Plenary Session Kaiser Permanente Healthcare It Journey
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5/9/2012 1 Kaiser Permanente's Healthcare IT Journey George C. Halvorson Chairman and Chief Executive Officer Kaiser Permanente Kaiser Permanente Kaiser Permanente is both a health care delivery system and a health insurance/financing mechanism. 2
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eHealth Week 2012 Presentation by George C. HalvorsonChairman and Chief Executive OfficerKaiser Permanente
Transcript of Plenary Session Kaiser Permanente Healthcare It Journey
5/9/2012
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Kaiser Permanente's Healthcare IT Journey George C. Halvorson Chairman and Chief Executive Officer Kaiser Permanente
Kaiser Permanente
Kaiser Permanente is both a health care delivery system and a
health insurance/financing mechanism.
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Hospitals
Clinics
Labs
Pharmacies
Image Centers
Etc.
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We provide all elements of care:
Kaiser Permanente
We are the largest private medical groups in the world and
we are one of the largest hospital systems in the U.S.
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Kaiser Permanente
We serve nine million member/patients.
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Kaiser Permanente
We employ 180,000 workers -- almost all in care delivery.
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Kaiser Permanente
We have annual revenues of $50 billion dollars.
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Kaiser Permanente
We are “prepaid” for our care.
We sell a total package of care.
We are not paid based on separate fees that are charged for separate pieces of care.
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Kaiser Permanente Flexibility
We can use the $50 billion we receive in revenue to provide the care that our
patients need… rather than just delivering the pieces of care to patients
that build a FFS piecework revenue stream for us.
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Kaiser Permanente
We are accountable for the total care -- and for the total health --
of our nine million members.
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Kaiser Permanente
We need to make smart decisions about how we
deliver care and how we create health.
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Kaiser Permanente
We know that --
Care costs are not evenly distributed.
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What does that tell us?
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It tells us to focus and it tells us to intervene.
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Who are the patients that are creating the major costs of
care?
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Are the high cost patients cancer, contagious disease,
broken bones and lacerations, and acute care patients?
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Do we spend most health care dollars on cancers, cuts, contusions,
concussions, and colds?
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NO.
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Cancer, contagious diseases, broken bones and lacerations,
and acute care patients?
Most care costs come from chronic conditions.
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Chronic diseases create 75% of the costs of care
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75% 25%
Chronic Care
Acute Care
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Patients with multiple health conditions -- co-morbidities -- create 80% of the costs of care.
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80%
20%
Co-morbidities
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How is that information useful to us?
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1) It tells us where to focus.
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2) It tells us how to make a real difference in care and costs.
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Patients with co-morbidities and chronic conditions need --
TEAM CARE
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We need the right care and we need consistent care… with teams of caregivers focused on the needs of
individual patients.
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Chronic Care Patients
Question:
Do you want your health care provider to work as a team to coordinate your care?
Answer: YES (97%)
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Chronic Care Patients
Question:
Do your health care providers work as a team to coordinate your care?
Answer: No (46%)
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How can we create team care, connected care, right
care, and best care?
Think Tools --
We need care support tools to help make that work possible.
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What tools do we need?
1. Data
2. Connectivity
3. Continuous improvement skills and processes
4. Care support protocols and tools
The Prime Directive:
Make the right thing easy to do!
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To make the right thing easy to do, we need to:
1. Figure out the right thing.
2. Make it easy to do.
(Make the right thing easy to do is the CMI mantra and the systems
commitment at Kaiser Permanente)
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Paper medical records are a huge impediment to care quality
and care improvement.
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Paper is isolated, inaccessible, not interactive, incomplete, and
often inaccurate.
Paper is -- at its best -- inert.
Paper is isolated, inaccessible, not interactive, incomplete, and often inaccurate -- it is at its best -- inert.
Paper records do not and cannot make the right thing easy to do.
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To deliver best care for each patient, we need real-time
information about all of our patients at the point of care.
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All All All
(Mantra number two)
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We very much need the caregivers who share patients to share data about their patients.
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We also need real-time information about medical science and best practices
available to our caregivers at the point of care.
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There are 60,000 medical journals published every year.
Medical science changes continuously. No caregiver can
keep up on their own.
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So what did Kaiser Permanente do to go
down those paths?
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We invested four billion dollars in building an electronic medical record and a set of care support tools for our care sites and care
teams.
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We have real-time and complete electronic patient information for our doctors
at the point of care.
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We have real-time information about most current medical science and best practices
available for our doctors and care teams at the point of care.
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We also now have the data needed to track care and to do real-time medical research and
process improvement.
