Diagnosing health care IT

Kaiser’s medical records odyssey reveals basic truths about doctors, IT, and resistance to change

A few weeks ago I stirred up a heap of contention with my column “RIP, electronic medical records?” about the battle at Kaiser Permanente over its pioneering health care digitization megaproject. The comments posted on the column by readers were like an instant replay of the finger pointing and armchair quarterbacking that’s apparently been going on inside that organization -- an interesting skirmish that showed the passion flaring on all sides of this issue.

As a follow-up, I invited Dr. Andy Wiesenthal, one of Kaiser’s lead docs on the project, to come to InfoWorld.com headquarters for a no-holds-barred video checkup on the Kaiser project and the state of health care IT in general. It was fun to be -- for once -- the person asking the questions in the examination room, though I didn’t make him put on one of those little gowns or wait in the cold while I finished up with another interview.

You can see the full, uncensored four-part Q&A here. Dr. Wiesenthal, despite being branded by some online critics as a corporate apologist, didn’t come across as defensive, and he seemed both balanced and articulate about what’s going on at Kaiser and in health care IT in general. An epidemiologist by training, he has street cred with me because he’s one of a handful of physicians who's been pushing electronic records systems at Kaiser since the 1980s.

One of his most interesting comments was about the generational differences in how doctors view new technology and digitizing their traditional workflows. Younger doctors are all for it, he said; having grown up with computers, their attitude is "why wouldn’t you do it?" Older docs, those already retired or getting close, also look at the technology and say, "That’s really cool, of course we should use it."

It’s the midcareer doctors, however, in the prime of their productive years, who are more cautious. They’re responsible for a system that’s operating (literally) at high volume, and they don’t want to jeopardize it. This seems natural -- it’s like the insurance company transaction processing operations manager who doesn’t want to move off the mainframe, even though the marketing department insists on it.

An "if it ain’t broke, don’t fix it" attitude can be healthy, but to its credit, Kaiser has decided that health care needs a tech upgrade anyway. I applaud the company and wish it luck. It may or may not be the health care provider that figures it out, but its efforts to overcome the inherent challenges (watch the video) and build the road map will ultimately benefit us all.

Big-game hunters department. Speaking of pioneers, what’s up with Apple deciding to port its Safari browser to Windows? While the blogosphere seemed to focus on flaws and security holes in the first beta launch, wasn’t anybody curious about the strategic intent? Doesn’t Apple already have a strong enough footprint in the Windows ecosystem, with more than 200 million copies of iTunes for Windows supposedly in circulation?

Perhaps iTunes is trapped by its musical association and therefore unsuitable for Windows world domination. So be it. But what prize could Apple be eyeing with this latest Trojan horse? Social networking? Search? We need another browser like a hole in the head. What do you think Apple is up to? Send me your ideas, your suspicions, your conspiracy theories -- and I’ll report the best ones next week.

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