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Healthcare Giant Faces IT Nightmare

Zonk posted more than 7 years ago | from the awesome-rpg-character-name dept.

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."

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342 comments

maybe they can merge (4, Funny)

yagu (721525) | more than 7 years ago | (#16872414)

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

Re:maybe they can merge (4, Insightful)

MyLongNickName (822545) | more than 7 years ago | (#16872450)

We have an opening for Dean of our MBA department. You are a shoo in. When can you start?

Re:maybe they can merge (5, Funny)

Anonymous Coward | more than 7 years ago | (#16872778)

Hold on a second!
He didn't mention the synergies that merging the two products would bring to the core competenancies of both organizations.

Now that I have, can I get the job?

Re:maybe they can merge (3, Funny)

creimer (824291) | more than 7 years ago | (#16872760)

While we're at it, let's combined the FBI, CIA, NSA and Defense Department IT departments into one nationwide organization and put FEMA in charge to manage that disaster.

Re:maybe they can merge (0)

Anonymous Coward | more than 7 years ago | (#16873676)

If this system isn't fixed the terrorists win.

Go USA! (0)

Anonymous Coward | more than 7 years ago | (#16872424)

We always new that the US health service was expensive.

Re:Go USA! (2, Funny)

Anonymous Coward | more than 7 years ago | (#16872576)

Did you also <joke>no</joke> that the correct spelling of new that you want is knew?

Jim

We're winning!!! (1)

TheDrewbert (914334) | more than 7 years ago | (#16872426)

Take that Brits! oh... wait.

Re:We're winning!!! (1)

badfish99 (826052) | more than 7 years ago | (#16872844)

No, we're still ahead. This company only wasted $4 billion, whereas in the UK we've wasted $24 billion. Granted, this company is ahead on waste-per-patient, but we're well in the lead on the total amount down the drain.

No we're not! (0)

Anonymous Coward | more than 7 years ago | (#16873180)

That is only one hospital. Epic Systems is run by MANY health care organizations.

News came out (3, Informative)

Hijacked Public (999535) | more than 7 years ago | (#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:News came out (1, Offtopic)

stevesliva (648202) | more than 7 years ago | (#16872808)

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 immediate action to bring efficiency and responsibility to our information technology operations. Many of the technology vendors and platforms which have been chosen and approved by Mr. Halvorson and Mr. Dodd are unreliable and costly. Unfortunately, these questions of financial responsibility and business integrity are not new:
  • Mr. Halvorson left the health plan he previously led, HealthPartners, in the midst of what, we would later learn, was an audit by the Minnesota Attorney General. The Attorney General uncovered years of financial irresponsibility and waste, and ultimately concluded that the HealthPartners Board of Directors provided inadequate oversight of Mr. Halvorson and other HealthPartners executives.
  • Mr. Dodd "invited" and oversaw the selection of Tanning Technology to "help ensure that the technical performance of Kaiser Permanente's Automated Medical Record (AMR) initiative meets the goals of the organization." Mr. Dodd later resigned as a director of that company "to avoid even the appearance of conflict."

Woo-Hoo! (2, Insightful)

Hap76 (995519) | more than 7 years ago | (#16872470)

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?

Re:Woo-Hoo! (1)

smooth wombat (796938) | more than 7 years ago | (#16872720)

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 to my medical the oral surgeon went.

Sure, the medical insurance would pay for it, but only if the teeth were impacted. Which they weren't. Silly me, I thought this was the 21st century where the comfort of the patient to be involved rather than the 5th century where you are given as much ale as you can drink then a clonk on the head before surgery.

Alas, for the thousands of dollars the taxpayers pay to cover me, I ended up paying for almost the entire operation. The only thing that my dental covered was the doctor's fee and the initial x-rays. At a reduced rate to the doctor no less.

What I paid out of my own pocket was more than what the medical insurance paid for and I can't even deduct it from my taxes.

So all that money the taxpayers pay for me to be covered went straight to the insurance company's pockets. The proverbial black hole.

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.

