Kaiser Permanente HealthConnect™ ImplementationAndy Wiesenthal, MD, SM Associate Executive Director, The Permanente FederationMedicina en Red, II ediciónMadrid, 23 Octubre 2006

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Agenda

• About Kaiser Permanente• Kaiser Permanente Before KP HealthConnect• KP HealthConnect Deployment

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About Kaiser Permanente

• Integrated health caredelivery system

• 8.4 million members

• Nation’s largest nonprofithealth plan

• 12,000+ physicians

• 140,000+ employees

* 2004 revenues

• 8 regions serving 9 states and D.C.

• 30 hospitals and medical centers

• 431 medical offices

• *$28 billion annual revenues

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Our Structure

Kaiser Foundation Health PlansNonprofit, public-benefit corporations that contract with individuals and groups to arrange comprehensive medical and hospital services. Kaiser Foundation Health Plans contract with Kaiser Foundation Hospitals and medical groups to provide services.

Kaiser Foundation HospitalsA nonprofit, public-benefit corporation that owns and operates community hospitals in California, Oregon, and Hawaii; owns outpatient facilities in several states; provides or arranges hospital services; and sponsors charitable, educational, and research activities.

Permanente Medical Groups Partnerships or professional corporations of physicians. Each region has its own Permanente Medical Group. The Permanente Medical Groups assume full responsibility for providing and arranging necessary medical care in each region.

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Our Mission

To provide affordable, quality health care services and to improve the health of our

members and the communities we serve.

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Before KP HealthConnect (circa 2002)

• Nine silos (8 regions + national)• No common platform• Numerous disparate IT systems• Limited standard data elements• Expensive IT maintenance costs• Region (physician) owns the paper medical

record• In 1999, began to build a nationwide Clinical

Information System (CIS)

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Make vs. Buy Decision

• CIS strategy was risky and expensive• Epic offered much broader integrated

applications portfolio including outpatient, inpatient and practice management, web interface for members and providers, reporting capability

• Ten-year costs were substantially less than a build and maintain strategy

• Total involvement converted a push strategy to a pull strategy

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Why We Chose Epic Systems

• Epic’s solution ranked highest in our technology review. • Epic had the best track record for implementation and

partnering.• Integration less complex because elements are already in

use in certain regions within the Kaiser Permanente system.• Epic eliminates redundant entry, thus eliminating more work

steps, increasing operational efficiencies and improving customer service.

• Epic had the highest industry rankings for relationships and commitment.

• Epic was most closely aligned with Kaiser Permanente’s program strategy.

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Kaiser Permanente HealthConnect™

• More than just an electronic medical record• The development and deployment of a highly-

sophisticated information management and delivery system

• A program-wide system that will integrate the clinical record with appointments, registration and billing

• A complete health care business system that will enhance the quality of patient care

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Kaiser Permanente HealthConnect™ Goals

Quality Our Patients Can Trust

High Quality• We have clinical information

available 24/7.• Our clinical outcomes are

unsurpassed.• Our clinicians know in real-time the

recommended best practices.• We are the national leaders in

patient safety.• We enhance our research to support

evidence-based care.

Personal & Convenient Service

Personal• We have and use up-to-date clinical,

social and patient preference information.

• We provide patients information for shared decision making.

• We enhance personalized care.Convenient• Our patients access information via

telephone, Web and email.• We actively support our patients’

participation in their own care.• We minimize wait times and out-of-

pocket costs with efficient access to care.

• We achieve superior integration and continuity of care.

Affordable Health Care

Affordable• We reduce the cost of care and

improve visit experiences.• We eliminate waste associated with

paper medical records and missing medical records.

• We eliminate costly in-person services unless medically necessary or desired by the patient.

• We streamline IT and administrative processes and costs

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Blue Sky Vision Themes2015: care delivery model is consumer-centric

Home as the Hub• The home, and other settings, will grow

significantly as a locale of choice for some care delivery (diagnostics).

