When a 20-something Kaiser Permanente employee sent to thousands of his co-workers an e-mail that criticized the operations and vendor selection of the Oakland, Calif.-based health plan's massive $3 billion electronic health-record implementation, the first reaction from officials at Kaiser and its main vendor -- Verona, Wis.-based Epic Systems -- was to belittle the messenger.

Now, however, both companies are directly addressing the issues raised by Justen Deal, a publications project supervisor in Kaiser's health education and training department, who shared his concerns in an internal message he e-mailed Friday, Nov. 3, which was then subsequently widely distributed by co-workers to the media and posted on Internet information-technology blogs.

Deal's e-mail surfaced at about the same time as J. Clifford Dodd resigned from his post as senior vice president and chief information officer for Kaiser Foundation Health Plans/Hospitals. All Kaiser would say is that the resignation had nothing to do with Deal's e-mail, and that Dodd had very little contact with Epic on the EHR project that it is calling KP HealthConnect.

Kaiser also noted that Deal had brought the same concerns up through regular corporate channels and his concerns were found to be without merit. Deal has posted copies of his correspondence with company officials on a Web site he created: www.fixkp.org .

The controversy refused to die, however, and Kaiser has since made public a letter it sent to its fellow Epic customers that declared its confidence in Epic to deliver the goods, and Epic released a Nov. 21 statement intended to "set the record straight."

Deal, who could not be reached for comment, had described Kaiser's selection of Epic as a unilateral decision imposed on the company by Chief Executive Officer George Halvorson, but Epic's statement declared that the selection was comprehensive and involved hundreds of Kaiser employees over a period of about six months.

Deal had suggested that Epic was having problems tailoring its products to the massive scale required to connect Kaiser's 12,000 physicians, 431 medical offices and 30 medical Centers. But Epic stated that the system it developed was "both scalable and robust" and able to handle 26,500 concurrent users.

Another major concern raised by Deal was that the system was typically down for thousands of user hours a month, but Epic's statement noted that "power problems" and not its software were the primary reasons for the downtime. It also stated that the system is available to employees 99.5% of the time.

Louise Liang, Kaiser Foundation senior vice president of quality and clinical systems support and Andy Wiesenthal, Permanente Federation associate medical cirector, expressed their confidence in Epic in a Nov. 9 letter to other Epic customers that has since been released to the media. The letter mentions Deal's e-mail without mentioning him by name.

"You have likely seen the recent media coverage regarding an e-mail sent out by a Kaiser Permanente employee calling into question the success of our KP HealthConnect electronic health record system," the letter stated. "While we would not normally feel the need to alert you to one person's personal commentary, we do understand that due to the amount of media attention it has received, it may be difficult to separate one person's viewpoint from fact."

The letter goes on to say that the Kaiser is pleased with Epic, and that the success of the implementation so far "is quite real" and includes deployment of electronic prescribing and registration, and that computerized physician order entry has been fully deployed at two hospitals so far.

Howard Landa, chief medical information officer at Hawaii Permanente Medical Group and vice chairman of the Association of Medical Directors of Information Systems, agreed that Deal's e-mail was inaccurate.

"Everything I know about in his letter was wrong -- it was either way exaggerated or outright false," he said, adding that what was true in the e-mail had been previously acknowledged by the company.

"There were some real downtime issues which -- over the last few months -- have been resolved," Landa said. "And Kaiser is having some financial difficulties, but that's not news. And there's no question it's cost more to implement than we've anticipated."

Landa explained that problems or confusion can be traced somewhat to the independent nature of the medical groups under Kaiser contract. "The old 'herding cats' mentality is still there," he said.

Landa added that KP HealthConnect will eventually serve as the model other organizations will follow. "As soon as we figure it out, the rest of the world will, too," he said.