Re:Woo-Hoo! (1)

stankulp (69949) | more than 7 years ago | (#16872888)

"What I paid out of my own pocket was more than what the medical insurance paid for and I can't even deduct it from my taxes."

As an evil rich person with a job, you are expected to pay for your own medical care.

Your medical premiums are used to provide free health care to illegal immigrants, which is why so many emergency rooms in cities near the Mexican border have had to shut down.

http://www.google.com/search?hl=en&q=emergency+roo ms+illegal+immigrants&btnG=Google+Search [google.com]

Re:Woo-Hoo! (2, Insightful)

jbrader (697703) | more than 7 years ago | (#16872916)

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:Woo-Hoo! (4, Insightful)

bfields (66644) | more than 7 years ago | (#16872934)

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! (2, Informative)

Johnny5000 (451029) | more than 7 years ago | (#16873012)

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 insurance, no less?

Probably not. (1)

Kadin2048 (468275) | more than 7 years ago | (#16873622)

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:Woo-Hoo! (0)

Anonymous Coward | more than 7 years ago | (#16873490)

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.

Car insurance is a worthless invesment too, unless you have a major accident. I don't plan on having one, but I still feel good about my car insurance. Same for my health insurance.

99.5% Uptime (0)

Anonymous Coward | more than 7 years ago | (#16872500)

That's less than my desktop box here at home. Poor Americans ;-(

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

bunions (970377) | more than 7 years ago | (#16872530)

The free market is more efficient than some socialist government project. There must be some error in the article.

Re:well this obviously can't be right (1)

TheDrewbert (914334) | more than 7 years ago | (#16872568)

The free market is more efficient than some socialist government project. There must be some error in the article.

The company obviously run by Democrats. [/republican]

Re:well this obviously can't be right (1)

ThosLives (686517) | more than 7 years ago | (#16872610)

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

Re:well this obviously can't be right (1)

bunions (970377) | more than 7 years ago | (#16872664)

what would you call it?

Re:well this obviously can't be right (0)

Anonymous Coward | more than 7 years ago | (#16872850)

> what would you call it?

It is a mixed system. The US Government (socialism) runs Medicaid, Medicare, VA.
The private sector (capitalism) offers insurance.

Re:well this obviously can't be right (1)

bunions (970377) | more than 7 years ago | (#16872920)

> It is a mixed system. The US Government (socialism) runs Medicaid, Medicare, VA.
> The private sector (capitalism) offers insurance.

And so KP is where in that spectrum?

Re:well this obviously can't be right (1)

MightyYar (622222) | more than 7 years ago | (#16873408)

They fall into the "overpay the hospitals because the government underpays them, yet mandates treatment" camp, like the rest of us paying suckers.

In general, unfunded mandates kind of suck.

Re:well this obviously can't be right (1)

bunions (970377) | more than 7 years ago | (#16873456)

... and yet, somehow manage to pull in $3.3 billion in profits over the last 5 years!

Man, the free market [i]is[/i] efficient!

Re:well this obviously can't be right (4, Insightful)

Brandybuck (704397) | more than 7 years ago | (#16872910)

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:well this obviously can't be right (2, Insightful)

bunions (970377) | more than 7 years ago | (#16873016)

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."

Re:well this obviously can't be right (0)

Anonymous Coward | more than 7 years ago | (#16873654)

Except that while the doctors are heavily regulated, the insurers are pretty much free to do as they please. Even stock-holding Republicans took issue with United Healthcare issuing its CEO two billion dollars in stock options, but you didn't see the government do a whole lot about it.

Re:well this obviously can't be right (1)

timeOday (582209) | more than 7 years ago | (#16873690)

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 (1)

spun (1352) | more than 7 years ago | (#16872908)

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] When a company, which buys things on the free market and sells health care on the free market (I mean, your company could go with any HMO, right?) can't do things right, who or what is to blame?

