Plenary Session Kaiser Permanente Healthcare It Journey
1. 5/9/2012
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
1
2. 5/9/2012
We provide all elements of care:
Hospitals
Clinics
Labs
Pharmacies
Image Centers
Etc.
3
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.
4
2
3. 5/9/2012
Kaiser Permanente
We serve nine million
member/patients.
5
Kaiser Permanente
We employ 180,000 workers --
almost all in care delivery.
6
3
4. 5/9/2012
Kaiser Permanente
We have annual revenues of
$50 billion dollars.
7
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.
8
4
5. 5/9/2012
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.
9
Kaiser Permanente
We are accountable for the total
care -- and for the total health --
of our nine million members.
10
5
6. 5/9/2012
Kaiser Permanente
We need to make smart
decisions about how we
deliver care and how we create
health.
11
Kaiser Permanente
We know that --
Care costs are not evenly
distributed.
12
6
8. 5/9/2012
15
What does that tell us?
It tells us to focus and it tells us to intervene.
16
8
9. 5/9/2012
Who are the patients that are
creating the major costs of
care?
17
Are the high cost patients
cancer, contagious disease,
broken bones and lacerations,
and acute care patients?
18
9
10. 5/9/2012
Do we spend most health care
dollars on cancers, cuts, contusions,
concussions, and colds?
19
NO.
20
10
11. 5/9/2012
Cancer, contagious diseases,
broken bones and lacerations,
and acute care patients?
Most care costs come from
chronic conditions.
21
Chronic diseases create 75%
of the costs of care
Chronic Care
75% Acute Care
25%
22
11
12. 5/9/2012
Patients with multiple health conditions --
co-morbidities -- create 80% of the costs of care.
Co-morbidities
80%
20%
23
How is that information
useful to us?
24
12
13. 5/9/2012
1) It tells us where to focus.
25
2) It tells us how to make a real
difference in care and costs.
26
13
14. 5/9/2012
Patients with co-morbidities
and chronic conditions need --
TEAM CARE
27
We need the right care and
we need consistent care…
with teams of caregivers
focused on the needs of
individual patients.
28
14
15. 5/9/2012
Chronic Care Patients
Question:
Do you want your health care provider to
work as a team to coordinate your care?
Answer: YES (97%)
29
Chronic Care Patients
Question:
Do your health care providers work as a
team to coordinate your care?
Answer: No (46%)
30
15
16. 5/9/2012
How can we create team
care, connected care, right
care, and best care?
31
Think Tools --
We need care support tools to
help make that work possible.
32
16
17. 5/9/2012
What tools do we need?
1. Data
2. Connectivity
3. Continuous improvement skills and
processes
4. Care support protocols and tools
33
The Prime Directive:
Make the right thing easy to do!
34
17
18. 5/9/2012
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)
35
Paper medical records are a
huge impediment to care quality
and care improvement.
36
18
19. 5/9/2012
Paper is isolated, inaccessible,
not interactive, incomplete, and
often inaccurate.
Paper is -- at its best -- inert.
37
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.
38
19
20. 5/9/2012
To deliver best care for each
patient, we need real-time
information about all of our
patients at the point of care.
39
All All All
(Mantra number two)
40
20
21. 5/9/2012
We very much need the
caregivers who share patients to
share data about their patients.
41
We also need real-time
information about medical
science and best practices
available to our caregivers at the
point of care.
42
21
22. 5/9/2012
There are 60,000 medical
journals published every year.
Medical science changes
continuously. No caregiver can
keep up on their own.
43
So what did
Kaiser Permanente do to go
down those paths?
44
22
23. 5/9/2012
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.
45
We have real-time and
complete electronic patient
information for our doctors
at the point of care.
46
23
24. 5/9/2012
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.
47
48
24
25. 5/9/2012
49
We also now have the data
needed to track care and to do
real-time medical research and
process improvement.
50
25
26. 5/9/2012
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.
51
We probably have the lowest
insurance related
administrative costs of any
health plan in America.
