using technology to achieve total health

Driving Total Health with Health IT and Health 2.0Ted Eytan, MD The Permanente Federation, LLC twitter:@tedeytan

Holly PotterVice President of Public Relations, Kaiser Permanente twitter:@htpotter

Conflict of Interest DisclosureTed Eytan, MD • Holly Potter

• Salary– The Permanente Federation, LLC (Eytan) – Kaiser Foundation Health Plan (Potter)

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Our Story: 2006 - 2010

Driving Total HealthHealth Information Technology as a toolHealth 2.0 as a potentiatorMeasuring our efforts and moving ahead

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(Your) HIT will generate interest

For its potential to fail...

Source: http://articles.latimes.com/2007/feb/15/business/fi-kaiser15

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For its potential to succeed...

(Your) HIT will generate interest

Source: http://www.signonsandiego.com/news/2010/jan/06/a-medical-breakthrough-va-kaiser-to-share-records/

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We Stand for Total HealthIntegrated Health Care

Easy, Excellent, Comprehensive

Commitment to PreventionAddress issues before they become problems

Empowering of the whole personBeyond health care - mind, body, spiritWhat you eat, the air you breathe, the environment you live in

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Kaiser Permanente: By The NumbersDoctor office visits} 36.7 millionPrescriptions filled} 129 millionSurgeries} 547,338Mammograms (women ages 42 to 69 years)} 1.1 millionColorectal cancer screenings} 1.6 millionResearch and evaluation studies} 3,150Biobank DNA samples collected} 110,000+Peer-reviewed journal articles published} 700+Community grants awarded} 2,400+Environmental Leadership Awards} 27HIMSS Analytics Stage 7 Awards} 24

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KP HealthConnect® – Enabling Patient-Centered Care

My Health Manager, part of a comprehensive electronic health record

Ambulatory deployment complete: 431 medical offices liveInpatient deployment nearly complete: 29 of 36 hospitals live24 HIMSS Stage 7 Hospitals

March 2010: Inpatient complete36 hospitals live

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My Health Manager – How big?

0

1,000,000

2,000,000

3,000,000

4,000,000

1Q 072Q 073Q 074Q 07 1Q 08 2Q 08 3Q 08 4Q 08 1Q 09 2Q 09 3Q 09 4Q 09

Registered members

40% signed on 11 or more times (in 2008)

91% of members satisfied or very satisfied with kp.org (survey in 2Q 2009)

Source: Kaiser Permanente Internet Services Group Web Analytics

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Transforming, Streamlining a System

0

1

3

4

5

Jan 2006

August 2008

Kaiser Permanente, Hawaii: Visits per Member

In PersonTelephoneSecure E-mail

“For the majority of (HEDIS Quality) measures that were comparable, performance remained stable during the study period.”

Source: Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: Transforming And Streamlining Modalities Of Care [Internet]. Health Aff. 2009 Mar 1;28(2):323-333.[cited 2009 Mar 11 ] Available from: http://content.healthaffairs.org/cgi/content/abstract/28/2/323

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...while prioritizing quality

50%

60%

70%

80%

90%

100%

2006 2007 2008

Hawaii Region Georgia Region

Source: Kaiser Permanente Integrated Analytics; Data is for commercial enrollees only; When I Grow Up (Hawaii) - Kaiser Permanente YouTube Channel - http://www.youtube.com/kaiserpermanenteorg

NCQA 2009 90th Percentile

Breast Cancer Screening • HEDIS 2009

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“Performance gets you the podium”

Jack Cochran, MD, CEO of The Permanente FederationNational Governor’s Association, Washington, DC

Providing care is inherently social

“Balancing Work and Family”Kaiser Permanente YouTube Channel

http://www.youtube.com/kaiserpermanenteorg

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Care delivery should be social, too

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Heather Heart,IT Support Manager, CO

“A Dashboard to My Job”

A future social workspace

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Health 2.0 = Participation“Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.” - http://www.tedeytan.com/2008/06/13/1089

Dave (Patient)

Kate (Physician)

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Our Converging PathsTed

(Washington) Holly

(California)

{ 2006 04 14 }

The Andon Cord and Patient Safety in EpicCare

“At any time during the production process at a

Toyota plant, any team member who spots a

problem can stop production by pulling the

“andon cord” located next to the assembly line.

An andon board (left) lets supervisors know the

location of the problem with a blinking light and a

distinct musical tone.”

This approach empowers employees to highlight defects and bring attention to their

solution without being penalized. When the line stops, everyone must stop what

they are doing and attend to the fix.

We have created a similar setup for EpicCare at Group Health. We now have

clinicians on call 24 hours a day, 7 days a week, to respond to any questions about

the functioning of EpicCare that are concerning for patient safety. In consultation

with the on call clinician, the “andon cord” will be pulled. When the cord is pulled, an

emergency response team will be assembled, which will do rapid analysis of the

problem and make decisions about next step.

The analogy here is the code team in a hospital, who will bring a code cart and

preparation to diagnose the patient and act quickly. Pulling the andon cord does not

mean that Epic will be shut down; it simply means that a team will be assembled

quickly and other work will stop.

The goal of this new process is “door to doc in 45 minutes.” We have had the

occasion already to use it in real time, and have been able to achieve this goal.

Posted by Ted Eytan on Friday, April 14th, 2006, at 6:31 am, and filed under

Safety. Popularity: 18%

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Participating as people . . .

May 28th, 2009 by Ted Eytan | Popularity: 36% May 28th, 2009 by Ted Eytan | Popularity: 36% | | Edit this entryEdit this entry 20 comments | show/add 20 comments | show/add »»

Is it meaningful if patients can’t use it?

I attended a smallish get together yesterday organized by Christine Kraft to think about Health

2.0 / DC in the epicenter type things, where we thought about some of the trends in social

media use, social media use by physicians and medical groups (I got a lot of help on this one),

journalists, and finally, a real story about a patient’s experience, here in DC, that really brings to

light a problem with a meaningful use definition that doesn’t include “and the patients can see

the data.”

I’ve been thinking about the idea that meaningful use must include “patients can see everything”

since ARRA came out, and see my first mention of it in the Twittersphere around April 22. I have

noticed since then that the idea seems to be picking up steam – initially I was told by some that

this would be a “distraction” to the conversation. Now I’m sure that it’s not. Read on…

This is the story of Regina Holliday – it’s really worth a read, and I’ll quote some of it here:

We will fight the good fight. Regina’s USA medical advocacy 2009

Why do we have more transparency in special education law then in medical care? Why do

we have more access to information on a box of Cheerios then on a medical chart? Why isn’t

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...and creating real relationships

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The full spectrum of engagement

The power of shared knowledge

“Connected”Kaiser Permanente YouTube Channel

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