Problems abound for Kaiser e-health records management system

Deal and an IT employee, who spoke to Computerworld on the condition of anonymity, said part of the problem with the HealthConnect system is that the Citrix Application Delivery infrastructure implemented by Kasier just can't handle the load of the Epic Systems.

"We're the largest Citrix deployment in the world," Deal said. "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," Deal said. "And we're wasting billions of dollars trying to make it. The big issues for me are the financial repercussions of trying to launch such an ineffective and inefficient and unreliable system across the organization."

According to Deal, Kaiser is wasting more than $1.5 billion a year, primarily on HealthConnect as well as on other inefficient and ineffective IT projects. Kaiser declined to provide financial details of the HealthConnect system, which it has been working on since 2003. Kaiser expects the outpatient portion of the project to be fully implemented in 2008, with the in-patient portion done in 2009.

Another issue is with the Epic software and its adaptability, according to Deal and the IT employee. They said the software was written in MUMPS (Massachusetts General Hospital Utility Multi-Programming System) -- a health care programming language originally developed in the 1960s.

"Basically, the problems really do follow the entire scope of the platform in that we have these issues with the adaptability of Epic and we have these issues with the information security of Epic -- so we implemented Citrix to try and protect that, and we're facing the scalability issues with that," Deal said. "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.

"I don't think that Citrix really appreciates what we're trying to do with their software," Deal said. "I don't think ... we have any [service-level agreement] from them because they would not guarantee that this was going to work at all for this implementation."

"From what I've read, Epic [is] not very scalable and not very robust, and when you're putting Citrix in front of that -- we have most the most number of Citrix servers in the world -- you're going to have problems," said the IT employee.