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    Wednesday, April 25, 2007

    Electronic Tempest: How one disgruntled employee used the cybersphere to irk his employer - or to focus attention on an important problem - depending on your view:

    On a Friday morning last November, Justen Deal, a 22-year-old Kaiser Permanente employee here, blasted an email throughout the giant health maintenance organization. His message charged that HealthConnect -- the company's ambitious $4 billion project to convert paper files into electronic medical records -- was a mess.

    In a blistering 2,000-word treatise, Mr. Deal wrote: "We're spending recklessly, to the tune of over $1.5 billion in waste every year, primarily on HealthConnect, but also on other inefficient and ineffective information technology projects." He did not stop there. Mr. Deal cited what he called the "misleadership" of Kaiser Chief Executive George Halvorson and other top managers, who he said were jeopardizing the company's ability to provide quality care.

    "For me, this isn't just an issue of saving money," he wrote. "It could very well become an issue of making sure our physicians and nurses have the tools they need to save lives."

    Mr. Deal signed the email. Before sending it, he says, he printed out a copy and handed it to his boss. "She gave me a look like, 'I think you're going to be fired,' " he recalls. Soon afterward, his office phone was ringing off the hook. IT staffers later arrived to seize his computers, and Mr. Deal was placed on paid leave from his $56,000-a-year job.

    ....After the message hit, Kaiser sprang into action to assess the damage and figure out a response. Since the missive was sent on a Friday, it went unread by many employees who had left for the weekend. Kaiser's IT staff scrambled to delete it before workers returned to their desks -- but with little success. By Monday, the mass mailing had reached an estimated 120,000 computers at the company. It had also leaked into cyberspace.

    It's not so easy to shut people up in the connected internet age. Here's the HISTalk interview with Mr. Deal. It's a good summary of the difficulties in converting a very large corporate medicine model over to electronic records. The Computer World article detailing their problems is here, and here is Matthew Holt's interview with the Kaiser side.

    UPDATE: From the comments, a link to this interview with a Kaiser physician:

    "In the past," Dr. Chiu said, "physician-patient relationships were built up slowly because we spent a lot of time talking to our patients." Physicians would usually devote their attention to the patient during the consultation, and fill out the patient chart after the patient had left. Now, physicians are encouraged to fill out charts on the computer as they are talking to patients, due to the increasing demand for efficiency. "Balancing good communication with the patient while filtering information to write down can be tough," admitted Dr. Chiu. "It's a little distracting, and you have to learn to be an exceptional listener in order to process and write things down while maintaining a rapport with your patient. It is especially bad for doctors like myself whose typing skills are not as developed as I would wish, because I have to divide my mind into three tasks: figuring out where the keys on the keyboard are, listening to my patient, and responding to my patient. And it's just one patient after another. I don't have much time in between patients."

    ....Sadly, Dr. Chiu remarked, "It seems to me that we are losing the 'human touch' that is so vital in physician-patient relationships. The emphasis on medical documentation is becoming increasingly important due to concerns about medical-legal lawsuits, so the growing trend is that physicians spend more time documenting the conversation than caring for patients. It seems to me that the capture of information is becoming more important than showing compassion towards you patient. It's hard to show compassion when one is constantly typing as the patient is talking." And while he acknowledges that documentation for the purpose of avoiding medical-legal lawsuits is important, Dr. Chiu exhorts physicians to "to be careful to keep it from becoming the focus of being a physician."

    It's the difference between being Dr. McCoy and being Dr. Crusher, who rarely touched or talked to her patients, but spent much time at her computer analyzing their scans.

    Every patient has a different narrative, and those narratives don't all fit neatly into drop-down boxes, so typing or writing or dictating is obligatory if the record is to be accurate. Recording those narratives truly is the most time-consuming aspect of a patient visit. And it's no faster with a computer than it is with a pen and paper.

    posted by Sydney on 4/25/2007 08:26:00 PM 1 comments


    There was an interview in the Next Generation with a doctor who works in Kaiser Permanente, and he says that their switch to electronic records has been real hard on his practicing.

    By Blogger such.ire, at 1:46 AM  

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