RIP, electronic medical records?

Kaiser Permanente's pioneering foray into digitizing health care records may mean the concept goes belly up

And so the story of the largest, most visible attempt to digitize health care delivery in the U.S. has finally been told on page one of the Wall Street Journal. And it ain’t pretty.

Two years ago, when I first met (then) CIO of Kaiser Permanente Cliff Dodd, health care IT professionals across the country were closely watching his company’s pioneering effort to digitize patient medical records. If Kaiser succeeded, they’d follow suit, pouring in billions to digitize their own IT systems. If Kaiser failed … well, pioneers are the ones with the arrows in their backs.

Because I don’t have an inside view, and the Journal didn’t do a very good job telling the story, I can only guess why this ended as such a perceived failure.

Cliff Dodd always began his speeches by noting that a 747’s worth of patients dies of preventable medical accidents -- for example, wrong dosages -- every day in the U.S. “If a 747 were crashing every day,” he’d say, “you can bet those planes would be grounded until we had a system in place to fix the problem.”

He’d then describe his company’s massive effort to digitize patient records and medical workflows to prevent such accidents, and to build data warehouses to better analyze the efficacy of various treatments. The company planned to buy and customize off-the-shelf packaged software, he’d add, to gain efficiencies and avoid the internal development quagmire that had bogged down previous efforts.

Fast-forward two years and several billion dollars, to the subject of the Journal article. A 22-year-old staffer blasts an e-mail to the entire company, claiming the project is being poorly executed and jeopardizing Kaiser’s ability to provide quality health care. Dodd resigns the next day -- was he just fed up with the backbiting?

Now, I have no idea how well the project was run. But I do know there are strong gravitational forces conspiring against digitizing health care -- all of which are likely to make early adopters’ lives miserable:

1) Doctors don’t want to comply with predetermined workflows -- that is, they don’t want to be accountable to a computer. It’s an ego thing; plus it's better for your paycheck to be viewed as an artist or magician than as a cog in the machine.

2) Some IT people who get emotionally invested in building their own custom app -- health care is full of legacy apps -- don’t really like the idea of outsourcing and may be looking for an “I told you so.”

3) There’s inadequate reward or accountability for either cost efficiency or better medical outcomes in the current health care system.

4) There’s a legitimate debate over whether health care facilities should go fully digital, potentially making them too dependent on technology and unable to dispense even basic care in the event of severe outages.

None of this is black-and-white, and Kaiser will probably end up as merely a footnote in the long view of health care IT. But I have to admit, I’m disappointed. When I first heard Dodd’s vision, I got really excited, and was pulling for the Kaiser project to succeed.

The bigger lesson for CIOs is this: Stick to your faith in technology, pay attention to the people and cultural issues, but know that although you may move the ball forward for humanity, you may not yourself get to enter the promised land.

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