Kaiser€Permanente€HealthConnect™ -...

Pamela Hudson, Vice PresidentKP HealthConnect National Business Program

Kaiser Permanente HealthConnect™The Substance, Strategy, and Impact of Kaiser Permanente’sElectronic Health Record (EHR) System

March 2007

2 © Copyright Kaiser Permanente

Agenda

• Kaiser Permanente Before KP HealthConnect• KP HealthConnect Deployment• Lessons Learned


Before KP HealthConnect (circa 2002)

• Nine silos (8 regions + national)• No common platform• Numerous disparate IT systems• Limited standard data elements• Expensive IT maintenance costs• Region (physician) owns the paper medical

record• In 1999, began to build a nationwide Clinical

Information System (CIS)


Integration & Leveraging•Medical services are

integrated with wellnessactivities; care deliveryprocesses are integratedwith health planoperations

•IT functionality enables usto leverage scarce orspecialized clinicalresources MDs, RNsand other clinical staff.

Secure and seamlesstransitions

•‘Warm Handoffs’ Thehuman skill sets andoperational processesto deliver care andservice effectively,efficiently, andcompassionately.

Customization•Occurs at any level of the members’journey with KP

(choosing health plans, cost sharing, individual carepathways, and communication modalities.)

•The member drives customization and KP responds.

Home as the Hub•The home, and other settings, will grow significantly as a locale of

choice for some care delivery (diagnostics).•An individual’s care delivery support system has expanded to

explicitly include other community and family resources

The Kaiser Permanente “ Blue Sky” Vision


“Lights On”

Deployment Rollout

“ Lights on” to “ Blue Sky”

StabilizationStabilizing what

we have deployed

IntegrationIntegrating with other initiatives

and business systems

OptimizationLeveraging the system to

achieve transformation

Benefits Realization


KP HealthConnect: Fundamental Redesign of Health Care

FoundationalTrends

Cost pressures

Aging population

Financial burden ofnew technologies and

drugs

Lack of a nationalhealth policy

FoundationalTrends

Consumer demand forservice

Consumer demand forchoice

Conversion of fataldiseases into chronic

illness

Health care lag behindother industries

Components of Care Delivery in 2015

Customization•Members select care•Communication modality

determined by member•Language preference

defined by member•Members have access to

medical record

Integration andLeveraging

•Cohesive approach toproviding care

•Enhanced access tospecialty expertise

•Member informationaccessible across alllocations

Secure and SeamlessTransitions

•Members asked forinformation once

•Members contact “realperson”when desired

•Proactive outreach

Home as the Hub• Integration with “smart”

homebased diagnostictechnology

• Remote member access toafterhours clinical staff

• Home monitoring by “caremanager”

Future Care Delivery Model“A ConsumerCentric Paradigm”

KP HealthConnect capabilities are required to fulfill the future requirements of the Care Delivery strategy.


Charting/Documentation

Automated Reminders(Preventative & Monitoring Tasks)

Improve compliance withpractice guidelines

Internet AccessEmail communications,

online health information, etc.

Medication Order Entry

Application Benefit

Remote Access

Clinical Decision Support

Reduce prescribing errors

Increased physician convenience,timeliness, efficiency

Degree of com

prehensive data and integration required

Improved diagnosisand disease management

Quality measurement andimprovement plus care researchIntegrated EHR

Inpatient, Outpatient, Lab , Pharmacy, etc.

Improved patient accessand convenience

Improve effectiveness throughaccess to patient history

Individual Practitioner

Group Practice

Health CareOrganization/Community

Leveraging Clinical IT


Kaiser Permanente HealthConnect™

• More than just an electronic medical record• The development and deployment of a highly

sophisticated information management anddelivery system

• A programwide system that will integrate theclinical record with appointments, registrationand billing

• A complete health care business system thatwill enhance the quality of patient care


Kaiser Permanente HealthConnect™ Goals

Quality Our PatientsCan Trust

High Quality• We have clinical information

available 24/7.• Our clinical outcomes are

unsurpassed.• Our clinicians know in realtime

the recommended best practices.• We are the national leaders in

patient safety.• We enhance our research to

support evidencebased care.

Personal & ConvenientService

Personal• We have and use uptodate

clinical, social and patientpreference information.

• We provide patients information forshared decision making.

• We enhance personalized care.Convenient• Our patients access information

via telephone, Web and email.• We actively support our patients’

participation in their own care.• We minimize wait times and outof

pocket costs with efficient accessto care.

• We achieve superior integrationand continuity of care.

AffordableHealth Care

Affordable• We reduce the cost of care and

improve visit experiences.• We eliminate waste associated

with paper medical records andmissing medical records.

• We eliminate costly inpersonservices unless medicallynecessary or desired by thepatient.

