An Overview of Health IT @ Kaiser Permanente

NIST Health IT Symposium Series – Gaithersburg, MD

April 15 2013

Walter G. Suarez, MD, MPH

Executive Director, Health IT Strategy and Policy, Kaiser Permanente

walter.g.suarez@kp.org
Copyright © 2013 Kaiser Permanente, Slide 2

Topics

Our History, Model and Mission

Transforming Care through Health IT

Health IT-enabled Quality Improvement Mission, Vision, and Strategy

Innovations and Telehealth/Telemedicine Mission, Vision, and Strategy

Opportunities and Challenges Ahead Mission, Vision, and Strategy
How Americans Receive Their Medical Benefits

149 M 48 M 69 M 11 M 49 M

Employers Medicare Medicaid

& State

Individuals Uninsured

- 6 M + 6 M + 15 M + 15M - 30 M

TODAY

2016

Copyright © 2013 Kaiser Permanente, Slide 3
Copyright © 2013 Kaiser Permanente, Slide 4

Our History, Model, and Mission
 Integrated health care 

delivery System

 9+ million members

 175,000+ employees 

 8 Regions Serving 9 states 

and the District of Columbia

 17,000+ physicians,

48,000+ nurses

 Nation’s largest nonprofit health plan

 37 hospitals and medical centers

 650+ medical offices

Pharmacies, Labs, Imaging Centers

 $50+ billion 2012 revenue

Kaiser Permanente by the Numbers

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 Founded in 1945
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Kaiser Permanente was born out of the challenge of providing medical care during 

the Great Depression and World War II, when most people could not afford to go to 

the doctor. 

From the Desert to the Shipyards

 1933: Dr. Sidney Garfield establishes a prepayment health plan for workers 

building an aqueduct in the California desert.

 1938-45: Henry Kaiser persuades Dr. Garfield to set up a prepaid group 

practice plan for workers and their families, first at the Grand Coulee Dam 

construction site, then during World War II at Kaiser shipyards in California 

and Washington.

 1945: Kaiser health plans are opened to the public in California, Oregon, and 

Washington.
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Innovative Ideas in a Fee-for-Service World

 Prepayment

 Group practice

 Prevention/total health

 Population-based approach

 Clinical information technology

Photo: Sidney Garfield, MD (left):

Surgeon, visionary, and trailblazer

Henry Kaiser (right): An entrepreneur who 

revolutionized ship-building and started global 

enterprises, including cement, steel, aluminum, 

and automobiles
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Our Mission and Vision

Mission: to provide high-quality, affordable 

health care services and to improve the 

health of our members and the communities 

we serve.

Vision: To be a leader in Total Health by 

making lives better.
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Our Blue Sky Vision

Integration and 

Leveraging

IT functionality enables us to 

leverage scarce or specialized 

clinical resources - MDs, RNs and 

other clinical staff and make our 

processes more efficient. 

Secure and seamless 

transitions

‘Warm Handoffs’ - The human skill 

sets and operational processes to 

deliver care and service 

effectively, efficiently, and 

compassionately.

Customization

Occurs at any level of the members’ journey with KP 

Home as the Hub

Focus on patient needs

The home, and other settings, will grow significantly 

as a locale of choice for some care delivery

Four Core Elements:

• Total health, patient-centered, connected care

• Integrated/coordinated vs independent/fragmented

• Prepaid vs Fee-for-service

• Common, interoperable EHR system vs

incompatible/disconnected systems
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Transforming Care through Health 

Information Technology
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Where is the US in the Health IT Adoption?

Doctors with EHRs and Multifunctional Health IT Capacity

97% 92%

98%

69%

56%

82%

98%

68%

60%

33%

27%

10% 7% 4%

0%

20%

40%

60%

80%

100%

120%

UK AUS NETH USA CAN GER NOR

Source: Commonwealth Fund 2012 International Health Policy Survey

Percentage of Primary Care Doctors

Using EHRs

with Multifunctional Health IT Capacity
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U.S. EHR Adoption by Practice Setting, 2011

11 physicians or more

86%

Health maintenance 

organizations

100%

Solo practitioners

29%

3- to 10 doctor offices

62%

Academic health

centers

69%

Community health

centers

73%

0%

20%

40%

60%

80%

100%

120%

Source: National Center for Health Statistics Data Brief, July 2012
Kaiser Permanente HealthConnect®

