In 1989, Southern California quality guy Sam Sapin, MD, made a prescient plea to Kaiser Permanente leadership: invest in information technology to improve quality of care. Having worked on quality issues for decades, Sapin saw the need for a database to be shared among all regions.
“This would allow us to compare ourselves to each other,” Sapin told a gathering of Kaiser Permanente quality professionals. He continued: “The data must be accurate, otherwise one loses credibility and effectiveness. The data must be timely, not two to three years old, because the environment changes quickly these days. . .We need to develop data that will show the outside world — the public, employers and legislators — how good we are.”
Twenty-two years later, Kaiser Permanente is positioned to capture detailed patient data across all Kaiser Permanente regions and to analyze it in many different ways to learn what’s working and what isn’t. With an abundance of data, KP can not only record adherence to best clinical practices, but also potentially figure out more precisely how treatment affects outcomes.
In 2002 when George Halvorson took over Kaiser Permanente as president and CEO, the Care Management Institute was well on its way to performing the essential function of developing and sharing best practices among all Kaiser Permanente physicians. But Halvorson, acutely interested and knowledgeable about medical information systems, was not satisfied that Kaiser Permanente was on the path to develop a patient data system that would support his vision for quality improvement.
He brought in Louise Liang, a physician, medical director and quality professional who had worked closely with Total Quality Management expert Donald Berwick at the Institute for Healthcare Improvement (IHI). She led the program-wide monumental task of finding an appropriate vendor, figuring out the best software and driving the implementation of Kaiser Permanente HealthConnect, ultimately the data collection and interpretation system that would transform Kaiser Permanente’s ability to assess and improve quality.
In 2005, Kaiser Permanente reorganized its quality management structure, creating the Kaiser Permanente National Quality Committee (KPNQC), which took the place of the Medical Directors’ Quality Committee. The NPNQC oversees all quality activities for hospitals, outpatient clinics, and outside care for all Kaiser Permanente regions.
Fully implemented in 2010, Kaiser Permanente HealthConnect has the capacity to generate comparable data across all Kaiser Permanente regions, thus enabling physicians and other quality analysts to measure and compare quality results from all of Kaiser Permanente’s facilities. KP HealthConnect also can use data to perform a much broader range of research to feed the CMI’s search for data to validate and refine Permanente best practices.
“Having data is extremely important,” Halvorson told the editors of the NCQA 20th anniversary report. “Whenever you have data you can reach conclusions and you can change process, you can re-engineer, you can make things better. But if you don’t have data, you don’t have any particular direction to go.”
He adds, “There is an evolution from process to outcomes, and measuring the mortality rate for different conditions is a wonderful measurement, sort of the ultimate definition of outcome. Measuring process is good, and a far better thing than not measuring quality at all, but organizations really need to focus on what happens to each person. How many people have failing kidneys is a great measurement.”
In her 20-year assessment of NCQA’s success in improving quality of care, President Margaret E. O’Kane concludes: “Our hard work has led to many gratifying and exciting results. In Northern California, for example, Kaiser Permanente has demonstrated that aggressive management of patients with coronary artery disease (CAD) pays off in the most important ways: fewer deaths.
“CAD is the leading cause of death in every other county across the U.S., but for Kaiser (Permanente) patients in Northern California it is second. This confirms that when quality measurement and science meet, patients benefit,” she wrote.
Kaiser Permanente’s electronic medical record system also makes it possible for physicians to access a patient’s full medical history anytime in any Kaiser Permanente facility.
“You never ever have to make a clinical decision about a patient without information,” Andy Weisenthal, Kaiser Permanente pediatrician and quality expert, told Charles Kenney, author of Best Practices: How the new quality movement is transforming medicine.” He adds, “I cannot tell you what that means to me as a doctor.”
Has Kaiser Permanente been successful in demonstrating its high quality of care? The abundance of accolades showered onto the Kaiser Permanente medical care program over the past decade speaks for itself.
In the fall of 2011, Kaiser Permanente received the highest rating in 11 effectiveness measures — more than any other health plan in the nation — in the 2011 NCQA’s Quality Compass results.
Kaiser Permanente also won J.D. Power & Associates first place awards, as well as the prestigious Davies Award for Kaiser Permanente HealthConnect, the patient data system.
Kaiser Permanente also distinguished itself by garnering Medicare five-star awards in five regions, outstripping other health plans in California, Hawaii, Colorado and parts of the Northwest. Only nine Medicare plans in the country earned five stars for the overall 2012 Medicare star quality rating.