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We have completely linked our care delivery facilities -- with
paperless lab reports, electronic transmissions of tests, and
electronic care reporting for our hospital and medical care.
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We probably have the lowest insurance related
administrative costs of any health plan in America.
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We have the best patient/doctor connectivity
-- through our electronic connections to our patients.
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We win just about every quality award in America.
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Top HEDIS scores in
21 categories.
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Medicare rated 459 health plans -- using 53 quality and
service measures.
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Health plans were rated from one to five stars.
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Only nine health plans in America earned five stars.
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Five Kaiser Permanente Regions won the full five stars --
and our lowest score for any KP Plan was 4.5 stars.
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We won the “Star Wars” for Medicare.
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We were also rated number one as a health plan by
J.D. Power & Associates.
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You can look up our consumer ratings.
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The tool kit works.
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Team Care Works
Reduced broken bones by 43%
Reduced HIV deaths to half the national average
Reduced heart disease deaths by 30%
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We also have set up important programs to
support safe care.
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Sepsis kills more patients in American hospitals than cancer, heart disease or
stroke.
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We put data supported team care in place for our sepsis patients -- and we cut the death rate from
sepsis by more than half.
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0
0.05
0.1
0.15
0.2
0.25
3981
4
3984
5
3987
3
3990
4
3993
4
3996
5
3999
5
4002
6
4005
7
4008
7
4011
8
4014
8
4017
9
4021
0
4023
8
4026
9
4029
9
4033
0
4036
0
4039
1
4042
2
4045
2
4048
3
4051
3
4054
4
4057
5
4060
3
4063
4
4066
4
4069
5
4072
5
4075
6
4078
7
4081
7
Sepsis Hospital Mortality Rates
Source: Joint Commission Journal on Quality and Patient Safety, November 2011
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If the rest of America had that same Kaiser Permanente sepsis response program in place, that would have saved 72,000 lives in America last year -- and reduced eight million
very expensive hospital days.
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Likewise -- with hospital acquired pressure ulcers --
focused science based team care can make a huge difference.
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Roughly 2.5% of patients in American hospitals get
pressure ulcers -- and many patients are damaged and
killed by those ulcers.
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Team care at Kaiser Permanente has reduced pressure ulcers by
two thirds.
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0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
Q208 Q308 Q408 Q109 Q209 Q309 Q409 Q110 Q210 Q310 Q410 Q111 Q211 Q311 Q411
All KP Hospitals CalNOC Average
CalNOC (2008) Average
KP Average
CalNOC consists of a coalition of California hospitals who are working together on patient safety issues.
Hospital-Acquired Ulcers (HAPU) Stage 2 Plus
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Having extensive and available data about care facilitates both
care improvement and care quality improvement agendas
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Our Board of Directors focuses on quality as a major
part of our governance process.
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Our Kaiser Permanente Board of Directors Quality Committee meets
more often and longer than our Board Finance Committee or our Executive
Committee.
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We provide the KP Board and senior leadership with a monthly update
on more than 200 measures of safety and quality.
The Big Q
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The Big Q report is available to any Board member at any time
by electronic reporting.
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•Health Plan Quality
•Healthcare Analytics
•Patient Safety
•Performance Improvement
•Population Health
•Quality Management
•Resource Stewardship
•Risk Management
•Service Quality
-- We Steer Toward Quality --
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HEDIS National 90th Percentile
• KP also invests in leading edge technology such as Archimedes.
• Archimedes is a person specific computer simulation model used to understand the likely health outcomes and costs of decisions from the policy level to individual patient decisions.
• Archimedes is now assisting the European Health Checks project.
• Targeted health checks for individuals at the highest risk are cost-effective.
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Archimedes
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We focus on quality and we use our systems to support our
quality improvement efforts.
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We also focus on connectivity.
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Our website -- KP.org -- was used a hundred million times by our
members and patients last year.
We started connecting with our members on the internet in large scale
efforts five years ago.
Our member website -- KP.org -- was used more than a hundred million
times last year.
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Our patients can use the internet to:
See their medical record
Make appointments
E-mail their doctors
Order prescription refills
Learn about their health or care
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We sent out 60 million lab results electronically last year.
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We believe that up to 40% of face-to-face patient visits might
be done electronically.
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We now do 40% of our dermatology visits with video
links and e-connectivity.
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Our new Android and iPhone app had nearly two million uses
in the first month.
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New Mobile Apps
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Patients love being connected.
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So where do we go from here?
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The Four Sites of Care
We believe that care in the future will be delivered in four distinct “sites of care.”
