Improving Care is What We’re After, Not Technology – Day 3 of #kppopcare – Kaiser Permanente Northwest

For day 3, we took a little sojurn from the medical office environment to meet the experts who created the Kaiser Permanente Northwest Panel Support Tool and are supporting the Kaiser Permanente Northwest health information technology infrastructure. It’s a little glimpse into the future right here in Portland.

It’s important to note that this part of Kaiser Permanente has been using the comprehensive electronic health record system behind KP HealthConnect longer than any other – more than 15 years, so you could almost say coming here is to find out what health information technology might look like in 2025, since many hospitals, doctors, and patients (!) in the rest of health care are just experiencing health information technology for the very first time in 2010. And yes, patients, since this part of Kaiser Permanente also piloted the first version of the personal health record for its members.

In 2010, this is a community where there is significant penetration of electronic health records, though, so having an EHR is not really differentiating, it’s how you improve care with it. And, having an EHR is not about having an EHR, it’s about managing the information that helps people, because the technology changes. Data that’s “close, fresh, complete” in an environment that’s about execution and integration around a person is hard to beat.

We learned that this region has 3 generations of patients with diabetes that it has been supporting through various iterations of the technology. The constant is not the technology, and from the way this group thinks, I’ll say it’s not even the data, it’s the people being taken care of.

We then got to interact with the group that includes medical leaders who work to coordinate the use of these systems. This group includes the legendary Homer Chin, MD, and Mike Krall, MD, as well as our awesome host, Rob Unitan, MD, and Adrianne Feldstein, MD, all of whom collaborated on the recently published research. More on that in a second. What caught my ear in the conversation, though, was the ability of this group to support workflow “at just the right time,” in Michael Krall’s words. For example, they don’t just have alerts and reminders at their disposal, they have a support suite that provides information in different contexts – some of it at the point of a health care visit where a medicine is ordered. But also at the point of the visit where a person’s care gaps are being reviewed, or when there is no visit and a physician, nurse, mid-level provider are reviewing their panel.

It’s not just about alerts anymore, when a system is matched holistically with a person. I asked Michael later in the day if the use of the panel support tool has diminished the need for certain alerts, and the answer is yes. What it does, interestingly, is use the human brain as an integrator. As Michael explained, there hasn’t been a lot of success creating alerts or reminders that fire on more than one thing at a time – for example, a patient with diabetes and a behavioral health diagnosis. The logic gets too complicated.

As a bit of an interlude, I spent time with Alex Lowenthal, the Senior Director of Care Delivery Informatics ( @alex_inpdx ), who I’ve known since I was at Group Health Cooperative, and exudes the attitude that I associate with the Pacific Northwest, which in my experience is independence of spirit and innovation. Watch this guy.

We visited later in the day with Yvonne Zhou, who is the lead author on multiple scholarly pieces of work that have defined the promise of health information technology in the industry, in my opinion – everything from demonstrating how the personal health record results in reduced in-person services use, to the more recent paper, about the impact of the panel support tool.

She explained something that I didn’t realize when I read the paper, which is that there is really nothing in the literature that studies a holistic approach to reducing care gaps in a population. Everything that has been studied has been about one condition, one reminder. We all know that this is not how patients live their lives. The breakthough here , then is going from 1 alert at a time to a holistic approach. Keep that in mind as you review the paper yourself.

I think Yvonne and Center for Health Research represent a future of health services research as well, which formerly included  pure, cleaned data sets that take a long time to acquire, and now have access to dynamically generated data around health care workflows that didn’t exist before, such as physicians e-mailing patients. I discussed this in a presentation during Health Innovation Week in San Francisco earlier this year. Great to see that things are moving ahead here.

Just one photo from today, overlooking downtown Portland, Oregon. The sun came out right after I took this one, as it should – things look bright here.

We’re not finished yet, today we’ll be spending time with specialty care providers. With great thanks to the team at @KPNorthwest working to create tools, keep them futuristic, keep them patient-centered throughout their lives.


Ted Eytan, MD