December 7, 2009

On the road to Kaiser Permanente HealthConnect®

Morris Collen conferring with informatician James Sweeney of Tulane University, 1969

Contributed by Lincoln Cushing, Archivist and Historian

Today Kaiser Permanente is a national leader in implementation of an integrated electronic health record. Kaiser Permanente physicians and specialists, nurses, pharmacists, lab technologists — all of the allied clinical professionals — can enter and retrieve data using a computer-based patient record cradled in security at any point of service from the medical office to hospital settings. Through Kaiser Permanente HealthConnect the member’s primary care physician and the clinicians involved in the total health care of the member can connect to information on therapies, interventions and preventive care to improve health and the quality of life.

Central Computer Center, Oakland, ca. 1969
Central Computer Center in Oakland, ca. 1969

The road that led to Kaiser Permanente HealthConnect goes back more than forty years when a secure, electronic health record in an integrated system was an aspiration of the team at Kaiser Permanente’s Medical Methods Research (MMR). In 1968 Morris F. Collen, MD and his team built a medical information system that peers described in the era as the most advanced of its kind. It was an aspiration of medical informaticians throughout the country, and Kaiser Permanente was uniquely qualified to deliver on the promise.

First some background. In 1963 the MMR team used an IBM 1440 computer to store patient clinical data collected in a discrete unit involved in the early detection of disease. The fledgling information system designed for the multiphasic screening exam stored patient identification data, physician examination and patient history data, lab results, and EKG and X-ray interpretations. Programmed rules and algorithms alerted physicians to diagnostic results that fell outside of normal limits. Patient histories were accessible to physicians for comparison study throughout the life of the patient. The system also advanced epidemiological research and evidence-based protocols.

With this as a starting point, MMR aspired to design a comprehensive information system with the patient record at its core and with ancillary subsystems for the storage of pharmacy and lab pathology data; administrative information (patient identification / account services); and hospital information (admissions, bed utilization, inventories). With computing ability to store and retrieve pertinent data amassed over years, the design called for real-time reporting and 24/7 communication of essential medical data at all points of service, with robust security protocols to protect member confidentiality.

By 1969 system design had matured and the National Center for Health Services Research and Development Agency funded a five-year pilot implementation at the San Francisco Kaiser Foundation hospital and medical offices.

Within four years the San Francisco Kaiser Foundation hospital and physician offices were recording and storing patient registration data and physician diagnoses from 13 outpatient clinics for 2000 visits daily in its medical, surgical, pediatric and obstetrical clinics. Pharmacists in the outpatient pharmacies entered 1,200 prescriptions daily into the appropriate electronic patient records. A clinical laboratory subsystem handled data for 3,000 daily lab tests. Electrocardiogram, pathology and radiology reports were recorded via IBM magnetic tape-selectric typewriters. All systems data was fed via phone data line from a Honeywell mini-computer on-site in San Francisco to the central IBM computer in Oakland.

Though the project terminated in 1973 when the granting agency went out of existence informaticians viewed the Kaiser Permanente San Francisco integrated system as a milestone achievement in medical information systems. A. F. Westin, Professor of Public Law & Government at Columbia University drew note to its distinction when he said that “few other medical institutions have moved as far in the development of a computerized medical record system.” Donald Lindberg, MD, the current Director of the National Library of Medicine, remarked: “…by far the most advanced of all American general MISs was that at Kaiser Permanente.”