Kaiser Permanente Implements Electronic Health Record (EHR) System

Kaiser Permanente is an integrated healthcare organization founded in 1945. The company operates one of the nation's largest not-for-profit health plans, with over 9 million health plan subscribers. Kaiser Permanente also includes Kaiser Foundation Hospitals (encompassing 37 hospitals) and The Permanente Medical Groups, with 611 medical offices. The company employs nearly 176,000 people, including 17,157 physicians. Its 2012 operating revenue was almost $51 billion.

HealthConnect is the name of Kaiser's comprehensive health information system. Over the past decade, HealthConnect has been a leader in the implementation of electronic health records (EHR), computer-readable records of health-related information on individuals. In 2003, Kaiser had announced its intention to work with Epic Systems Corporation over a three-year period to build an integrated set of systems to support EHRs, computerized physician order entry, scheduling and billing, and clinical decision support at an estimated cost of $1:8 billion. This decision came after Kaiser had already made several unsuccessful attempts at clinical automation projects. The project eventually ballooned into a seven-year, $4:2 billion effort as the scope of the project was expanded time and again. Training and productivity losses made up more than 50 percent of the cost of the project as Kaiser had to cut physicians' hours at clinics during training and was forced to hire physicians temporarily to handle the workload.

However, in 2010, Kaiser announced that it had fully implemented EHR applications at all of its hospitals and clinics. Finally, it could begin reaping the benefits from its efforts.

The HealthConnect system connects Kaiser plan subscribers to their healthcare providers and to their personal healthcare information. The system uses EHRs to coordinate patient care among physician's offices, hospitals, testing labs, and pharmacies. The EHR is designed to ensure that patients and their healthcare providers all have access to current, accurate, and complete patient data. The system and its data are now accessible via smartphone as well as personal computer. During 2012, there were over 88 million subscriber sign-ons to the system.

Physicians and nurses in hospitals, clinics, and private offices document treatment in the EHR system. After a physician enters a diagnosis into the system, he or she may receive a system message indicating that there is a "best practice order set" available for treating the condition. When they enter a medication order, physicians receive alerts about potential allergic reactions or adverse drug reactions based on other medications a patient is already taking. Physicians also receive automatic notifications about how lab test results should affect medication orders.

HealthConnect also provides capabilities to support bar coding for the safe administration of medicine. Under this system of administering medication, the nurse first scans the patient's barcoded identification wristband. The nurse next scans a bar code on the medication container that identifies the specific medicine and dosage. The system verifies that this medicine and dosage has been ordered for this patient. If there is not a match, the nurse receives an audible warning signal.

Kaiser has found that use of a comprehensive EHR improves health plan subscribers' satisfaction with the healthcare delivery system. In addition, HealthConnect empowers healthcare plan subscribers to take more responsibility for managing their own health care. Kaiser subscribers can access HealthConnect via a Web portal at kp.org. Here they are able to view most of their personal health records online, including their lab results, medication history, and treatment summaries. Patients can enter their own readings from blood pressure and glucose meters.

They can also securely email their healthcare providers, which cuts down on the amount of time patients spend on hold waiting to speak to a doctor and on the number of office visits (the number of outpatient visits has dropped an average of 8 percent in the one and one-half years following EHR implementation at each hospital). Each month patients send over 1 million emails to their doctors and healthcare teams through this component of the system. Over 29 million lab test results were viewed online in 2011. In addition, approximately 827,000 prescriptions are being refilled online monthly, and 230,000 appointments are scheduled monthly.

HealthConnect enables physicians to benchmark their performance against colleagues on a number of fronts- efficiency, quality, safety, and service. Hospitals can also benchmark each other on measures such as adverse events and complications. "Best in class" practices can be identified, and physicians and hospitals can borrow these best practices from one another to further improve the overall quality of care. As the EHR system is further enhanced, Kaiser will likely find new ways to reap benefits from its system to improve efficiency and the quality of healthcare.

Kaiser began working on implementing an EHR system in 2003 and finally completed the implementation in 2010. Along the way, the company tried several different approaches, ran into numerous problems, and spent millions of dollars. It is just now beginning to reap the benefits from this effort. It likely will take time, further system enhancements, and additional expenditures for many other organizations to see similar benefits.

Discussion Questions
1. What troubles did Kaiser run into when it first tried to implement the EHR system? Is Kaiser's experience typical of leading-edge companies? If so, how?

2. Researchers associated with Kaiser Permanente have used the patient record database to make numerous worthwhile discoveries in the areas of preventing whooping cough, determining the correlation between HPV vaccination and sexual activity in young girls, improving methods of cancer detection, avoiding blood clots in women using birth control pills, and lowering cholesterol.

Do you think that access to this valuable data should be granted to researchers not associated with Kaiser Permanente? Should researchers be charged a fee to access this data to help offset the ongoing cost of upgrading the system?

Critical Thinking Questions
1. What strategic advantage does Kaiser gain from its EHR system?

2. What do you think are the greatest benefits of the HealthConnect system for Kaiser Permanente subscribers? Can you identify any potential risks or ethical issues associated with the use of this system for Kaiser healthcare plan subscribers? How would you answer these questions from the perspective of a physician or nurse?