• The world’s largest and one of the 

most advanced civilian deployments 

of an electronic health record

• KP HealthConnect was implemented 

specifically to transform care and 

service delivery

• Our greatest benefits are the 

resulting improvements in quality, 

effectiveness, efficiency, safety, and 

support for new health delivery model

Kaiser Permanente Health IT:

 Combination of tools, resources, 

processes and workflows working 

together in an integrated environment 

to deliver high-quality affordable health 

care 

 A program-wide system that integrates 

the clinical record with population 

management, patient/consumer 

interface, telehealth, administrative and 

consumer support systems

“...the right information 

about the right patient 

available to the right 

provider all the time...”

Our Investment in Health IT

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Kaiser Permanente Health IT

 HealthConnect ® Electronic Health Record System

 Member/Patient Portal

 Clinical Decision Support and Population 

Management

 Interoperability - Standards - Terminology

 Health Information Exchange, CCC, CIMI

 Health IT-enabled Quality Improvement
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Kaiser Permanente typically spends about 5% of our total revenue on information 

technology. KP HealthConnect (our integrated system for care delivery) is:

Kaiser Permanente HealthConnect

 More than just an electronic medical record

 A Program-wide system that integrates the clinical record with appointments, 

ancillary and specialty services, registration, and billing

 A complete health care business and management system that enhances the 

quality of patient care

 A personal health record for more than 4 million Kaiser Permanente members 

(60% of members over 13 with Internet access)

Note: Return on investment was estimated at 8.5 years (but this was a 

strategic investment, not based on ROI)
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Kaiser Permanente HealthConnect

 More than just an electronic medical record

 A Program-wide system that integrates the clinical record with appointments, 

ancillary and specialty services, registration, and billing

 A complete health care business and management system that enhances the 

quality of patient care

 A personal health record for more than 4 million Kaiser Permanente members 

(60% of members over 13 with Internet access)

Note: Return on investment was estimated at 8.5 years (but this was a 

strategic investment, not based on ROI)

Linking across patient episodes, providers, settings

Decision Support Tools

System Modules
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kp.org and myHealthManager

Health Services More Accessible

 Appointment Manager

 Renew prescription orders

 Access to lab results

 Special conditions (i.e., allergies, medications)

 Email with providers

 Access to medical record information (problem lists, 

medical history, immunizations, tests, etc)

 Download health record (“Blue Button”)

 Tools to select providers, locate services

 24x7 Call Center

Wellness and Engagement

 Health encyclopedia online 

 Access to HealthWise Manual

 Health Calculator

 Tools for self-evaluation of health conditions

 Announcements

 Educational programs

 Healthy Living educational modules
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53% of U.S. adult cell phone 

owners have smartphones.

One in three cell phone owners 

have used their phone to look 

for health information.

The KP app can help you:

 locate facilities

 access medical records

 refill prescriptions 

 make appointments 

 email caregivers 

 view test results

KP App - Anytime, Anywhere Access

Pew 2012 Mobile Health Survey
• Access to library of KP knowledge and 

best practices at the point of care

• Tools and templates that facilitate the 

delivery of evidence-based medicine

• Dynamic decision-support tools that 

enhance quality and patient safety

– Drug-Drug Interactions Alerts

– Drug Allergy Alerts

– Best Practice Alerts

– Health Maintenance Reminders

– Alternative Order and Medication Alerts

• Proactive alert and notification system

Clinical Decision Support and Population 

Management Tools

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Panel Support Features

• Tools to support the systematic analysis and 

management of all patients assigned to a 

providers using national guidelines

• Effective in managing and improving the health 

of predefined population and sub-population 

groups, the short- and long-term quality of 

services, and the improvement of service 

coordination and continuity of care

Population Management and Panel Support Tools

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• Tools include 

interactive, real-time 

graphic display of 

‘vital signs’ of a 

provider’s panel

• Comparative analysis 

of results

• Different levels of 

specificity of 

indicators

Population Management and Panel Support Tools

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Panel Support Tools for Specialists

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Standards and Interoperability

• KP has always been at the forefront of 

development, adoption and use of health IT 

standards

• Currently actively engaged in most national 

and international SDOs including ISO, HL7, 

ASTM, DICOM, X12, NCPDP, NQF, others

• Applied across entire spectrum of programs 

and services (clinical, labs, pharmacy, 

imaging, administrative, research, etc)

• Developed Convergent Medical Terminology 

(CMT) tool to cross-reference multiple clinical 

terminologies

• Engaged in additional multi-lateral efforts to 

advance interoperability

– Clinical Information Modeling Initiative (CIMI)

– Care Connectivity Consortium (CCC)

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What is Interoperability?