If you said "The individuals involved," well, then I hope you say the same thing when a socialist system fails too, otherwise you are being a big old hypocrite. If you said "The system" then, again, you should apply the same reasoning to socialism, and when things fail in that system, blame that system. If you said, "It depends," or "I don't have enough information to judge," well, there's an old dead Greek guy [wikipedia.org] who would have loved to meet you.

Re:well this obviously can't be right (1)

jimmyfergus (726978) | more than 7 years ago | (#16873512)

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

Absolutely, as we know, Free Markets produce the best possible results, so if imperfect results come from The Market, then The Market has by definition been distorted. The most frequent type of distortion of The Free Market is usually caused by something called "reality".

What're you talking about? (1)

Colin Smith (2679) | more than 7 years ago | (#16872666)

Kaiser Permanente are clearly much more efficient at wasting money than the NHS, almost 3 times more efficient at it.

 

Re:What're you talking about? (0)

Anonymous Coward | more than 7 years ago | (#16873236)

Kaiser Permanente actually was the second cheapest plan (for employee + family) compared to the other 5 offered by my employer. I've had very few issues with KP from a care perspective, in fact I find dealing with them to generally be very easy. Any prescriptions from the doctors office are directly available at the pharmacy (which is very convenient which two children). Need X-Rays, blood work, etc..., just go to the office for those and you get right in. The doctors have almost instant access to the results and I often get a follow up phone call from the doctor with information.

Now the one thing that I can't tell is which system is being used by my local KP offerings. I'm in the Maryland area and between the New Kensington, Columbia, and Baltimore (forget the locality name for this one) offices, they've always had access whenever I visit. Maybe it's a local system and the one they are rolling out is to replace it. If what they have now is the one the article refers to though, I see no problems from a customer standpoint. I have reasonably priced service at a satisfied service level.

Jim

Re:What're you talking about? (0)

Anonymous Coward | more than 7 years ago | (#16873502)

convenient which two children

I guess I should have previewed my reply. This text should read
convenient with two children

Re:well this obviously can't be right (0)

Anonymous Coward | more than 7 years ago | (#16872826)

Dispute that with just 3 words: Medicare part D

Re:well this obviously can't be right (2, Insightful)

Dr. Zowie (109983) | more than 7 years ago | (#16872854)

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.

Re:well this obviously can't be right (1)

Red Flayer (890720) | more than 7 years ago | (#16873132)

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 cities where KP has a monopoly on hospitals (there are plenty)? What then? The consumer has no option but to go to a KP hospital... so there's no competition that can usurp KP's position in that city as the most efficient healthcare provider.

Re:well this obviously can't be right (1)

scheme (19778) | more than 7 years ago | (#16873708)

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.

Re:well this obviously can't be right (0)

Anonymous Coward | more than 7 years ago | (#16873028)

One of my main issues with Justen Deal is that he claims that the entire IT budget is related to health connect. The entire IT budget is his $1.5G/year figure. In reality Health Connect is probably about 25% of that or less. Also he thinks he is some sort of superhero. Check out his web blog: http://justen.blogspot.com/ [blogspot.com]

Anyways, to sum it up, we're not as bad as the british! w00t!

Re:well this obviously can't be right (0)

Anonymous Coward | more than 7 years ago | (#16873364)

Yes, yes! When the UK government health system goes bankrupt, most Britons will switch to the French government system. Much more efficient.

Bloody Yanks (1)

Colin Smith (2679) | more than 7 years ago | (#16872546)

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.

 

Re:Bloody Yanks (0)

Anonymous Coward | more than 7 years ago | (#16872962)

Exactly. Who gives a f*** if some US corporation is several times more expensive for the same services than some other entity? At least nobody is forced to be a client there, unlike with the NHS, which I'm sure is at least partly funded by taxpayers, if they choose to buy they health services elsewhere or not.

Take that! (0)

Anonymous Coward | more than 7 years ago | (#16872560)

Take the you limey bastards! U.S.A!! U.S.A!!!

Wow. We Are Not Alone (1)

segedunum (883035) | more than 7 years ago | (#16872562)

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 companies are very keen on the figures handed around of £30 billion, not that I'm suggesting they've been buttering up our politicians or anything ;-). The mind boggles......

