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At Kaiser, “The EMR is the Foundation of Everything We Do”

Continuing his series of interviews about the business care for Health 2.0, here Scott Shreeve interviews Anna-Lisa Silvestre, the VP of Online Services for Kaiser Permanente.

SS: Anna-Lisa, nice to meet you. Tell me a little about your background?

AL: I started out with Kaiser Permanente 23 years
ago as a health educator. I was fortunate to be able to transition into
the interactive technology unit that was created in the mid 1990’s. We
had a singular focus on developing online capabilities back in the good
old HTML days. However, things have dramatically changed since then and
we now have over 2.5M members who have activated an online account; 60%
of those users signed on two or more times last year.

SS: What do you find is the thing that draws people to your online services?

AL: We have found that it is not just one online
service. For example, while we have found that most people initially
come online to access “Actionable” information, such as laboratory
results, they come back because they are finding value in the tools or
content that is available. And it is not just one or two capabilities,
it is many different things to many different people who have many
different needs. We have worked very hard to identify capabilities that
make the online consumer experience more effective – new services must
be something that the user needs to do (access lab tests), there must
be additional offerings that keep them there (appointment scheduling),
and the user interface must be as seamless and simple as possible.

Remember, we are just in v1 of our online activities. While Lab
online prescription refill was the initial motivator to go online, we
are continuing to enhance our offerings to ensure our content is
relevant and meaningful to our members. Providing members with
actionable information drives everything we do.

SS: How has Kaiser supported the online services effort?

AL: We currently have a team of approximately 150
people dedicated to creating the most useful, effective, and relevant
patient experience we can. In partnership with care delivery
operations, we plan, develop, and implement online capabilities for
Kaiser Permanente. We have recently been engaged in moving to a new Web
2.0 technology platform (Websphere 6.0.1.4) that will allow us to be
more nimble, more flexible, and more capable of integrating other
sources of data/content moving forward. This is a big step for us, and
we are excited to get there as quickly as possible.

Kaiser Permanente has been investing in engaging the patient for a
long time. We have over 60 years of longitudinal experience managing
our patients health. As an integrated system designed to care for
patients for life, we take the really long view in terms of our
investments, strategies, and how we measure our success. As a result of
this alignment, we are realy focused on prevention, primary care, and
patient engagement because we kno wall of these efforts get us to where
we want to be – patients, families, and communities that Thrive!

SS: How do you define Health 2.0?

AL: Health 2.0 implies that the consumers are
finally able to engage in their health and get connected to what they
need in term of their health. We have not had many applications to help
people make a behavior change in the past – where is our iHealth
equivalent app? You know, behavior change is really, really hard. The
more tools that are available to help people change their behavior the
better. I firmly believe in the “Let a 1,000 flowers bloom
philosophy. Since it is so hard to manage diabetes, manage weight loss,
or quit smoking, we need to provide as many tools as possible to help
personalize the quest for each individual. Health 2.0 is a descriptive
term for this new level of engagement.

SS: How did the KP mothership get engaged in Health 2.0?

AL: Well, we have been innovating online for a long
time. We have been fortunate, based on our size, to do some really
interesting tests with technology to improve how our we interact with
our patients interact with us. At the end of the day, you only get
value when the tools/technology is easy to use and allows consumers to
get connected to each other. It is as people begin to network, that the
network effect and synergies between information resources starts to be
realized. At Kaiser Permanente, we have been exceptionally fortunate to
have made a major investment in health care information technology.
From the core EHR investment, we have been able to wring out several
additional layers of value. Because we have demographic information, it
allows us to auto enroll patients in other services; because
information can be shared between our services, we can dramatically
improve our responsiveness; and because we have access to all this
information, we can measure, monitor, and improve our patients health
experiences much more rapidly.

We are very actively engaged at looking at all the emerging Health
2.0 tools/technologies that allow us to engage patients more
effectively. We are constantly looking at new businesses and new
business models that we think can help us accomplish our core
objectives.

SS: What has enabled KP to be successful in engaging the patient?

AL: I believe it is our breadth of services, our
focus on the ease of use, and our efforts to deliver
relevant/actionable services that matter to the patient. Its a very
simple formula actually, but much harder than what how  it sounds
(knowingly laughs).

SS: You guys have had several haymaker announcements over
the year with nearly every major player in health care? Do you mind
running through a couple of them?

AL: Yeah, here are a few notables:

Kaiser Permanente HealthConnect

  • KP HealthConnect, the electronic health record built on Epic
    Software code and customized clinical content from Kaiser Permanente,
    serves as the foundation of nearly everything that we do on kp.org. The
    fact that we have this level of clinical information is an exceptional
    foundation from which to build our online capabilities. We could have
    never gotten where we are without having Epic and MyChart as foundation
    elements.
  • We have accomplished a great deal in terms of implementing KP
    HealthConnect, but we believe that this is just the beginning. The real
    work lays ahead of us, optimizing the health information technology to
    transform the way we deliver care. There is so much we can do now that
    we are fully digital and getting more and more adoption by physicians,
    patients, and our health plan all the time.

My Health Manager on kp.org

  • The Kaiser Permanente personal health record on kp.org which allows
    members and their care teams to share the same medical information via
    KP HealthConnect.
  • In terms of online services, we have seen immediate value from our
    investment: nearly 100,000 people a day are coming online to make
    appointments, refill prescriptions and email their doctors. This is an
    incredible time saver for everyone, improves satisfaction,and improving
    convenience, and saving money for everyone involved.
  • It has also allowed us to begin to look at how primary care is delivered.

Microsoft Health Vault

  • We have announced a data exchange project with Microsoft Health
    Vault. We are currently planning for the exchange of information. We
    have completed the prototypes that are required to test the concept,
    and begun the validation work.
  • This is not to mention all the security, legal, and regulatory work
    between HIPAA and non-HIPAA covered entities (that is pretty
    interesting in and of itself). It is highly complex to figure out all
    the things required to move data around.

Google Health

  • In full disclosure, I have served on the advisory council for Google since 2007
  • We have had a number of conversations with Google. We look forward
    to continuing the dialog around bi-directional information flow between
    our two organizations.
  • A lot of our conversations have been focused on standards –
    including our desire to use CCD and Googles experience with the CCR at
    the Cleveland Clinic.

Veterans Administration

  • We have been approached by several government organizations to
    help make their intakes much easier. We have all this information that
    is useful for them and they are asking us to work with them.
  • This particular project has to do with eligibility/demographic exchange between one Provider (KP) and another Provider (VA).

SS: What is it about KP that has allowed you to be so far out on the edge?

AL: It’s a good question; and actually Kasiser
Permanente is quite a unique place. We are a non-profit, fully
integrated (insurance, provider, and members all a part of a single
organization) delivery system with an extensive array of offerings and
a 60 year history of caring for our members. As a result, we are fully
aware of the need for preventive services to be applied across the
lifetime of the member. It is in our best interest, to have the
patients best interest top of mind. Innovation, an important part of
what Health 2.0 offers, helps us stay in front of this curve and more
importantly deliver these advances in the most efficient, relevant, and
engaging way possible.

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