For several years, I followed and admired the organizational process and excellent results of Kaiser Permanente Health organization. I truly think that this is one of the best example of sustainable economic model and wise use of eHealth. Founded in 1945, Kaiser Permanente is the nation's largest not-for-profit health plan, serving more than 8.6 million members, with headquarters in Oakland, California It comprises:
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Several studies outlined the outstanding results of Kaiser Permanente as shown in one of previous presentations:
The whole system is build around empowerment of patient, increased collaboration between healthcare professionals and with the patients, pay per quality ad performance. The patients are encouraged to manage their own health, are educated and informed. They have their own health space (called My Health Manager) based on a web access provided by the supplier of technology - Epic Systems. Additionally, the HealthVault platform was connected to the EHR of Kaiser Permanente and allows the exportation of medical results to the PHR.
On the healthcare professionals side, the ICT tools are very advanced with the use of EHRs with Clinical Decision Support, agreed Care paths and clinical process management. This would not be possible without semantic interoperability and agreed terminology. The integration along the clinical process allow them to achieve a multi-specialty coordination for chronic conditions and outstanding results.
A recent study published in March 2009 shown that "Kaiser Permanente Colorado has significantly reduced the mortality rate for patients with heart disease, which is the US's number one killer for both women and men. Using team-based medical best practices and computer-supported care registries, doctors and clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent. Coronary Artery Disease is the dangerous buildup of plaque inside the coronary arteries. Cardiac mortality refers to all deaths related to heart events.
The ability of clinical care teams to coordinate their efforts in cardiac care is greatly enhanced by the availability of electronic health information-which provides instant access to patient information-and evidence-based clinical care guidelines and protocols.
What is the impact of Chronic Conditions : Ten percent of U.S. patients account for 80 percent of all health care costs, and 75 percent of those costs are related to chronic conditions. CAD affects 80 million Americans and is one of the five top chronic conditions that drive the vast majority of health care costs. It remains the leading cause of death in the United States. Poorly managed, CAD too often results in hospitalization and early death. The American Heart Association and the National Heart, Lung and Blood Institute estimate that the total U.S. medical and social costs associated with heart disease and stroke was $475.3 billion in 2008.
Managing Chronic Conditions: Empowering People with Technology
Clinicians at Kaiser Permanente are working in teams and across departments and using electronic health information to help prevent manageable diseases, like CAD, from becoming life-threatening crises.
The care teams in Colorado tackled CAD by creating a new electronic care registry and support program called the Collaborative Cardiac Care Service. Recognizing the importance of early treatment and intervention, every patient who presented with CAD was enrolled in the program for both short- and long-term care.
Physicians, nurses and pharmacists, using proven CAD risk-reduction strategies, work collaboratively with CAD patients to coordinate care. Activities such as lifestyle modification, medication management, patient education, laboratory results monitoring, and management of adverse events are all coordinated across a multifunctional team.
The program is driven by agreed-upon, consistent clinical care guidelines and protocols that are integrated into Kaiser Permanente HealthConnectT as decision-support tools to guide the care teams, at the point of care, as they treated more than 12,000 CAD patients. Immediate access to reliable, evidence-based information at all points of care enables each care team member to support a given patient's care plan, encourage treatment adherence, and allow disparate care teams-from primary care to pharmacy to rehabilitation centers-to coordinate care, regardless of setting.
Clear Results: Better Survival Rates and Reduced Need for Emergency Interventions
The results were impressive. Nationwide, research indicates that fewer than 20 percent of CAD patients are expected to survive 10 years after their first heart attack. The coordinated, evidence-based care, enabled by KP HealthConnect and an electronic care registry, increased that survival rate dramatically. It is estimated that more than 135 deaths and 260 costly emergency interventions were prevented annually, as a result of improved care.
In addition, the program achieved the following results:
Implications for Health Care Policy and the Future of Care Delivery
These early results illustrate how coordinating activities between various health providers throughout the care delivery system, and equipping caregivers with real-time information, can support patient care and improve outcomes. Maximizing information for the clinician means optimizing care for the patient. Done well, a computerized system supports clinicians' efforts to spend more time with patients, have better information about their care and spend less time with traditional paperwork. Health information policy for the United States must include incentives not only for implementing electronic medical records in provider offices, but also for developing the skills of the people who use the tools and for coordinated use of information systems between providers. The value of information technology is directly related to how caregivers and staff use it and whether it supports sharing information between settings of care.
The right information systems and the right delivery system reform will create care teams that are able to coordinate care across every point of service-the physician's office, laboratory, pharmacy, hospital, on the phone, and even online-thus providing patients with affordable, well-informed, customized and compassionate care. " For more information see here.
What can we say? I think this is a brilliant example that we should follow in Europe. The tools are available: putting together on an integrated platform EHRs synchronized on line with Clinical Decision support and Process Management, coupled with a PHR (HealthVault) we can provide healthcare organizations with the tools to increase the quality of healthcare provided, decrease costs and explore new ways of payment of health professionals (such as pay per performance). For the existing implementations , using Amalga UIS would facilitate integration with HIS and other legacy system and achieve the vision of coordinated, integrated care. There are providers today able to offer the new type of EHR, EPR with clinical decision support- Medicognos, Fresenius, C-Systems and some others. They can be the suppliers of an integration system encompassing patient needs, health professionals activity and institutional management requirements. In one single view:
In perspective, the future will be to fusion the PHR and EHR in one synchronized platform with two views: one for patient and one for health professionals, each equipped with specific tools according to the activity of each user. As a first step, in order to achieve quick savings, the availability of an PHR such as HealthVault will be enough, as outlined in a speech of George Halvorson, the CEO of Kaiser Permanente.
As a conclusion, I encourage you to take several minutes and watch this video featuring from Kaiser Permanente CEO who suggests his version of how we should change health delivery and discusses prospects for health reform.
George Halvorson, CEO, Kaiser Permanente from Health 2.0 on Vimeo.
Dr Octavian Purcarea
Global Solutions Manager,
World Wide Health
Microsoft