Don't get comfortable you Yanks. No one outdoes the UK Public Sector for very long in terms of utter incompetence!

Re:Wow. We Are Not Alone (1)

sparkane (145547) | more than 7 years ago | (#16872668)

except it won't solve anything and it will be broken in no time

The real question is how long is it going to take before people have an ingrained suspicion of The Latest Thing. As we become more and more dependent on software and the devices that run them, we are going to have to become less and less susceptible to these magic bullets. Seems to me anyway, but what do I know.

Takes one to know one. (0)

Anonymous Coward | more than 7 years ago | (#16872588)

FBI IT Department to Kaiser IT Department: "Amateurs."

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

jmyers (208878) | more than 7 years ago | (#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."

Re:Why the hell do they use Citrix? (1)

NeutronCowboy (896098) | more than 7 years ago | (#16872764)

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? (0)

Anonymous Coward | more than 7 years ago | (#16873086)

Not that i'm a big Citrix fan or anything, but I worked for a company heavy on the thin clients and they used Citrix and I managed and installed servers in the farm. I actually had little to no trouble with it. It's install procedure was pretty wacked out, but it still worked. Some fiddling to get apps working properly, but with the proper lockdowns in place, the users only ever ran exactly what you expect them to run. Didn't have much trouble with them after they were setup as well. Saved a company a small fortune when they were looking at upgrading desktops. But (I didn't read the article) I see posts mentioning an in house applications, which spells trouble to me, add that to a complex environment (Citrix) and you could have your hands full.
 
I don't know what your talking about with monitoring, if you've got 50 000 people in Citrix, than you only have to maintain a small amount of servers in a farm rather than 50 000 pc's. I prefer the less is more attitude in that i would rather work on a few computers that support many than many computers supporting one.

Re:Why the hell do they use Citrix? (1)

certain death (947081) | more than 7 years ago | (#16872806)

They use Thin Clients, and run Citrix to them all. That means, that they are having trouble scaling it to meet the memory, diskspace and memory, oh, did I say memory? Yeah...memory requirements.

Re:Why the hell do they use Citrix? (1)

pesho (843750) | more than 7 years ago | (#16873148)

No they don't. At least in the facility in Glendale CA, they are running it on fully functional desktops. I was there two weeks ago and witnessed a confused doctor having difficulties accessing my daughter's records and apologizing for the new system.

Re:Why the hell do they use Citrix? (3, Interesting)

Zontar_Thing_From_Ve (949321) | more than 7 years ago | (#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.

We use Citrix for Epic Systems (0)

Anonymous Coward | more than 7 years ago | (#16873022)

Citrix allows us to keep the application updated without having to touch all of the desktops. You shouldn't confuse Kaisers System with Epic Systems software.

Epic itself is part of the puzzle. (And is a pile of crap that doesn't scale.) (Written in MUMPS etc on Cache with a Windows Front End -- all of the communication to the clients is done over Telnet!!!)

I rest my case.

Re:Why the hell do they use Citrix? (2, Informative)

DelawareBoy (757170) | more than 7 years ago | (#16873426)

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 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.

coincidence? (1)

sparkane (145547) | more than 7 years ago | (#16872604)

99.5% uptime means 7.2 minutes of downtime per day.

Meanwhile, the report that came out is 722 pages long.

You be the judge!

Problem solvers with no experience (0, Troll)

Anonymous Coward | more than 7 years ago | (#16872630)

From the Epic Systems website (emphasis added):

Problem Solver / Technical Services

Are you interested in learning more about software development? Combine your problem solving skills and technical interest with our comprehensive training to support our nation-wide clients. You will have the opportunity to participate in many aspects of the software field, including analysis, training, quality assurance, troubleshooting, install, and implementation. Most importantly, you will help clients get the maximum benefit from their software.

Because we train internally, no prior technical experience is needed. Candidates must have a BS or BA, a history of academic and professional success, and a willingness to travel 10%.

