By Monica Mehta
Founded in 1945, Kaiser Permanente is one of the largest nonprofit health plans in the U.S. and serves more than 8.6 million members in nine states and Washington DC. Kaiser Permanente’s integrated model of care delivery enables physicians from multiple specialties to work together to coordinate each patient’s care. In such a system, having access to real-time, accurate, and up-to-date patient information can be the difference between life and death.
That fact was realized from Kaiser Permanente’s early days in the 1960s, when one of its founding physicians, Dr. Sidney Garfield, gave a radical speech in which he suggested that on a patient’s first visit to the hospital, “a history would be taken and fed into a computer. A duplicate of this history would be sent to his service area. On each periodic visit or service visit, further data would be taken . . . and fed into this record. This would not only develop records never before available, but might do so at a great savings in time of physicians.”
Garfield’s prescient comments have become policy: the U.S. Affordable Care Act, the health reform law enacted in 2010, mandated that providers create and maintain electronic medical records for patients to improve efficiency and reduce potentially dangerous errors. Creating an IT system to support these records will require a massive effort for health providers still operating in the paper age. However, thanks to forward-thinking leaders such as Garfield, Kaiser Permanente already has a major head start.
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Indeed, over the years, Kaiser Permanente’s leadership has made technology a critical part of patient care and services, physician support, and operations management. “Technology-enabled healthcare” makes it possible for Kaiser Permanente to deliver high-quality and affordable healthcare to its members and patients. Oracle’s PeopleSoft applications play a key role in the execution of that vision.
In 2004, Kaiser Permanente began its investment in its US$4 billion electronic health record (EHR) system called Kaiser Permanente HealthConnect (KP HealthConnect), which connects its 8.6 million members and patients to their healthcare teams, personal data, and medical information. The largest and one of the earliest comprehensive nongovernmental systems of its kind, KP HealthConnect gives every medical facility within the Kaiser Permanente system a view of a patient’s health record. Authorized medical staff can securely access a patient’s full medical history to make better diagnoses and provide better end-to-end care across Kaiser Permanente’s integrated health system.
KP HealthConnect also removes the hazards of incomplete, missing, or unreadable charts and adds access to information on the latest treatments and protocols to ensure that patients are receiving the right care at the right time. Information that once took days to retrieve now takes less than a second. Members and patients can also securely access portions of their KP HealthConnect record directly via kp.org, which also affords them the ability to securely e-mail their physician, set up an appointment, look up a test result, fill a prescription, and read the latest best-practice medical research to proactively manage their health.
“If you asked one of our doctors what is the most central part of their day in terms of managing patients and communicating with other physicians and nurses, every single person would say it’s all KP HealthConnect,” says John Mattison, chief medical information officer at Kaiser Permanente. “KP HealthConnect is the way that work is managed throughout the organization, so it has become the very fabric of what we do.”
Implementing KP HealthConnect has already improved the quality of care delivery. A 2009 study of Kaiser Permanente clinics in Hawaii found that patient office visits dropped 26 percent after KP HealthConnect was implemented, as patients could resolve many issues through e-mail or a telephone appointment. A July 2010 study showed that secure patient-physician e-mail messaging improves the effectiveness of care for patients with diabetes and hypertension. Patients are actively taking advantage of a more direct link to their doctor, sending more than 700,000 e-mail messages each month. Also, in the first quarter of 2007, barcode scanning linked to KP HealthConnect resulted in a 57 percent reduction in medication errors in a Kaiser Permanente hospital.
“KP HealthConnect allows coordination of patient care between the physician’s office, the hospital, radiology, the laboratory, the pharmacy, and the home,” says Philip Fasano, chief information officer at Kaiser Permanente.
Another significant benefit of being able to access the electronic medical records of 10 million past and present Kaiser Permanente members is the ability to do large-scale clinical research studies, while completely protecting patient privacy. Kaiser Permanente deidentifies data that can be used by its 130 researchers, allowing them to scan everything from DNA studies to pharmaceutical effectiveness in disease. Kaiser Permanente EHR studies add to Kaiser Permanente physicians’ knowledgebase and are regularly published in prestigious medical journals.
Fasano says KP HealthConnect’s chief innovation is that it connects every part of the care system for a member. “If you go outside of Kaiser Permanente and you have to go to your primary care doctor, even if they have a medical record that automates their office, the second they send you to a specialist, you’re dealing with someone who doesn’t have your information,” says Fasano. “At Kaiser Permanente, your health record is accessible by all of your caregivers universally. This in and of itself is innovative, both from a quality and outcome care perspective, and from a cost-of-care perspective. It clearly makes caregiving more efficient to have all of the information available about the patient all the time.”
Kaiser Permanente has already received awards for its industry-leading use of IT in general and EHRs in particular for providing patient care. The Healthcare Information and Management Systems Society (HIMSS) has awarded Kaiser Permanente’s hospitals with 24 “Stage 7” awards—its top award for achieving the highest level of EHR implementation. Only 39 American hospitals have achieved this status. By the end of this year, Kaiser Permanente is striving to have all of its hospitals achieve this status; indeed, several of its new hospital facilities have opened without a single chart room, including those in Orange County, California, and the California cities of Downey and Antioch. As retired Kaiser Permanente physician Louise Liang writes in her new book, Connected for Health: Using Electronic Health Records to Transform Care Delivery (Jossey-Bass, 2010), “This was not merely a big IT project. It was putting down the infrastructure for redefining and transforming healthcare.”
