Kaiser e-Health Records Management System Implementation:

Kaiser Foundation Health Plan/Hospitals’ implementation of HealthConnect, a $4 billion electronic health records management system from Epic Systems Corp., received media attention as another IT project in serious trouble. As the project drew public attention, Kaiser"s CIO, Cliff Dodd, resigned while another Kaiser employee, Justen Deal, sent a memo to all fellow employees detailing the project"s financial and technological problems. Deal, a publication project supervisor in the Health Education and Training Department, stated that he also made his concerns known to Kaiser management, but company officials reported that Deal"s concerns were looked into and that the HealthConnect project"s implementation was not a failure. One of Kaiser"s attorneys replied in a letter to Deal that “in the implementation of a new, large and complex system such as KP HealthConnect, various technical problems are likely to arise, but none that you mention are unknown to KP-IT nor were as insurmountable as you imply.”

Kaiser did not offer any details regarding Cliff Dodd"s departure, and Justen Deal was placed on administrative leave.

The HealthConnect system was expected to provide more than 100,000 of Kaiser"s doctors and employees with immediate access to almost 9 million patient medical records. In addition, the system would provide e-messaging, online order entry and filling of prescriptions that would also integrate with appointment scheduling, registration and billing, as well as other functionality that would be available to Kaiser members through its Web site.

However, a 722-page internal report obtained by Computer world listed hundreds of technical problems, some that impacted patient care. Deal"s memo stated that reliability and scalability were the main issues because the Citrix Application Delivery infrastructure implemented by Kaiser could not handle the load of the Epic system. According to Deal, “We"re the largest Citrix deployment in the world. 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. Epic simply cannot scale to meet the size and needs of Kaiser Permanente. And we"re wasting billions of dollars trying to make it. The issues for me are the financial repercussions of trying to launch such an ineffective and inefficient and unreliable system across the organization. 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.” Deal also stated that Kaiser is wasting more than $1.5 billion a year on HealthConnect as well as other troubled IT projects.

Scott Herren, a group vice president and general manager at Citrix Systems Inc., believes the problem isn"t scalability but the overall architecture that is being used to support loads this large. Moreover, he states that Health-Connect"s problems do not have anything to do with the Citrix product: “In fact, we have many very large successful Epic deployments around the world. However, in order to support large deployments, the Citrix implementation must be architected accordingly.”

Matthew Schiffgens, a spokesperson for Kaiser, said “As you move out with a very large deployment like this, you encounter challenges along the way, and we have a process to systematically address challenges as they arise. The problem at the Corona data center was a good one. It came up, we addressed it, and we feel confident that we made the proper infrastructure to manage that. That is a fundamental practice of running a good business. Does that mean there are systematic and ongoing problems? No. You identify issues and address them as they go along.”

However, a number of Kaiser employees are still concerned. As one Kaiser IT employee, who wished to remain anonymous, stated: “People out in the field are frustrated, and the people in IT are just as frustrated because this was a solution forced upon us and was not an IT solution. I know in conversations I"ve had with my superiors there was a big push back in selecting Epic, and it was not a choice made by IT simply because of the large infrastructure needed to support it.”

1. In your opinion, do you think by "blowing the whistle" Justen Deal was a troublemaker, or a concerned employee who did the right thing by detailing the project's problems to all employees across the organization? Justify your position.

2. Compare the views of Justen Deal, Scott Herren, and Matthew Schiffgens. Why would these individuals have such different views of this project's implementation?

3. Should Kaiser terminate this project? Or should it continue with the implementation? What are the ramifications for terminating the project? What are the ramifications for continuing?