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Site One -- Staffed Beds
Hospitals
Nursing homes
Places where people sleep and care is delivered.
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Site one will be incredibly and increasingly well supported
with great technology.
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Site Two -- Face-to-Face
Clinics, Offices
Direct ambulatory caregiver encounters
Exam rooms
Wide array of care sites (Offices, work places/ vans / etc.)
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Site two will also be incredibly and increasingly well supported with great
technology.
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Site two technology will be diagnostic, therapeutic,
communicative and remediative -- with full EMR connectivity and
care linked to patient specific care plans.
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Site Three -- In-Home Care
The home will be a primary site of care.
Care tools will be on-site in many people’s homes.
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Site three will be incredibly and increasingly well supported with great
technology.
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Some site three technology for in-home care two years from now will
be as good or better than actual hospital inpatient technology was
five years ago.
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In-home monitoring, EKGs, ultrasounds, video conferences, blood and fluid diagnostic and
testing tools and patient communication tools will be increasingly sophisticated,
effective, and cheap.
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For most people, the home will be the primary site of care -- very well equipped to be a
great site of care.
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In-home care will function best in the context of a care team
who knows the patient’s total situation and full set of care
needs.
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Site Four -- The Web
The internet will deliver a lot of care
Connected, web-located care will expand rapidly
Web care will be available everywhere, all of the time.
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Site four will also be incredibly and increasingly well equipped
with great technology and tools.
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Portable EKGs
Care tracking
Electronic consults
Perpetual monitoring -- linked to interventions.
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Full data flow for each patient
Interactive diagnostic work and care planning.
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Entirely current, complete patient specific care data --
at a very low cost.
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The world is now flat for a lot of care.
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Next steps?
Continuous learning will be the future of health care.
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DNA
and Causality Research
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Research Question:
When mothers have a uterine infection during pregnancy --
does that create higher asthma risk for their kids?
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Answer:
YES
The asthma risk is a lot higher for the kids.
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African American kids
98% increase
Source: Archives of Pediatric and Adolescent Medicine
How much higher?
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Hispanic kids
70% increase
Source: Archives of Pediatric and Adolescent Medicine
How much higher?
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Caucasian kids 66% increase
Source: Archives of Pediatric and Adolescent Medicine
How much higher?
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Asian American kids
Source: Archives of Pediatric and Adolescent Medicine
???
How much higher?
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Asian American kids
Source: Archives of Pediatric and Adolescent Medicine
Zero % increase
How much higher?
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There was no additional risk for Asian American kids.
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African Americans
Hispanics
Caucasians
Asian/Pacific Islanders
increase 98%
70%
66%
0%
increase
increase
increase
Source: Archives of Pediatric and Adolescent Medicine
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KP is currently collecting DNA data.
200,000 samples -- stored in Berkeley.
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Chronic Care Patients
All Patients:
My health care data should be used to help improve the care of future patients who might have the same or similar conditions.
Agree: 89% Strongly Disagree: 3%
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One use of that data will be to figure out what might be a
genetic factor for the asthmatic kids.
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Electronic data lets us discover unexpected
linkages and unsuspected causalities.
Alzheimer’s Research
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High cholesterol
in 30s
260% higher Alzheimer’s rate
in 70s
(longitudinal data -- long time
members)
Hypoglycemic attack pre-60s
80% higher rate of Alzheimer’s
in 70s
(two attacks -- 160% higher
rate)
Heavy smokers in mid life
157% increased risk of
Alzheimer’s
172% increased risk of vascular dementia two decades later
(EMR Applied to Longitudinal Research)
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Autism Studies
30% Higher for older mothers
50% Higher for older fathers
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The risk of autism for children was three times higher when the
mothers to be took a particular drug in the first trimester of
pregnancy and twice as high if the mother took that same drug in the
second trimester.
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Which trimester is the higher risk?
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No one suspected any link between that drug and Autism --
until the Kaiser Permanente study was done.
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Kaiser Permanente patient data resulted in Vioxx being removed
from the marketplace.
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We need electronic data.
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We need electronic data to improve care.
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We need electronic data to improve science.
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We need electronic data to save lives.
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We need electronic data to link caregivers.
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So Kaiser Permanente is building a tool kit and learning to use the
new tool kit to make care better, safer, more accessible, smarter,
and less expensive.
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We spent four billion dollars at KP on computer based care
support tools.
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Our annual cost and expense level is more than five billion dollars a
year below where it would be if we did not have those tools.
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It’s a good time to use computers to support care.
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Be well