99.5% availability is par for the course. (3, Insightful)

NeutronCowboy (896098) | more than 7 years ago | (#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:99.5% availability is par for the course. (0)

Anonymous Coward | more than 7 years ago | (#16873494)

Good point!!

I'm wondering how much of this bullshit is due to Board member and Middle Management stroking their software connections, probing for a quarterly bonus. That, and how much money is wasted on Licensing concerns due to certain monopolies convincing gov. regulators that closed source is whats best!

America is getting fleeced, and moreso now than ever. In every sect, state, and level of society. If any U.S. citizens refuse to SEE this, they are part of the problem, and part of the scam!!

Re:99.5% availability is par for the course. (2, Insightful)

CodeMasterPhilzar (978639) | more than 7 years ago | (#16873564)

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...

Let me guess... (0)

Anonymous Coward | more than 7 years ago | (#16872702)

Accenture.

Any time I hear of some massive project that goes way over budget, doesn't work, and fails to meet requirements, I usually find out that Accenture was the consulting company contracted to do the work.

The difference being ... (0)

Anonymous Coward | more than 7 years ago | (#16872710)

US consumers and companies can walk away from KP and find a competent HMO, whereas the poor saps in the UK are stuck with their NHS.

(Granted, I don't like having to let my employer choose my health plan, but if it gets egregious enough, I can choose another employer if I'm not satisfied with the benefits from the current one.)

Re:The difference being ... (0)

Anonymous Coward | more than 7 years ago | (#16872818)

(Granted, I don't like having to let my employer choose my health plan, but if it gets egregious enough, I can choose another employer if I'm not satisfied with the benefits from the current one.)


i've had to do that. The company I left used KP, but I didn't have it because they don't operate in my part of the country. So they found something equally bad. I started looking for a new job the day they announced the change to the health benifits.

Citrix? (2, Insightful)

McNihil (612243) | more than 7 years ago | (#16872718)

Don't send a boy to make a mans job. AS/400!

Re:Citrix? (0)

Anonymous Coward | more than 7 years ago | (#16872846)

KP (atleast in Colorado) used to run on IBM big iron, up until a few years ago... Then again, the clients were running on *cough* os/2 *cough cough* win311 *cough*

4 BILLion?!?!? (1)

MrTester (860336) | more than 7 years ago | (#16872742)

How the hell do you spend 4 billion dollars on software?
I didnt see anything over what time frame that $4 billion was spent, but even if we assume 10 years, thats $400 million a year. Assume an insane $100 million a year spent on hardware and infrastructure, another $100 million a year for unspecified overhead and an insane salary strucutre with an average of $200k a year, thats still 500 developers, 400 testers and 100 managers working on this project every year for 10 years and they cant make it work?

I could have made it fail for a fraction of the cost with only one person on the payroll.
I am now taking bids for any other project doomed to failure.

Re:4 BILLion?!?!? (2, Funny)

thomas.galvin (551471) | more than 7 years ago | (#16873698)

How the hell do you spend 4 billion dollars on software?

A couple of their secretaries upgraded to Vista.

Only the scale is a surprise. (1)

NorbrookC (674063) | more than 7 years ago | (#16872752)

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 having to try to make a square peg fit into a round hole. The blame then falls on everyone but the executive who made the decision in the first place. The solution always seems to be to try to fit a different square peg into a round hole.

The end result is a lot of money and time wasted. The only difference is the scale.

Not surprising at all (2, Insightful)

realmolo (574068) | more than 7 years ago | (#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.

Re:Not surprising at all (1)

jmyers (208878) | more than 7 years ago | (#16872964)

If you look at the scope of this system they probably could have paid some high school students 4 grand to write the system in PHP/pg-sql on apache and had no problem scaling to 100k users.

OK, I'm joking, but this does not look like a complicated application on the surface, they just picked a platform with major overhead and complexity (citrix). It basically looks like a CRM system with a few tweaks.

