An HIT Moment with ... is a quick interview with someone we find interesting. Justen Deal was the Kaiser Permanente employee made famous when his November 2006 internal e-mail criticizing the organization’s HealthConnect EMR project was leaked out to the press. The CIO left, the CEO was publicly and somewhat arrogantly defensive, and HIStalk’s readers voted Justen Deal Industry Figure of the Year in the HISsies that year.
What has your post-Kaiser Permanente life been like?
In one word, interesting. Challenging at times, as well. It helps to have the perspective afforded by two years, though. Challenging in that the first few days, weeks, and months took a lot of patience, quite a bit of deliberation, a fair amount of persistence, and a ton of coffee.
Interesting in that I came to see healthcare information technology from a different angle. I saw the provider side, the needs, the costs. I saw the vendor side, the challenges, the risks. If you got past the headlines, I always defended Kaiser Permanente and the importance of the HealthConnect project, and on more than one occasion, I pointed out the strengths and advantages of Epic.
I eventually began working on Vieue, which has given me the opportunity to put some of that perspective to use. I know that no one company or person can solve every healthcare information technology problem, but there are a few we’re working on.
What good and bad effects resulted from your famous e-mail?
We’re just shy of about two years out, so, as I said, the time allows a bit more perspective.
The negative was that I ended up leaving Kaiser Permanente, which is an organization I believed in and still very much care about.
On the positive side, speaking about healthcare in general, I think there has been a small, but real shift in how electronic health record projects are assessed, in terms of their costs and successes. I think there still is a lack of thorough, public, critical analysis of the efficiency and effectiveness of electronic health record projects, but it has definitely improved, and I hope my e-mail played some small part in that.
HealthConnect is getting good press about improving patient outcomes. Are you buying it?
I think we all agree that smart, interconnected electronic health record systems can have an enormously positive impact on patient outcomes. The recent report that Kaiser Permanente is leading the nation in terms of breast cancer screening rates is great news, and it comes after more than a decade of work at KP specifically geared towards increasing detection. For 2005, the Southern California region achieved a mammography screening rate of 84%, which, as you’ve mentioned, has reached 87% according to the most recent data. By comparison, the current national average is 72%.
Other regions have seen success, as well. In 1996, the Georgia region had a screening rate of 74%. In 1997, they implemented their Breast Health and Cancer Detection Program, and by 1999, they had significantly increased their rate to over 84%. The combination of building smart reminders into healthcare information systems and relevant patient workflows can obviously go a long way to improving patient outcomes.
Broadening your question just a little bit, I think the question for healthcare has to be whether we’re actually taking meaningful steps towards taking breast cancer screening rates up nationally, towards catching the hundreds of thousands of deaths every year caused by preventable medical errors, towards tracking and ensuring better compliance and follow-up on chronic conditions. I just don’t think we’re seeing the sizable shift we should be seeing there across the country, and I think that’s because the software isn’t as "smart" as it needs to be to catch, track, and prevent.
The other issue, I think, is cost. Across healthcare, we’re spending tens of billions of dollars on healthcare information technology, and the return on investment just isn’t there yet, until we are indeed meaningfully and quantifiably improving outcomes and reducing the cost of care. I worry about whether we’re wearing out our welcome with providers and insurers alike when we over promise, under deliver, over budget.
Lots of folks said you were highly analytical and well spoken in your HIStalk interview, but said they would never hire you because of the risk of a similar situation down the road. Has that been the case?
I decided fairly early on that I wanted to focus on Vieue, so I was thankfully spared any awkward interview moments. For any companies that might care about my particular perspective, though, I will say that I think it is critical to have a thorough, sincere, and independent compliance process, which can go a long way towards catching and addressing concerns proactively. I think it is a mistake to view compliance as a public relations apparatus, but the reality is a competent compliance process can often help prevent internal problems from becoming public problems, not through suppression but through correction.
Kaiser chairman George Halvorson is speaking at the HIMSS conference in Chicago next year. If you were in the audience, what questions would you ask him?
I honestly can’t think of a single question.