“We are realizing our vision of connected care with electronic health records supporting collaboration and communication among care teams and patients, and we are proud to be honored for those capabilities once again this year,” says Fasano. “The Stage 7 Awards value the important role of health IT in improving the quality of care and the overall patient experience, and these are the very objectives at the heart of Kaiser Permanente’s health IT efforts.”
Kaiser Permanente is also working with other healthcare organizations, the U.S. Department of Veterans Affairs, and the U.S. Department of Defense to determine ways to securely share patient information from KP HealthConnect. This leading-edge initiative uses Nationwide Health Information Network standards when patients are under the care of multiple health systems and provides a process for individual patients to authorize secure sharing of their records. This sharing of information will ensure that each care team treating the patient has complete, up-to-date clinical information. Eventually, government and healthcare industry leaders hope that a patient’s medical record will be seamlessly accessible by all healthcare organizations once the patient authorizes that exchange. It’s an ambitious goal, well under way, and it will revolutionize modern healthcare.
Enhancing Human ResourcesIn 2003, Kaiser Permanente experienced a period of rapid growth and evolution. Managers needed more-convenient access to consistent HR management system information in order to make disciplined, data-driven decisions and to better enable compliance reporting. A common human resources information system (HRIS) infrastructure encourages information sharing and improves reporting across the organization.
Thus, HR transformation became a major national initiative for the company, and the creation of a new human resources system, called My HR, became the key enabler to this transformation. Oracle has a significant footprint at Kaiser Permanente, and PeopleSoft applications were ultimately chosen to run My HR.
The main objective of My HR was to create a core HRIS foundation by providing an integrated, programwide platform to process day-to-day HR, benefits, and payroll transactions through Web-based self-service. Management wanted analytical and reporting tools that would support faster, information-driven decisions and would enable analysis of data to support strategic planning and organizational benchmarking.
Kaiser Permanente chose PeopleSoft human capital management solutions as a key component of Kaiser Permanente’s My HR program, which supports HR, payroll, benefits administration, and performance management functions for all Kaiser Permanente nonphysician employees. PeopleSoft Enterprise customer relationship management supports transaction processing at Kaiser Permanente’s HR Service Centers. PeopleSoft enterprise performance management solutions support national HR and compliance reporting. These applications are single-instance across the enterprise.
Kaiser Permanente management has seen good return on its investment in PeopleSoft applications. The company now has a consistent, scalable national HR capability and integrated application architecture. Additionally, Kaiser Permanente benefits from a common integrated HR, benefits, and payroll transaction processing platform with enhanced capabilities. Self-service features provide employees access to personal data 24 hours a day, seven days a week, via both internet and intranet.
Finally, PeopleSoft applications have played a role in bringing together personalized content, role-based knowledge, workflow, and decision support tools to help Kaiser Permanente employees and managers make decisions and complete transactions via the Web. More than 160,000 employees are registered to use My HR to complete self-service transactions and view online content. On average, more than 50,000 self-service transactions are submitted each month through the My HR Websites.
Fasano says he appreciates that Oracle has an understanding of Kaiser Permanente and its business. “Oracle is improving its healthcare product line and enhancing its ability to service us,” he says. “Kaiser Permanente gets good value from the capabilities that Oracle provides, and we feel that our Oracle products are well suited to our purposes.”
Mike Brady, senior vice president of the Infrastructure Management Group at Kaiser Permanente, says that as Oracle expands its portfolio and is able to vertically integrate to provide full solutions, it is better aligned with the significant and growing infrastructure needs at Kaiser Permanente. “Because of our significant growth in information,” says Brady, “leveraging all of Oracle’s engineering capabilities and expertise in a vertical way to deliver full solutions really leverages Oracle’s focus on technology and lets us focus on technology innovation that directly supports Kaiser Permanente’s ability to deliver better-informed care.”
Indeed, that is the goal of any organization: to have its back-end operations taken care of so that it can devote more time and resources to its mission-critical operations. “We’re consolidating to one claims platform—most health plans think that’s impossible, but we’re in the process of doing it,” says Fasano. “We’re upgrading to one new outpatient pharmacy system and consolidating our national call centers and the systems that support them. The goal is not only to enhance integration of our business systems throughout this activity, but also to enhance their performance for the benefit of our members and our members’ access.”
Measuring SuccessWith continued investment in and commitment to the innovative use of IT, leaders at Kaiser Permanente recognize that the availability of information is central to successful clinical outcomes. In the prophetic words of Garfield, “the computer cannot replace the physician, but it can keep essential data moving smoothly from laboratory to nurse’s station, from X-ray department to the patient’s chart, and from all areas of the medical center to the physician himself.”
Ultimately, Kaiser Permanente measures the success of its IT systems in its clinical outcomes. “If you’re a Kaiser Permanente heart patient in Northern California, you’re 30 percent less likely to die of a heart attack than the general population of patients in that region,” says Fasano. ”If you’re a diabetic patient at Kaiser Permanente, you’re 50 percent less likely to be hospitalized from a complication from being a diabetic. That’s a consequence of our integrated system and IT capabilities. We consider our IT function as a critical element of care delivery, and we look at our IT function and systems as life critical.”
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