened), along with the 50 different state law sets must have created quite the nightmare.

    • Re:Huge Opportunity (Score:5, Interesting)

      by frank_adrian314159 ( 469671 ) on Thursday November 16, 2006 @05:21PM (#16875908) Homepage
      Is this problem really so hard that nobody can write the software without a major cluster-f***k?

      Oddly enough, yes.

      Health care management systems are a royal pain to build. They need to (if you want to be inclusive) do all of the following: billing, insurance submission, pharmacy and supply ordering both provider and vendor side (including inventory management), lab work integration, patient record management, facility booking, scheduling, and or interfacing with all of the above. You're doing this in a highly distributed system (both logically and physically), where fault tolerant behavior is required (and the 99.5% uptime mentioned is drastically too low). You're trying to do this while gathering inputs from hundreds or thousands of different systems, both internal and external, all of which talk different protocols using different vocabulary, all of which need to be reconciled, and all of which have their own quirks. To operate this system you have your standard IT grunt that has no more than 2 years of ITT Tech training. All of this needs to be done in a high-security environment where information is compartmentalized, both at the functional and the individual level. The users of this system range from physicians who don't know how to use a keyboard to administrators who want customized reporting and statistics out of the thing. A large subset of the users are prima donnas who *are* essential to your operation and who *will* walk if you don't satisfy their whims. Now go up another level - you also want a system that's easy to customize and extend (medical science doesn't stand still). Without a doubt, due to the fragmentation of the health care provision in our country, the range of users and functions these systems have to cover, and the extension requirements in place, these systems are some of the most complex that are constructed. K-P actually had an easier time of it, because of their vertical nature where so much of their operations are internal, but even so they needed to interface with hundreds of external contractor's systems (they contract out specialty care like heart surgery).

      So, no, it's not an easy job; no, you can't just buy one off the shelf; and, unless you want to go to a much more regimented and controlled health care system, it's not going to get any easier. There's a reason why there are hundreds of companies in this business and why multi-billion dollars worth of this type of work is being done each year.

  • We should see news stories about large IT projects that aren't big boondoggles.

    "Large New System, in development to replace working system foo, way over budget, doesn't work, no fixes in sight" isn't news, any more than "Airline flight arrives without crashing" isn't news.

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