• An individual’s care delivery support system has expanded to explicitly include other community and family resources

Integration and Leveraging• Medical services are integrated

with wellness activities; care delivery processes are integrated with health plan operations

• IT functionality enables us to leverage scarce or specialized clinical resources - MDs, RNs and other clinical staff.

Secure and seamless transitions• ‘Warm Handoffs’ - The human

skill sets and operational processes to deliver care and service effectively, efficiently, and compassionately.

Customization• Occurs at any level of the members’ journey

with KP (choosing health plans, cost sharing, individual care pathways, and communication modalities.)

• The member drives customization and KP responds.

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Home As the HubSelf-monitoring with patient-based decision support

They are already on their own most of the time

The care teamIs notified of patient decisionsReceives all data, but attention is only drawn to data requiring a decision from the team

The office visit no longer defines the core activity of the primary care physician, true panel management does

Systems will deliver and maintain the decision support tools for patientsSort through and prioritize incoming dataProvide horizontal views of an individual patient and aggregate views of populations and subpopulationsAllow for easy intervention at the population level

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Secure and Seamless Transitions

The patient will not bear the responsibility for system navigation

Some transitions will be automated based on evidenceExample: a patient drops below an LVEF threshold for the first time, automatically triggering a cardiology referral, any indicated further tests before the referral, and an email to the patient helping them to make the appointment unless the APC doc chooses to redirect

The care team will not have to remember the navigation rules

This “business intelligence” will be built into the system

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Customization

Patients will choose how they want to communicate with the care team and the system will know that

Information delivered to patients can be tailored to their problems and social history and circumstances

An Enterprise Data Warehouse will help us craft a Life Care Planfor every member, based on everything we know (and some things other organizations know)The Life Care Plan will be actionable by the patient as well as the health care team

Mass communications to populations can be customized to each individual within the population

Example: “.lastlab” within a letter

Pre-visit questionnaires can result in better focus during a visit

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Integration and Leveraging

Scarcer adult primary care physicians will be more leveraged

More support staff doing more things for physician reviewNB: regulatory changes may be crucial here—the licensing world has to catch up with the capabilities of the new information world, and we should direct lobbying efforts toward that endManage the panel, not results and messages layered on to a day filled with visits

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Panel Members are in Control

Don’t devote resources to being at war with members in “trenches”

The system will let them control the simple transactionsAppointment making (just like the airlines)Lab and imaging results reviewManaging their illness according to guidelinesCommunicating with the team asynchronously—a huge potential time saver and satisfier for them and for the clinician

Take those resources not devoted to these functions and use them for communication management, panel management, and “outlier management”

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Scope of Kaiser Permanente HealthConnect™

Care Delivery Core

Outpatient Inpatient

Scope of Epic Suite

Scheduling

Registration

Clinicals

Billing

Scheduling

Admission, Dischargeand Transfer

Clinicals

Billing

Pharmacy

EmergencyDepartment

Operating Room

Lab

Radiology/Imaging

Others (immunizations, EKG, dictation)

Outpatient Pharmacy

Health Plan

ClaimsProcessing

Membership/Benefits

Benefits Accumulation

PricingSystem

Web Access Portal

Ancillaries

Ref

erra

l & U

tiliz

atio

n M

anag

emen

t

Finance

Capital Planning

General Ledger

FinancialReporting

Data Warehouse / EDR Enterprise Data Repository

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Regional Go-Live Schedule – KP HealthConnect As of 3-31-06

1Q ‘04 2Q ‘04 3Q ‘04 4Q ‘04 1Q ‘05 2Q ‘05 3Q ‘05 4Q ‘05 1Q ‘06 2Q ‘06

20042003 2005

4Q ‘063Q ‘06

2006

OHNC

ALSC

ALMA

SHI

NW

Collaborative Build Sent to Regions

Outpatient Registration & Prof Billing, Enroll&Benefits (10-20-03)

Outpatient Clinicals (5-31)

Outpatient Clinicals (9-8)

Phase 2: IP Clinicals( Clinical/ED Doc) OR Mgmt (TBD)