Re:Not surprising at all (1)

realmolo (574068) | more than 7 years ago | (#16873112)

Oh, I agree. That's another problem with custom software development. Management knows nothing about software development, and hires whichever developer had the best sales pitch.

Of course, the developer's goal is to make the system as complicated and proprietary as possible, because, again, they want to keep that support/update money coming for as long as possible.

Bad Math?! where does 77k/(year*doctor) come from? (1)

fortinbras47 (457756) | more than 7 years ago | (#16872798)

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:Bad Math?! where does 77k/(year*doctor) come fr (2, Informative)

TopShelf (92521) | more than 7 years ago | (#16873630)

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.

Evil Monkey (2)

SuicidalLabRat (804152) | more than 7 years ago | (#16872814)


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 (2, Insightful)

phorest (877315) | more than 7 years ago | (#16872900)

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 interesting that a mere power-outage grinds the system to a halt as apparently they don't appear to have any plans for that, but to blame Citrix for their implementation woes is going abit overboard. An organization that big should stick with regional datacenters then to put all its eggs in one basket.

Re:Get used to IT (1)

Budenny (888916) | more than 7 years ago | (#16873020)

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 material constraints.

hospital IT system gets case of the MUMPS .. (1)

rs232 (849320) | more than 7 years ago | (#16873002)

"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 (Massachusetts General Hospital Utility Multi-Programming System) -- a health care programming language originally developed in the 1960s"

I recall someone telling me about MUMPS. You ran it off 5 ¼ floppies and accessed the data through direct access to a b-tree.

"Using Citrix is something that defies common sense. It would be like trying to use a dial up modem for thousands of users. It's just not going to work, and it's not something anyone would tell you a dial-up modem should work for"

What if anything is Citrix designed for but for large scale [citrix.com] remote access.

Yuo 7ail it (-1, Flamebait)

Anonymous Coward | more than 7 years ago | (#16873074)

Luck I'll find you join today! moronic, dilettante to happen. My reaper Nor do the rotting corpse a co?nscious stand OF AMERICA) is the words, don't get

99.5% uptime (1)

Brandybuck (704397) | more than 7 years ago | (#16873076)

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 make people start to question their choice of Windows as a one-size-fits-all solution.

Nah...

No one knows how to do commercial software (1)

plopez (54068) | more than 7 years ago | (#16873168)

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".

Epic Systems.. not too bright... H-1B's.. (0, Offtopic)

FirstOne (193462) | more than 7 years ago | (#16873284)

You get what you pay for..

From 1999 to 2001 they applied for and were granted LCA's for 230 H-1B's..
Top H-1B wage 62,000 (2).. lowest wage 31,000(10) average wage ~38,000..
Add in another 56 LCA's for green cards(1999-2000).. top wage 60,500 average wage ~40,000.

Note: The Zazona.com database stopped collecting LCA records back in 2002..

Here is a link to Madison Wisconsin Blog about Epic Systems [livejournal.com] .. read it and be informed..

Funny thing. (4, Informative)

WindBourne (631190) | more than 7 years ago | (#16873348)

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 (2, Insightful)

massysett (910130) | more than 7 years ago | (#16873368)

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".

5 tons of $%^&^ on a 1/2 ton truck .... (1)

RabidAmerican (863381) | more than 7 years ago | (#16873384)

This is a perfect example of an application environment that should have been a front-ended mainframe (z9 ???) driven (CICS & DB-WHATEVER). This would have allowed scalability, security, robust architecture, etc. The right platform for the workload.....

Gee, 2 and 1/2 nines ain't so bad (1)

Morrigu (29432) | more than 7 years ago | (#16873632)

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.

re:Healthcare Giant Faces IT Nightmare (1)

JohnVanVliet (945577) | more than 7 years ago | (#16873642)

well there seam to be a lot of people that are upset . So how about this OPEN SOURCE THE WHOLE THING AND MAKE IT A SOURCE FORGE PROJECT

Ego vs In the know (1)

C_Kode (102755) | more than 7 years ago | (#16873742)

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.
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