Kaiser & Epic Respond to Justen Deal's E-Criticism

I have published previous notes about the Kaiser HIT meltdown and made specific mention of Justen Dean, the whistle-blower who called attention to some of the computer problems with a widely circulated internal email. Deal has created his own web site called fixkp.org (as in Fix Kaiser Permanente) to support his case. The EMR vendor for Kaiser is Epic and part of the criticism in this tumult has been directed toward this company and their product. Modern Healthcare published an article recently [Kaiser recognizes employee's e-criticism of EHR vendor] about Kaiser/Epic v. Justen and below is an excerpt from it (boldface emphasis mine):

When a 20-something Kaiser Permanente employee sent an e-mail to thousands of his coworkers that criticized the operations and vendor selection of the giant, Oakland-based health plan's massive $3 billion electronic health record implementation, the first reaction from officials at Kaiser and its main vendor--Epic Systems--was to belittle the messenger. Now, however, both companies are directly addressing the issues raised by Justen Deal, a publications project supervisor in Kaiser's health education and training department, who shared his concerns in an internal message he e-mailed on Friday, Nov. 3 which was then subsequently widely distributed by coworkers to the media and posted on Internet information-technology blogs.

The article offers a number of carefully constructed statements from Kaiser and Epic executives that I quote below in italics. Quotations and statements from healthcare executive sometimes lack clarity so, in the public interest, I follow each of these statements with my own translation or explanation.

Deal had suggested that Epic was having problems tailoring its products to the massive scale required to connect Kaiser's 12,000 physicians, 431 medical offices and 30 medical Centers. But Epic stated that the system it developed was "both scalable and robust" and able to handle 26,500 concurrent users.
Translation: We have our fingers crossed and so should you.

Another major concern raised by Deal was that the system was typically down for thousands of user hours a month, but Epic's statement noted that "power problems" and not its software was the primary reason for the downtime. It also stated that the system is available to employees 99.5% of the time.
Translation: We at Epic have total confidence in Kaiser's ability to support our product but are are not as confident that they will be able to keep their lights on.

...Kaiser [stated that the organization] is pleased with Epic and that the success of the implementation so far "is quite real" and includes deployment of electronic prescribing and registration, and that computerized physician-order entry has been fully deployed at two hospitals so far. 
Translation: Given that we have 30 medical centers and 431 medical offices scheduled for deployment, we certainly have our work cut out for us but look forward to this challenge. We are carefully crafting a statement for future release that will define the point at which progress in this project becomes non-real.

"There were some real downtime issues which--over the last few months--have been resolved," Landa said. "And Kaiser is having some financial difficulties, but that's not news. And there's no question it's cost more to implement than we've anticipated."
Translation: See above in which Epic describes system availability as 99.5%.

Landa explained that problems or confusion can be traced somewhat to the independent nature of the medical groups under Kaiser contract. "The old herding cats mentality is still there," he said.
Translation: When in doubt, blame the docs. This always plays well.

Landa added that KP HealthConnect will eventually serve as the model other organizations will follow. "As soon as we figure it out, the rest of the world will, too."
Translation: We are not exactly sure that this statement will make you feel better or that you are even working on the same problem.

Comments

[Blake M.]

Sure, Dr. Landa. Whatever you say.

[Howard Landa, M.D. CMIO, KP Hawaii]

If you want to know what I mean, all you have to do is ask...

There were some real downtime issues which--over the last few months--have been resolved," Landa said. "And Kaiser is having some financial difficulties, but that's not news. And there's no question it's cost more to implement than we've anticipated."
Translation: See above in which Epic describes system availability as 99.5%.

Re-Translation: 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%
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Landa explained that problems or confusion can be traced somewhat to the independent nature of the medical groups under Kaiser contract. "The old herding cats mentality is still there," he said.
Translation: When in doubt, blame the docs. This always plays well.

Re-Translation: 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.
Landa added that KP
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HealthConnect will eventually serve as the model other organizations will follow. "As soon as we figure it out, the rest of the world will, too."
Translation: We are not exactly sure that this statement will make you feel better or that you are even working on the same problem.

Re-Translation: The first part of the statement related the goal of an integrated electronic health record coving ambulatory and in patient care, providing decision support as well as a personal health record for patients to access their own data, obtain reliable health information, and communicate with their healthcare providers. "As soon as we figure it out, the rest of the world will, too."