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Our Vision of Interoperability

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Standards and Interoperability

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Standards and Interoperability

Drivers and Challenges

DRIVERS

• HIPAA

• Meaningful Use

• Health Reform

– Insurance Reform: Health Insurance 

Exchanges

– Care Delivery Reform: Care Coordination, 

Seamless Transitions of Care

– Payment Reform: Performance/outcomes 

based bundled payments

CHALLENGES

• Rigidness vs flexibility

• Required vs situational

• Benefits vs Risks

• Multiplicity of disjointed requirements

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HITECH EHR Incentive Program (Meaningful Use)

• MU serves as a great impetus to further improve health care quality, service and safety

• Financial incentives are resulting in significant increase in national health care system's 

adoption of EHRs

• KP actively prepared for MU, reached out to regulators to offer perspectives, and is 

exceeding requirements into areas beyond MU

• Because Kaiser Permanente has invested heavily in health IT over many years, we are 

well-positioned to meet meaningful use objectives -- but not without hard work and 

dedication

• Like other health care providers, we have to look at our technologies with fresh eyes and 

examine ways to make it more meaningful

• We are now focusing on achieving full compliance with the next MU milestone (Stage 2)

• We believe that this work and the investment in HIT is important and will change the way 

each and every person receives health care in the future

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Health Information Exchanges

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Care Connectivity Consortium (CCC)

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What’s not working today....

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What we are achieving

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Next Steps

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Clinical Information Modeling Initiative (CIMI)

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Clinical Information Modeling Initiative (CIMI)

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Health-IT Enabled

Quality Improvement
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Examples of Quality Improvement

 We have reduced mortality from sepsis 

infections by 40%.

 Our Healthy Bones program has reduced 

broken bones for our senior patients by 

nearly one-third.

 The death rate for our HIV patients is half 

the national average, due to our highly 

effective HIV team care programs.
• HIT-Enabled Diabetes Care

 44% lower failure rate of metformin treatment for type 2 diabetes

Examples of Quality Improvement

• HIT-Enabled Cholesterol Management

 40% more very high risk patients achieve national cholesterol guidelines 

• HIT-Enabled Screening

 Best breast cancer screening rates in US

 Best HIV/AIDS screening rates in US

• HIT-Enabled Cardiac Care

 24% lower probability of death from heart attack

 62% lower probability of serious heart attacks doing permanent damage

 90% lower mortality from second heart attacks

 89% lower all-cause cardiac mortality

1

2

3

4

• HIT-Enabled Patient Satisfaction

 Higher patient involvement in care

 Over 800% more scheduled e-visits

 Almost 600% more secure messaging with doctors

 24% fewer office visits

5

Copyright © 2013 Kaiser Permanente, Slide 39
Secondary Failure of Metformin Monotherapy in Clinical Practice; Jonathan B. Brown, Christopher Conner, and 

Gregory A. Nichols ; Diabetes Care March 2010 volume 33 number 3 

References

Attainment of Low-Density Lipoprotein Cholesterol Goals in Coronary Artery Disease; Amy B. Kauffman, Kari L. 

Olson, Morgan L. Youngblood, Emily B. Zadvorny, Thomas Delate, John A. Merenich, Clinical Pharmacy Cardiac 

Risk Service Study Group et al. ; Journal of Clinical Lipidology May 2010 Volume 4, Issue 3

NCQA 2008 Quality Compass ® , Healthcare Effectiveness Data and Information Set (HEDIS) ; National 

Committee on Quality Assurance ; see also subsequent years’ HEDIS.