• We streamline IT andadministrative processes andcosts


Scope of Kaiser Permanente HealthConnect™

Lab

Radiology/Imaging

Others(immunizations,EKG, dictation)

OutpatientPharmacy

Health Plan

ClaimsProcessing

Membership/Benefits

BenefitsAccumulation

PricingSystem

Web Access Portal

Data Warehouse / EDR Enterprise Data Repository

Ancillaries

Ref

erra

l & U

tiliz

atio

n M

anag

emen

t

Finance

CapitalPlanning

GeneralLedger

FinancialReporting

Care Delivery Core

Outpatient Inpatient

Scope of KP HealthConnect Suite

Scheduling

Registration

Clinicals

Billing

Health InformationManagement

Admission, Dischargeand Transfer


Clinicals

Billing

Pharmacy

EmergencyDepartment

Operating Room


www.kp.orgMember Web Portal

Members Can Actively Participate in Care

Make/change appointments

Send email to doctor

Check lab results

Access health Information

Access medical record

Expanded Online Access for Members

Account summary

Review eligibility & benefits

Care Delivery Core

Outpatient Inpatient

Scope of KP HealthConnect Suite

Scheduling

Registration

Clinicals

Billing


Admission, Dischargeand Transfer


Clinicals

Billing

Pharmacy

EmergencyDepartment

Operating Room

http://www.kp.org


• Your allergies• Your immunizations• Your lab test results• Your ongoing health

conditions• Past office visit

information• Online Rx refills

• Email your doctor• Your future

appointments• Your eligibility &

benefits• Request a change to

your medical record• Act for a family member

MemberCentric Services


System Enhanced with KP Clinical Content

• Access to library of KP knowledge and best medicalpractices at the point of care

• Tools and templates that facilitate the delivery ofevidencebased medicine

• Dynamic decisionsupport tools that enhance qualityand patient safety§ DrugDrug Interactions Alerts§ Drug Allergy Alerts§ Best Practice Alerts§ Health Maintenance Reminders§ Alternative Order and Medication Alerts

• Patient education and tools to support selfcare


Supporting Patient Safety

• IHI 100K Lives bundles• Drug alerts• Health maintenance reminders• Best practice reminders• “ Close the loop” with results, referrals, and

followup appointments• Patient safety metrics


Safeguards for Privacy

• Protects member privacy and keeps healthinformation secure

• HIPAA compliant• Administrative procedures, physical safeguards

and technical security mechanisms§ User authentication Unique user records, automatic logout of user

and/or securing of application, configurable password rules and aging§ Entity authentication –Automaticlogoff, unique user IDs, password, PIN,

biometrics, token, single signon§ Access control –userbased, rolebased and contextbased access§ Authorization control –rolebased and userbased access§ Web access control highlysecure internet connections with unique

passwords required


Challenges

System capability needed to:§ Share data and move information across 18

instances in 8 regions real time§ Provide a consistent data model to populate a

national data repository to support all reportingneeds§ Reduce variation and provide evidencedbased

clinical decision support and documentation§ Share successful work practices across the

country to streamline internal processes andreduce work variation


Challenges

DifficultVendor / Project Team/Regions Responsibility

DemandingRegions’Responsibilitywith help from National

Project Team

Formidable

Leadership &Regions’Responsibility

Collaborative Build

ImplementKP HealthConnect

Get Value fromKP

HealthConnect

• A clear plan for change andoperationalized use of theEpic system.

• Business goals enabled bythe Epic system

• Higher quality, more efficient,effective operations

• Sponsorship / leadership

Success is...

• Effectively trained users• Consistent and complete

system use• Ease of use

• Programwide system• Reliable, consistent

and maintainable• Robust functionality


With KP HealthConnect (circa 2007)

• Collaborative culture• One technology platform• Integrated systems

§ Inpatient/outpatient§ Inter/Intraregion

• Standardizing data elements• Retiring expensive legacy IT systems• Member owns the medical record and is

engaged in their own care


Percentage of KP Population Coverage by Year/Suite

Population coverage based on actual & planned finish dates

20042004

2005

2005

2005

2006

2006

2006

2006

2007

2007

20072007

2008

2008

2009

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Practice ManagementBilling & Registration

Outpatient Clinicals andDecision Support

Inpatient Clinicals KP HealthConnect Online

Revised 42406


Caregiver Benefits• Single, comprehensive medical record available 24/7• Alerts that support patient care by catching abnormal

results, negative trends, patient history, chronic problems,and drug/procedure combinations

• Access to current treatment guidelines via online referencesand resources

• Care Management Institute (CMI) protocols and standardtest/screens decision support

• Prescribe medication, order lab work, radiology and providereferrals at the pointofcare

• Expanded communications opportunities to improvepartnering between patient and caregiver§ After visit summary to support care post officevisit§ Secure messaging and other online services


KP HealthConnect Clinicals Ambulatory


Health Plan Benefits

• Eliminate waste associated with papermedical records and missing medical records

• Provision of multiple services in a single visit• Increased efficiency for office and emergency

room visits• Reduction in unnecessary office visits• Elimination of duplicate lab and radiology• More appropriate and timely referrals• Increased adherence to formulary


Early Value Realization

• 21st Century Care Innovation Work• Enhanced Care Team Communication• Increased Member Satisfaction• Secure Messaging and EHR Impact on Visit

Demand• Improved Patient Safety• System Retirement• Data Consistency/Reporting Efficiency

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