Dr. Howard Landa of Kaiser Responds

Dr. Howard Landa, who is the Chief Medical Information Officer (CMIO) of KP Hawaii, has responded to my note of yesterday (see: Kaiser & Epic Respond to Justen Deal's E-Criticism). You can view it by clicking on the "comments" link under the note but I publish here the key portions so that they can be easily viewed.

System Downtime:
There were significant issues with the IT infrastructure causing the downtimes WHICH HAVE BEEN SOLVED. Since then downtimes have been substantially reduced. The clinicians DO NOT view the amount of downtimes as a significant issue at at this point. We continue to strive to meet the goal of 99.8%

Role of Physicians in Adapting to the New System:
Policies, procedures and practices that work are reluctantly abandoned unless hard data supports the change, and even then, change management is not a easy task. There is little true evidence based medicine for the majority of healthcare decisions. This was not intended to blame the physicians for being independent thinkers. We take pride in being inventive, creative, and thinking outside the box.

Regarding the Statement "As soon as we figure it out, the rest of the world will, too."
The first part of the statement related to the goal of an integrated electronic health record covering ambulatory and inpatient care, providing decision support as well as a personal health record for patients to access their own data, obtaining reliable health information, and communicating with their healthcare providers.

Comments

[A.B.]

With the exception of the downtime due to the quake, Hawaii and some of the other (smaller) regions have been doing relatively fine, in terms of downtime. (I say relatively because nobody in their right mind would accept 99.5% uptime in a health care setting.)

The two California regions are the big problem, though, and they account for the vast majority of Kaiser members. Someone calculated that there's been a 500% surge in downtime from the first of June until the last of October: that is exactly what we're seeing, and a big part of that is from the two hospitals in Northern California that have gone live.

Unfortunately, November hasn't been any better. We're well in excess October's downtime already for November, and until management starts to realize we've got to do something about this instead of yelling "full speed ahead," it's only going to get worse.

I don't know Howard Landa personally, but I've heard he was one of the only physicians in Hawaii who was really pleased to see the old CIS system replaced with Epic. It seems like he's trying to do his best to get people to pay attention to the trees, instead of the forest, too.

[Howard Landa]

To Gadfly:
While “This Guy’s” primary job is in Hawaii, I have been very involved with the vendor selection, implementation and optimization of KP HealthConnect throughout the organization. There is inter-regional physician involvement and oversight for the entire project and while I don’t speak FOR the other regions, my comments reflect what I have heard and experienced.
I have had the pleasure of being present for many of the design and build sessions nationally since early 2004 and was on sight support for the in-patient go-lives at hospitals in both northern and southern California.

[gadfly]

I'm still trying to figure out whether this guy from Hawaii is supposed to be responding about Kaiser's EMR in general. The situation is different in various reasons. Hawaii enjoyed the earliest roll out, and it's a small region - i.e., not typical.