Outpatient Clinicals (11-30)

CDR Viewer (10-7)

Outpatient Scheduling Conversion (7-1-03)

Outpatient Registration, Prof Billing, Check In/Check Out (11-1) (End Date 5-1)

Outpatient Clinicals Conversion (2001)Phase 1 Inpatient: ADT, ED Mgr/Tracker, HIM, Hosp Billing, IP Pharmacy (1-14)

Outpatient Scheduling, Registration, Prof Billing, Enroll&Benefits (7-19)

Outpatient Clinicals (10-11)

Outpatient Registration, Prof Billing, Check-in/Check-out, Enroll&Benefits (10-25)

Outpatient Clinicals (2-2)

Outpatient Scheduling (12-3)

Outpatient Registration, Check-In (9-1)

Outpatient Registration, Prof Billing, Check In, Enroll&Benefits(12-8)

GA

Prof Billing, Enroll&Benefits ( 9-1), Hosp Billing (11-14)

Ends 12/07

Ends 6/08

EXEMPLA: ADT, Scheduling, ED Mgr/Tracker IPClinicals (Order Entry), IP Pharmacy, OR Mgmt, Hosp/Prof Billing (12-1)

Outpatient Scheduling, Registration, Prof Billing (6-25)

CO

http://kpnet.kp.org/kphealthconnect/pc/rcoordination.htm

Enroll&Benefits, Utilization/Case Mgmt, KPHC Online-Aff (12-15)

(Note: Orange County IPRx Implementation in 3/07)

OP Scheduling (6-6) Big Bang (7-12)

Enroll&Benefits (6-25) Utilization/Case Mgmt (Date TBD)

Phase 1 Inpatient: ADT, ED Mgr/Tracker, IP Clinicals (Order Entry), HIM, IP Pharmacy, Hosp Billing (10-1 TBD)

Phase 2: IP Clinicals (Clinical/ED Doc) OR Mgmt (2007 TBD)Outpatient Scheduling, Registration, Prof Billing, Enroll&Benefits (4-3) Big Bang (6-1)

Phase 3: IPClinicals: CPOE (2007 TBD)

[11/22/02] PHL (MyChart) Upgrade

KP HealthConnect Online-Mbr (8-22)

OR Mgmt (Under Discussion - Date TBD)

Q2/08

Phase 1 Inpatient: ADT, ED Mgr/Tracker, Hosp Billing, IP Pharmacy (6-24)

Phase 2: IP Clinicals (Clinical/ED Doc, Order Entry) and HIM, OR Mgmt (7-28)

Outpatient Clinicals (4-20)

Utilization Mgmt (TBD)

Utilization Mgmt (7-12)

KP HealthConnect Online-Mbr (5-9)

KP HealthConnect Online-Mbr (2007 TBD)

KP HealthConnect Online-Mbr (11-2)

KP HealthConnect Online-Mbr (8-17)

Phase 1 Inpatient: ADT, IP Clinicals (Order Entry), ED Mgr/Tracker & HIM/Chart Tracking (11-30)

Outpatient Clinicals (10-7)

HIM/Abstracting and Coding ( 6-15)IP Pharmacy (11-14)

Join Collaborative Build (5-7)

Join Collaborative Build (1-30)

KP HealthConnect Online-Mbr (8-5)

HIM/Chart Tracking (4-4)

KP HealthConnect Online-Mbr (11-13)

20071Q ‘07 2Q ‘07 4Q ‘073Q ‘07

KP HealthConnect Online-Mbr (7-28)

2008

Move to Hyperspace

IP Clinicals (Clinical Documentation) End Date 9/06)

FOR INTERNAL USE ONLY

Outpatient Scheduling w/Chart Pull (10-25)

Case Mgmt (12-6)

Utilization/Case Mgmt (Under Discussion - Date TBD)

Phase 3: CPOE (TBD)

Phase 2: IP Clinicals (Clinical/ED Doc), OR Mgmt (8-22) Phase 3: CPOE (10-10)