52
26
27. 5/9/2012
We have the best
patient/doctor connectivity
-- through our electronic
connections to our patients.
53
We win just about every
quality award in America.
54
27
28. 5/9/2012
Top HEDIS scores in
21 categories.
55
Medicare rated 459 health
plans -- using 53 quality and
service measures.
56
28
29. 5/9/2012
Health plans were rated from
one to five stars.
57
Only nine health plans in
America earned five stars.
58
29
30. 5/9/2012
Five Kaiser Permanente Regions
won the full five stars --
and our lowest score for any
KP Plan was 4.5 stars.
59
We won the “Star Wars”
for Medicare.
60
30
31. 5/9/2012
We were also rated number
one as a health plan by
J.D. Power & Associates.
61
You can look up our
consumer ratings.
62
31
32. 5/9/2012
The tool kit works.
63
Team Care Works
Reduced broken bones by 43%
Reduced HIV deaths to half
the national average
Reduced heart disease deaths
by 30%
64
32
33. 5/9/2012
We also have set up
important programs to
support safe care.
65
Sepsis kills more patients in
American hospitals than
cancer, heart disease or
stroke.
66
33
34. 5/9/2012
We put data supported team care
in place for our sepsis patients --
and we cut the death rate from
sepsis by more than half.
67
Sepsis Hospital Mortality Rates
0.25
0.2
0.15
0.1
0.05
0
39934
40756
39814
39845
39873
39904
39965
39995
40026
40057
40087
40118
40148
40179
40210
40238
40269
40299
40330
40360
40391
40422
40452
40483
40513
40544
40575
40603
40634
40664
40695
40725
40787
40817
Source: Joint Commission Journal on Quality and Patient Safety, November 2011
68
34
35. 5/9/2012
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.
69
Likewise -- with hospital
acquired pressure ulcers --
focused science based team care
can make a huge difference.
70
35
36. 5/9/2012
Roughly 2.5% of patients in
American hospitals get
pressure ulcers -- and many
patients are damaged and
killed by those ulcers.
71
Team care at Kaiser Permanente
has reduced pressure ulcers by
two thirds.
72
36
37. 5/9/2012
Hospital-Acquired Ulcers (HAPU) Stage 2 Plus
All KP Hospitals CalNOC Average
4.0%
CalNOC (2008) Average
3.5%
3.0%
KP Average
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Q208 Q308 Q408 Q109 Q209 Q309 Q409 Q110 Q210 Q310 Q410 Q111 Q211 Q311 Q411
CalNOC consists of a coalition of California hospitals who are working together on patient safety issues.
73
Having extensive and available
data about care facilitates both
care improvement and care
quality improvement agendas
74
37
38. 5/9/2012
Our Board of Directors
focuses on quality as a major
part of our governance
process.
75
Our Kaiser Permanente Board of
Directors Quality Committee meets
more often and longer than our Board
Finance Committee or our Executive
Committee.
76
38
39. 5/9/2012
We provide the KP Board and senior
leadership with a monthly update
on more than 200 measures of
safety and quality.
The Big Q
77
The Big Q report is available to
any Board member at any time
by electronic reporting.
78
39
40. 5/9/2012
-- We Steer Toward Quality --
•Health Plan Quality •Quality Management
•Healthcare Analytics •Resource Stewardship
•Patient Safety •Risk Management
•Performance Improvement •Service Quality
•Population Health
79
80
40
41. 5/9/2012
HEDIS National 90th Percentile
81
Archimedes
• 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.
82
41
42. 5/9/2012
We focus on quality and we use
our systems to support our
quality improvement efforts.
83
We also focus on connectivity.
84
42
43. 5/9/2012
Our website -- KP.org -- was used a
hundred million times by our
members and patients last year.
85
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.
86
43
44. 5/9/2012
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
87
We sent out 60 million lab
results electronically last year.
88
44
45. 5/9/2012
We believe that up to 40% of
face-to-face patient visits might
be done electronically.
89
We now do 40% of our
dermatology visits with video
links and e-connectivity.
