The senior executive overseeing Kaiser Permanente's massive effort to digitize its members' medical records is being replaced, the company said Monday, the latest sign of turmoil for the $4-billion project, one of the nation's largest.
The departure of Bruce Turkstra, interim chief information officer, comes just four months after he was tapped to replace the health maintenance organization's previous CIO, J. Clifford Dodd.
The announcement is yet another jolt for the nation's largest nonprofit HMO, whose high-profile electronic medical records project has repeatedly been hailed as a possible national model.
With evidence suggesting that digitized record keeping can lower health costs and save lives, President Bush is pushing for every American to have a digital medical record by 2014. About 90% of the healthcare industry still operates with paper records.
But over the last year, Kaiser's new digital system has faced growing problems as it has been expanded into more locations.
Turkstra has directly overseen the creation and rollout of the project, called Health Connect, since its inception in 2003. Kaiser's website Monday referred to him as the program's information technology architect.
Troubles with the effort, which may be endangering patient safety, were detailed by the Los Angeles Times two weeks ago. Oakland-based Kaiser says no patients have been harmed and the technical problems have been solved.
Kaiser said its new technology chief would be Philip Fasano, who oversaw technology departments at Deutsche Bank Group and JPMorgan Chase & Co.
In a statement, Kaiser Chief Executive George Halvorson said he valued Turkstra's "contributions throughout the KP Health Connect project."
A Kaiser spokeswoman said Halvorson decided to hire an outside candidate rather than make Turkstra a permanent chief information officer, a move that was widely expected when he was given the interim job in November.
Turkstra, who wasn't available for comment, is staying on at least through Fasano's transition, Kaiser said. Company executives said the change was not related to recent problems with Health Connect.
In The Times' report, documents and interviews with current and former Kaiser employees showed the effort had encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds.
At times, doctors and medical staff haven't had access to crucial patient information, and system outages have led to delays in emergency room care, the documents show.
Other problems have included malfunctioning bedside scanners meant to ensure that patients receive the correct medication, according to Kaiser staff.
Internal Kaiser "Availability Trend" reports documenting the reliability of Health Connect over nine months last year found the system was available 88% of the time some days and less than 80% in certain locations. That rate is considered very low for the healthcare industry, which increasingly is aiming for systems with availability in the "multiple nines," or 99.99%, because of patient safety risks that can arise during system outages.
Concerns about Kaiser's effort recently led the California Department of Managed Health Care to request information about the project, a first step before a possible formal investigation.
Experts say the glitches are worrisome and illustrate the difficulties healthcare providers may encounter as they try to implement complex computerized medical systems.
"We all have a lot more work to do before we can expect to see all the benefits and rewards electronic medical records can bring," said David Brailer, a former national health information technology coordinator who serves as a health technology advisor for the Bush administration. Brailer didn't comment on Kaiser's plan specifically because he was not sufficiently familiar with the project.
Kaiser said it expected Health Connect to be fully rolled out in two years.