Phase 3: CPOE (9-5)Q3/09

KPHC Online-Aff (10-11)Case Mgmt (TBD)

CPOE St Joe’s Hospital (TBD) Lutheran Hospital (TBD)

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Objectives

Deploy the Epic suite of products in a multi-facility, multi-state

system within four years

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Challenges

System capability needed to: Share data and move information across 18 instances in 8 regions real timeProvide a consistent data model to populate a national data repository to support all reporting needs Reduce variation and provide evidenced-based clinical decision support and documentationShare successful work practices across the country to streamline internal processes and reduce work variation

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Challenges

DifficultVendor / Project Team/ Regions Responsibility

DemandingRegions’ Responsibilitywith help from National

Project Team

Formidable

Leadership & Regions’ Responsibility

Collaborative Build

Implement KP HealthConnect

Get Value from KP

HealthConnect

• A clear plan for change and operationalized use of the Epic system.

• Business goals enabled by the Epic system

• Higher quality, more efficient, effective operations

• Sponsorship / leadership

Success is...

• Effectively trained users• Consistent and complete

system use• Ease of use

• Program-wide system • Reliable, consistent

and maintainable• Robust functionality

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Areas of Risk

Project managementInfrastructure capacityInsufficient implementation support or

ongoing supportFocus on goals—

ImplementationBenefits realization

Leadership

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Approach to Implementation

Collaborative Build

•Fully Integrated System•Integrated Workflow

•Common Data Definitions & Model

•Common Interfaces

Regional Deployment

•Business Process Redesign•Regional Modifications and Mapping

to Collaborative Build•Order of Epic application deployment

based on regions’ priorityand business case

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Approach to Implementation

• Critical physician leadership and participation• Common system elements developed on a

national collaborative basis• Additional regional choices made to reflect

workflows• Implementation strategies developed and

supported jointly• Continuous evaluation and learning • Strong emphasis on capturing benefits

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Health Data Standards

KP HealthConnect meets national and international standards for the transmittal and storage of health data:

HL7SNOMED-CTLOINCRXNORMNICNOCNANDADICOM, etc.

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With KP HealthConnect (circa 2006)• Collaborative culture

Focus on sharing and leveraging lessons learnedQuarterly interregional deployment meetingsKP HealthConnect Users’ Conference

• One technology platform• Integrated systems (inpatient/outpatient and inter/intra-

region)• Standardizing data elements• Retiring expensive legacy IT systems• Member owns the medical record!

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Current StatusCollaborative build completed in October 200318/18 scheduled deployments completed in 2004Care Everywhere (synchronization) software successfully deployed in both

California regions in 200423 deployments scheduled for 2005—22 completed. Initial deployments of inpatient

clinicals in California delayed due to data center availability problemsBy end of first quarter 2006, the Practice Management Suite is 100% deployed,

Outpatient Clinicals is 60% deployed, and Inpatient Clinicals is about to be deployed—we are meeting a schedule that no one in the industry believed possible

Web functionality for members will be deployed in all regions except Ohio by Summer of this year

Several regions are embarked on optimizing use of the system

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Members Can Actively Participate in Care

www.kp.orgMember Web Portal Make/change appointments

Send email to doctor

Check lab results

Access health Information

Access medical record

Expanded Online Access for Members

Account summary

Care Delivery Core

Outpatient Inpatient

Scope of KP HealthConnect Suite

Scheduling

Registration

Clinicals

Billing

Scheduling

Admission, DischargeAnd Transfer

Clinicals

Billing

Pharmacy

EmergencyDepartment

Operating RoomReview eligibility & benefits

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Lessons Learned

• Consistency and local modification need to be balanced

• Centralized control vs. local autonomy• IT is the “great magnifier”• Integration into the basic work is critical• IT system drives massive change• Operational leadership is essential

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How does it work?

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How does it work?

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How does it work?

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How does it work?

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How does it work?

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How does it work?

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How does it work?

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Questions?