90
45
46. 5/9/2012
Our new Android and iPhone
app had nearly two million uses
in the first month.
91
New Mobile Apps
92
46
48. 5/9/2012
The Four Sites of Care
We believe that care in the future will be
delivered in four distinct “sites of care.”
95
Site One -- Staffed Beds
Hospitals
Nursing homes
Places where people sleep
and care is delivered.
96
48
49. 5/9/2012
Site one will be incredibly and
increasingly well supported
with great technology.
97
Site Two -- Face-to-Face
Clinics, Offices
Direct ambulatory caregiver encounters
Exam rooms
Wide array of care sites
(Offices, work places/ vans / etc.)
98
49
50. 5/9/2012
Site two will also be incredibly
and increasingly well
supported with great
technology.
99
Site two technology will be
diagnostic, therapeutic,
communicative and remediative
-- with full EMR connectivity and
care linked to patient specific
care plans.
100
50
51. 5/9/2012
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.
101
Site three will be incredibly
and increasingly well
supported with great
technology.
102
51
52. 5/9/2012
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.
103
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.
104
52
53. 5/9/2012
For most people, the home will
be the primary site of care --
very well equipped to be a
great site of care.
105
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.
106
53
54. 5/9/2012
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.
107
Site four will also be incredibly
and increasingly well equipped
with great technology and tools.
108
54
55. 5/9/2012
Portable EKGs
Care tracking
Electronic consults
Perpetual monitoring -- linked to
interventions.
109
Full data flow for
each patient
Interactive diagnostic work
and care planning.
110
55
57. 5/9/2012
Next steps?
Continuous learning will be the
future of health care.
113
DNA
and Causality Research
114
57
58. 5/9/2012
Research Question:
When mothers have a uterine
infection during pregnancy --
does that create higher asthma
risk for their kids?
115
Answer:
YES
The asthma risk is a lot higher
for the kids.
116
58
59. 5/9/2012
How much higher?
African American kids
98% increase
Source: Archives of Pediatric and Adolescent Medicine
117
How much higher?
Hispanic kids
70% increase
Source: Archives of Pediatric and Adolescent Medicine
118
59
60. 5/9/2012
How much higher?
Caucasian kids
66% increase
Source: Archives of Pediatric and Adolescent Medicine
119
How much higher?
Asian American kids
???
Source: Archives of Pediatric and Adolescent Medicine
120
60
61. 5/9/2012
How much higher?
Asian American kids
Zero % increase
Source: Archives of Pediatric and Adolescent Medicine
121
There was no additional risk
for Asian American kids.
122
61
62. 5/9/2012
African Americans 98% increase
Hispanics 70% increase
Caucasians 66% increase
Asian/Pacific Islanders 0% increase
Source: Archives of Pediatric and Adolescent Medicine
123
KP is currently collecting DNA data.
200,000 samples -- stored in Berkeley.
124
62
63. 5/9/2012
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%
125
One use of that data will be to
figure out what might be a
genetic factor for the
asthmatic kids.
126
63
64. 5/9/2012
Electronic data lets us
discover unexpected
linkages and unsuspected
causalities.
127
Alzheimer’s Research
High 260% higher (longitudinal
cholesterol Alzheimer’s rate data -- long time
in 30s in 70s members)
Hypoglycemic 80% higher rate (two attacks --
of Alzheimer’s 160% higher
attack pre-60s in 70s rate)
172% increased
Heavy smokers 157% increased
risk of vascular
risk of
in mid life dementia two
Alzheimer’s
decades later
(EMR Applied to Longitudinal Research)
128
64
65. 5/9/2012
Autism Studies
30% Higher for older mothers
50% Higher for older fathers
129
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.
130
65
66. 5/9/2012
Which trimester is the
higher risk?
131
No one suspected any link
between that drug and Autism --
until the Kaiser Permanente
study was done.
132
66
70. 5/9/2012
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.
139
We spent four billion dollars
at KP on computer based care
support tools.
140
70
71. 5/9/2012
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.
141
It’s a good time to use
computers to support care.
142
71