PCHIT in California; Kaiser Permanente HealthConnect Online Leadership Meeting

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Kate Christensen, MD, Medical Director, kp.org, with Paulanne Balch, MD, Physician Lead for HealthConnect Online, Colorado Region

Greetings from Oakland, where I have been graciously invited to attend a get together of Kaiser Permanente’s clinical and business leadership for HealthConnect Online, which serves the personal health record connected to the electronic health record, HealthConnect, and accessible through kp.org.

I will say that even in the absence of the PCHIT work, I would want to be here. Why? Because I have always thought that the most innovative staff within Kaiser Permanente support the HealthConnect project, and the most innovative of that group support HealthConnect Online.

This was the first such meeting with every Kaiser Permanente region now fully live with the PHR, with Ohio up now for 30 days. And from my perspective, the news is good. As each region of the system discussed their current and future plans for the PHR, commentary focused on value of each feature for the members. I really liked what Gail Sands, Director of Innovative Projects for the Ohio region said: “This is the patient’s chart. They should know what’s inside.”

Strides in Transparency

  • More regions than ever are now sending laboratory results to patients at the same time they are being sent to doctors. The Northern California region moved this way in August, 2007, and with an annual volume of 21 million lab tests, this is significant. The experience of patients and care teams is showing that more transparency is better.
  • The Mid-Atlantic Region has opened up the schedule books online, allowing patients to select and make appointments with their primary care providers. Mid-Atlantic in general has been one of the most active in pioneering new features for members.

Patient-entered data: Getting there

There has been a big interest in members themselves entering data into the electronic health record, with several solutions attempted. With a good evaluation of the patient experience, the discovery is that the technology may not be ready to implement across populations. Another discovery is around the type of information that members want to add to their chart, which includes not only things like blood pressure, but also tracking things like weight and other measures of wellness and health. There are many tools out there that allow for tracking of a wide variety of biometrics, so this is promising information, when combined with the idea that a health care organization like Kaiser Permanente can integrate this data directly into the health record and the care experience.

My sense is that routine entry of data by patients directly into the health record will be possible across a large population like this when it can be assured that when members add to their medical record, it’s easy to do, relevant to them, and it reduces uncertainty for themselves and their care teams.

13 Replies to “PCHIT in California; Kaiser Permanente HealthConnect Online Leadership Meeting”

  1. Also of great interest is our members' participation in our Total Health Assessment, and Balance program for weight loss. Very impressive data on sustained weight loss. Suggests that to be truly member centered, we need to provide a variety of access formats: on-line visits/interactive programs, phone visits, mobile phone, group visits. With this many options, we will see the role of face-to-face visits begin to recede, as we empower people to direct and implement, rather than just receive, their care.

  2. Hi Ted & Paulanne:

    This is exciting stuff!

    Can you tell me how Kaiser Permanente (or Group Health for that matter) is using that consumer/member-generated data as information triggers for the prescription of Ix (the proactive delivery of tailored health content) to help members better manage their health?

    Thanks,
    Josh

  3. Josh –

    Why yes, I can, and thanks for asking. For Group Health, their Health Profile was launched in October, 2006, and it combines information from the electronic health record and the patient's own information to deliver tailored content both to the patient and to care teams.

    Kaiser Permanente is doing similar work, and in fact showed off some very impressive data around some of the improvements they are seeing in members' health and health care from using these services, just as Paula states above. I will check into providing some of that detail here.

  4. I like Gail's comment from a philosophical point of view – but is the information organized in a useful and understandable format – as we know neither clinicians or patients necessarily want or need to see EVERYTHING in the longitudinal record.

  5. Rachel, who are we to decide what the patient wants to see in their medical record?

    As each KP region implemented KP HealthConnect's ambulatory application many decisions were made re what historical information should be migrated over – how many years of lab results, which lab results, as well as which health conditions come over as active and chronic vs every cold, etc.

    In speaking with Ohio's chief of Behavioral Health re: mental health and A/CD information she wanted as much information to be made available not only to other clinicians (within legal guidelines) as well as to patients. How can organizations such as Kaiser ad Group Health be successful group practices if everyone involved in the patient's care does not have a view into their total health. Certainly the very confidential or information that could harm a patient is not made available.

    While Ohio has had only a month's experience presenting patient information to them – the response has been overwhelmingly positive. It takes the KP Promise – caring with a personal touch, we know you, convenient and easy and affordable one step closer.
    One of our region's major competitors from a care delivery perspective vs insurance) has the PHR tool. Their physicians decide what the patient will see (i.e. health conditions) and whether the patient can communicate with them online.

  6. Ted,

    It's exciting to see patient-entered data populating EHRs finally arrived. It generates a highly needed complement to our current reactive-driven healthcare delivery. Structured queries to members through portals will improve identifying factors that impact on outcomes. While providers may not be ready for patient-entered data, the literature is strong on how computerized data collection not only is perceived as having more "privacy" by patients (who knew?), but is more complete and more accurate. A quick review of comparative measurement research shows that screening both teens and adults, e.g. on substance use, sexual practice and mood disorders, yields higher rates of self-report by computer than face-to-face or paper surveys. Patient satisfaction is higher as well.

  7. Thanks for your comments, Gail! yourself and the team from Ohio made an impression on the group, because you have been able to take the accumulated knowledge of all of the other regions and deploy them with confidence for Ohio members. And you are right there with the rest in supporting complete transparency. I have so many discussions with folks about "how do we spread innovation," and here you have done what many think is complicated – using what works, even though you didn't invent it.

    Rachel, you also make the point that in your service to a very wide diversity of people in New York State, you don't have to just be there in the support of transparency (which I know you are); you have to go to the extra step of doing it in a health literate way.

    I suppose my question at this point would be: Gail, what is the patient population that you serve in Ohio like? And are there challenges in terms of language, health literacy, or accessibility of the information that you encounter?

  8. Susan,

    Your comments also hit upon a strong desire of the group this week – everyone wants to realize the dream of the proactive, prepared health system that is there for patients before they are in need. I actually misinterpreted how interested the team is in making this happen – it's extremely high, to the point of really quite thoroughly reviewing all of the options available to make it work. They're ready to get the data and use it to help people, now.

    Group Health has been accepting structured patient entered data into its EHR since October, 2006, and as you can probably imagine, it's a big win.

  9. glad to see my comment elicited such response! To Gail – I wasn't implying that it would be a unilateral decision but a shared one – which requires a process for input. I have heard from many clinicians that they don't want to see everything in a patient's history which could include myriad hospital tests etc etc that have no bearing on the patient's visit or current health needs. I was getting after simplicity and relevance as themes, not paternalism.

  10. When Kaiser nationally kicked off its Translation Services initiative it discovered that Ohio could be a Center of Excellence for Eastern European cultures. In addition, Ohio's membership is made up of a high percentage of Medicare members (18%. While language challenges are minimal we do deal with health literacy. The latest METEOR report shows that 15% of the members surveyed either have online access and do not use it or do not have access. When we were promoting registration in our facilities a few of the members (many Medicare) indicated that they did not have access to the Internet nor were they interested in access if it would be provided via kiosks in the facilities or from a Senior Center or the library.

    Rachel – apologies for misunderstanding your comment and I agree there is no point in seeing tests results from an inpatient stay 4 years ago for a problem that has been resolved.

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