The current Kaiser HIT dogfight is too complicated for me to summarize. Mr. HIStalk has some of the links and details here. Part of the story is that the CIO has been fired and a Kaiser whistle-blower named Justen Deal has broadcast a critical email across the whole enterprise (links here). What interests me the most, however, about this brouhaha is the comment below from a reader at HIStalk (link here) that makes specific reference to Kaiser's deployment of the Epic EMR. This reader's nom de plume is EpicKoolaidAcidTest -- I wonder if this name has some significance? The reference to Maharajah Judy below can be decoded as Judy Faulker, the founder and CEO of Epic.
"Before the Epic moonies log on and defend the Maharajah Judy until they pry the keyboard from her cold dead hands, let's be clear - Epic does not scale. Kaiser has at LEAST 15 separate instances of Epic running individually. So much for an integrated system! They talk about adding more instances - possibly tripling this number. This whistle blower is spot on in many ways. When you think about it, this is the first big inpatient deal Epic announced - the beginning of Epic being seen as a real inpatient EMR provider. This is also the first of many scaling issues reported in addition to functionality gaps and endless promises made by Epic as they've won deals around the country. Every dog has its day in HIT and this is just the latest in a long line of spurts of greatness (in amassing orders) then failure (in actually executing) starting with SMS with the baton then being passed to HBOC, Eclipsys, Cerner and now Epic."
This note brings to my mind some conversations that I had in the mid-80s at my hospital when the HIS (hospital information system) manager pointed out to me that my LIS was toast -- she predicted that all business and clinical applications in the hospital would soon be running on the mainframe computer. Put all your eggs in one basket, as it were, and watch that basket. This fanciful HIS vision of that former time failed as will today's global EMR vision (see above).
In their quest to execute their monolithic and impractical vision for system-wide EMRs, some healthcare CIOs are splitting their system into non-integrated "instances" as noted above. So like the HIS-centric vision of the past, the EMRs vision of today will fail. It now appears that the epicenter of the HIT tectonic plate may be located on the West Coast at Kaiser. I personally believe that only the Federated Electronic Health Record (FEHR) architecture (link here) will succeed in the long run. We can't keep flogging today's inflexible monolithic model forever.
Its so interesting to see all of the Epic bashing when KP's problems seem to stem from hardware/systems issues, especially since KP's implementation will pretty much be the largest you will ever see outside the UK. I love all of the 'facts' that are thrown around in that diatribe without any validation. Speaking from experience, there are separate 'instances' of Epic running, but they talk to each other periodically to minimize size issues, as a doctor in San Francisco doesn't need to be able to look up all 8 million KP clients.
Posted by: Fly on the Wall | November 14, 2006 at 07:23 PM
Did you see my screenshot of the Epic consultant bagging on the work ethic of Kaiser IT support staff?
http://corphq.livejournal.com
Posted by: Gadfly | November 09, 2006 at 03:49 PM