Development of National and Multiagency HIV Care Quality Measures ; Michael Horburg; Institute of Medicine, 

Board on Population Health and Public Health Practice , Testimony, February 28, 2011

1

2

3

4 Collaborative Cardiac Care Service ; Brian G Sandhoff, Susan Kuca, Jon Rasmussen, John A Merenich ; 

Permanente Journal, 2008 Volune 12 Number 3 ; See also, James A Vohs Award for Quality, 2007 and 2009

Preventing Myocardial Infarction and Stroke With a Simplified Bundle of Cardioprotective Medications; R. James 

Dudl, MD; Margaret C. Wang, PhD, MPH; Michelle Wong, MPH, MPP; and Jim Bellows, PhD ; American Journal of 

Managed Care. 2009;15(10)

Population Trends in the Incidence and Outcomes of Acute Myocardial Infarction; Robert W Yeh, Stephen Sidney, 

Malini Chandra, Michael Sorel, Joseph Selby ; New England Journal of Medicine 2010 ; June 10, 2010; 362: 2155-

2165

Transforming and Streamlining Modalities of Care; Catherine Chen, Terhilda Garrido, Don 

Chock, Grant Okawa, Louise Liang ; Health Affairs ; March/April 2009, Volume 28, Number 2

5

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Innovations and 

Telehealth/Telemedicine

@ Kaiser Permanente
INNOVATORS

Kaiser Permanente Innovation Ecosystem

Innovation Fund, 

Challenge & Awards

Innovation 

Lab

Innovate Community:

Ideabook, Intranet 

Innovation Retreat &

Innovation Hunters

Clinical 

Advisors

KP Ventures 

& Corporate 

Development

Innovation

Learning

Innovation Tech 

Research & 

Services Kaiser Permanente

Simulation

National Facilities Services: 

Strategy Planning & Design

Innovation Learning 

Network

Innovation 

Consultancy

8 Research Institutes & 

Fdn

Garfield Innovation 

Center

Center for Total 

Health

INNOVATORS

Copyright © 2013 Kaiser Permanente, Slide 42
Sidney R. Garfield Health Care Innovation Center

 37,000 sq. ft. simulated care delivery

environment for testing new ideas and designs

– Located in San Leandro near Oakland Airport

– Funded internally by Kaiser Permanente

– Opened 2006

 Space includes:

– Inpatient clinical mockups

 Full sized med/surgery unit & patient rooms

 Labor, delivery, recovery & postpartum setting

 Operating room

 ED treatment bay

– Outpatient clinical mock ups

– Home health environment

– IAT technology laboratory

– Open prototyping area 

– Learning & conference space

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• Recognized national leader in 

telehealth adoption/implementation

• All hospitals and most medical clinics, 

imaging labs built with telehealth/ 

telemedicine capabilities

• HealthConnect® EHR supports 

telemedicine applications

• In 2011, implemented over 50 telehealth/telemedicine 

projects that provided 250,000+ visits/encounters

• Focus in two areas: management of chronic illness and 

delivery of specialty services

• Chronic patients Æ 5-10% of members Æ 60% of total costs

Copyright © 2013 Kaiser Permanente, Slide 45
• Personalized, 

patient-centered,

meaningful integrated

approach to the utilization of information 

and communication technologies to 

support health and health care services

• Involves multiple types of technologies 

and different modes of communication and interaction

• Tailored to the patient, the environment, the condition

• Requires care redesign, pathway/workflow reengineering, patient 

education, training of clinicians/workforce and system interoperability

• Involves:

– EHR, patient portal, low-level asynchronous communication, interactive 

teleconsultation (Patient-Provider and Provider-Provider), biometric 

monitoring, auto-upload, proactive communication

– Support for wired, wireless, home-based, mobile platforms

A New Framework for Telehealth/Telemedicine

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Opportunities and Challenges Ahead

Innovations;

mHealth; Cloud

Patient/Provider ID 

Management

Scalability

Provenance 

of Data

Cybersecurity

Health 

Reform

Consent 

Management

Big Data

Semantic 

Interoperability

Genomics

Trust

Copyright © 2013 Kaiser Permanente, Slide 47
CONTACT:

Walter G. Suarez, MD, MPH

Executive Director, Health IT Strategy and Policy

Kaiser Permanente

walter.g.suarez@kp.org

Thank You!