February 15, 2007

Kaiser Permanente HealthConnect™: Transforming Medical Care and Service

Kaiser Permanente's widescale electronic health record puts patient safety first

Less than three years ago, Kaiser Permanente began a journey to deploy a comprehensive electronic health record in more than 430 medical office buildings and 36 hospitals.

Today, Kaiser Permanente HealthConnect™ is the largest civilian electronic health record in the world. It securely connects 8.6 million people to their health care teams, their personal health information, and the latest medical knowledge. Although the system has yet to be fully deployed in every Kaiser Permanente location, all Kaiser Permanente members have an active KP HealthConnect record, providing them with new and evolving ways to partner with their doctors and other care providers.

Benefits of the System

KP HealthConnect's built-in treatment guidelines are helping the organization improve the management of common/chronic conditions such as diabetes and hypertension. Kaiser Permanente is also enhancing patient care by increasing the accessibility of the patient medical record. Doctors and caregivers have data at their fingertips to identify what treatments and protocols work best.

Industry studies show that paper medical records are unavailable up to 30 percent of the time for patient office visits and are almost never available for patient care in an emergency room. Kaiser Permanente's electronic health record is available when and where it is needed. Having electronic health information that is integrated into Kaiser Permanente's services helps the organization's doctors care for its patients in ways never experienced before. With a patients' lifetime health record at their fingertips, doctors and other clinicians are improving care and services.

In addition, because KP HealthConnect includes more comprehensive patient information, it is helping caregivers address multiple problems or the provision of multiple services in a single visit, reducing the need for additional follow-up appointments. And Kaiser Permanente's new online features found at kp.org (secure e-mail to your doctor's office) have brought members unprecedented access to Kaiser Permanente care. Over time, it is expected these changes will bring measurable improvements to the quality, patient safety and service experienced by Kaiser Permanente members each and every day.

"I know that when I see a member, the chart is available...I can see all the pertinent information, write my notes, order labs and medications, and feel secure that the next provider who sees this member will have all this information as well."

— Nancy Goler, MD, The Permanente Medical Group, Kaiser Permanente Northern California

"Patients are very amazed, especially ones that go over to urgent care and they say, "Oh, you already have my records?' On the flip side, if they go in to see the doctor, the doctor already knows the patient went in to urgent care. For the doctor to know that real-time is very impressive to patients."

— Beth Lopez, RN Manager, Kaiser Permanente Southern California

"KP HealthConnect is my lifeline. Everything is on it from my schedule to my patients to my phone calls to patient history. I don't know how I survived with the paper chart."

— Linda Ramirez, medical assistant, Kaiser Permanente Northwest

As these doctors and clinicians report, Kaiser Permanente is pioneering new ways to work and care for patients.

The Case for Health Information Technology

The 2001 ground-breaking report Crossing the Quality Chasm challenged the health care industry to set new performance standards by addressing multiple factors, including the improvement of clinical information systems. In 2004, President Bush set the goal for a majority of Americans to have computerized health records by 2014. These calls to action are based on the benefits and advantages electronic medical records offer.

For an integrated health care system like Kaiser Permanente, this capability helps the organization create a seamless experience for its members as their health information moves quickly and securely between doctors' offices, hospitals, outpatient centers and pharmacies, allowing scenarios in which emergency room staff could immediately access information about a patient's blood type, allergies and medications.

Industry studies are already demonstrating tangible benefits of electronic health care, including:

  • Reduced medication errors
  • Improved clinical decision making
  • Increased care coordination across care teams, as well as primary and specialty care
  • New ways to engage patients in their care, including online communications
  • Kaiser Permanente is at the forefront of making these advances for its members and health care providers.

    Kaiser Permanente's Methodical Approach

    An undertaking of this size, scope and importance was not taken lightly. This multibillion dollar project began with a formal vendor selection process to ensure that the technology was reliable and robust. After a careful and thorough review by doctors, nurses, clinicians, and technology professionals, Kaiser Permanente chose Epic Systems.

    Once the technology was selected, literally hundreds of doctors, nurses, clinical experts, key business stakeholders and IT experts worked together for months to figure out the features and functions Kaiser Permanente needed to best serve its members. These pioneering professionals worked long hours for months, and in addition to the technology work, also helped us change some of Kaiser Permanente's operation processes and procedures to make the organization's technology and services work well together.

    In preparation for the launch of KP HealthConnect, many Kaiser Permanente staff members visited health care organizations across the country who had already implemented electronic medical records systems. These visits allowed Kaiser Permanente's teams to learn from others' experiences and better prepare for KP HealthConnect deployment. In addition, the Kaiser Permanente Northwest region had been using the same medical record software for more than a decade, so there was a great deal of institutional knowledge to leverage.

    Protecting Patient Safety

    As Kaiser Permanente deploys KP HealthConnect, the organization is taking extra precautions to ensure that patient safety is protected and patient care is not interrupted. Caregiver and supporting personnel are provided extensive trained and Kaiser Permanente has reduced some work schedules during deployments to help its doctors and nurses adjust to exam room and bedside computing. The teams are supported for weeks beyond the initial deployment with on-site technical and training support.

    Kaiser Permanente hospitals are now launching clinical documentation and ways for its doctors to order medication, tests and other services via the computer. Dedicated teams of nurses and other care professionals carefully audit medication and clinical orders to ensure that patient safety is protected during the transition to the new procedures and computer system.

    While there is still work to do to complete this rollout, the organization has made significant progress.  Kaiser Permanente's goal is to have KP HealthConnect available for use everywhere and every time it is needed to provide care and service to Kaiser Permanente members. The organization's technical goal for system availability is 99.7 percent.  Kaiser Permanente currently averages 99.2 percent availability and is aggressively working to meet its ultimate availability goal. In the case that the system is not available, we have backup systems and documented downtime procedures in place to ensure the organization can continue to care for its members.

    In Praise of KP HealthConnect

    Though there have been many challenges over the past three years, Kaiser Permanente has accomplished a great deal and has much to teach the industry.

    "If you don't know you're a leader, step back, breathe, and realize that you are a leader," said David Brailer, MD, PhD, the former national coordinator for Health Information Technology, said in August 2005, citing Kaiser Permanente's work in implementing KP HealthConnect as pioneering. "Cherish the work you're doing," he told the crowd of over 500 KP physicians, nurses, business professionals, information technology experts, and operations managers."

    Brailer explained that Kaiser Permanente is a model that the government is watching closely and learning from as it develops its own 10-year health IT strategy. "This is a one-time chance to get in place the foundations," said Brailer, also noting that KP is privileged to have the money, capacity, and the people to accomplish the task. "Organizations like [Kaiser Permanente] are necessary to propel us into the far future."

    Scope and Scale

    For the first time, all eight of Kaiser Permanente's regions are operating on a common technology platform through KP HealthConnect. A change of this magnitude required significant IT infrastructure upgrades, as well as an unprecedented level of collaboration.

    This conversion has also had a profound impact on the day-to-day work of Kaiser Permanente physicians, clinicians and staff. More than moving from paper to electronic processes, the organization has completed extensive examinations of workflows and care practices to optimize the care members receive throughout our system. This has required significant training and support.

    The organization has always been honest and forthcoming regarding its successes as well as the challenges it has faced and overcome. Kaiser Permanente knows that these challenges of infrastructure, deployment, and adoption are not atypical for an IT implementation of our size and scope.

    To learn more about the impact KP HealthConnect is having on care, videos profiling real members and caregivers are available for viewing at http://www.youtube.com/kaiserpermanenteorg/