Press Releases: Ohio

November 1, 2005

Contact: John C. Westropp, 216-479-5079

Electronic Health Records: Technological Innovation on the National Front and at Kaiser Permanente

A talk by Andrew M. Wiesenthal, MD, SM, associate executive director of clinical information support, The Permanente Foundation

Wednesday, November 30, 2005
Clarion Hotel and Conference Center, 8 to 10 a.m.

About Dr. Wiesenthal
In his role as associate executive director of the Permanente Federation for clinical information support, Dr. Wiesenthal oversees development and deployment of automated medical records, decision support, and other clinical systems for Kaiser Permanente. His perspective and expertise is informed in part by his clinical experience as well as an interest in quality management. His clinical experience includes pediatrics and consulting on pediatric infectious disease consulting for the Colorado Permanente Medical Group (CPMG); he also led their quality management program and served as associate medical director for medical management, with responsibility for quality management, utilization management, regulatory compliance, risk management, credentialing and physician performance, and informatics.

Dr. Wiesenthal holds the BA in Latin American studies from Yale University and the MD from State University of New York, Downstate Medical Center, Brooklyn. After completing pediatric residency at the University of Colorado, he became an epidemic intelligence service officer with the Centers for Disease Control and Prevention. That stint was followed by a return to the University of Colorado for a pediatric infectious disease fellowship. He recently earned the MS in science in health care management from the Harvard School of Public Health.

KP HealthConnect: Program Overview
Kaiser Permanente HealthConnect is a highly-sophisticated information management and care delivery system designed to enhance the quality of patient care. KP HealthConnect integrates the electronic medical record with appointments, registration and billing. The system will also link KP facilities across the nation and provide members, physicians and other authorized health care providers with online access to clinical information 24/7.

The full implementation of KP HealthConnect will provide tangible benefits for both our patients and our business operations. KP HealthConnect will enhance patient safety, provide overall cost savings, and enable KP to offer new products - ultimately adding value to the communities we serve. The impact and benefits of KP HealthConnect are expected to be felt throughout all of KP and to set new standards for the health care industry as a whole.

Benefits
KP HealthConnect is designed to assist our physicians, nurses and staff in delivering care that improves our members' health and quality of life, to strengthen communications between health care teams and patients, and to enhance our ability to practice personalized health care that is based on the best medical practices.

With the help of KP HealthConnect, Kaiser Permanente will be better equipped to:

• Ensure patient safety and quality care by providing access to comprehensive patient information and the latest best practice research all in one place.
• Coordinate patient care at every step of the way - between the physician's office, the hospital, radiology, the laboratory, and the pharmacy.
• Access accurate and complete patient information 24/7.
• Give physicians and health teams the full picture of a patient's history and medical condition by providing comprehensive information at the point of care.
• Eliminate the pitfalls of incomplete, missing, or unreadable charts.
• Protect the privacy and security of our patients' health information.
• Help make health care more convenient and efficient for patients by allowing them to get the right care, when they need it.

Getting acquainted with KP HealthConnect
This content in this section provides an overview of KP HealthConnect™ Clinicals—Ambulatory, Phase II of Kaiser Permanente’s initiative to implement a sophisticated, efficient electronic information management and care delivery system that will enhance the quality of patient care throughout the KP network.

Phase I, which launched in July 2004, focused on automation of scheduling, registration and billing operations. Phase II focuses on launching the electronic medical record system (EMR), a versatile, nimble software application customized by KP clinicians for the KP ambulatory clinical environment. With an EMR system, patient data (e.g., medical and office visit history, medication history, laboratory test results, radiologic findings, prescription orders, caregiver contact information) are collected and stored electronically, making them accessible 24/7 to authorized clinicians throughout the KP system.

Overview of the KP HealthConnect initiative
KP HealthConnect is Kaiser Permanente’s pioneering initiative to build a comprehensive information management and electronic medical record, or EMR, system, throughout the nationwide Kaiser healthcare network. This information management system replaces pen and paper with computers and electronic files and automates many of the tasks involved in patient management.

For instance, all of the paperwork associated with a patient’s care—appointments, pharmacy, lab and radiology ordering; benefits information; billing; patient records; physician notes; and more—is collected, stored and managed electronically. This information resides in a centralized database accessible to clinicians and other authorized healthcare personnel, 24 hours a day, from any properly equipped location. Also, in the future, KP members will have 24-hour access to their medical records and appointment and billing information via the Internet.

An effective health information management system is seamless, spanning the ambulatory, emergency department, operating room, affiliate provider and payer environments. An electronic medical record:

• eliminates the issue of hard-to-read handwriting
• protects against dosing errors or drug-drug interactions
• offers clinicians access to evidence-based guidelines and other data that can optimize and streamline patient care
• reduces costs associated with recording (transcribing) patient notes
• and minimizes the need for paper.

Built-in safety features help maintain patient privacy and daily back ups preserve stored data.

What makes the system work?
The KPHC system is made up of several integrated software applications. These are based on software products (or modules) produced by Epic Systems Corporation (Madison, WI), the manufacturer of the Epic suite of health information management tools. Within each Epic module are software components designed to handle a specific function (see table 1).

Clinicians, for example, use Epic’s ambulatory clinical module to check formularies, prescribe medications, record patient notes, document diagnoses, and create orders for treatments, interventions, tests, and referrals. The Epic products also help support staff manage, document and record all aspects of patient care.

Each module—whether activated during phase I or II of KPHC—is designed to work seamlessly with its counterparts. This provides an integrated information management system that can help improve service and care delivery.

One module, two names
Each Epic module has a proprietary name as well as a corresponding KPHC name. For example, the corresponding KPHC for EpicCare® Ambulatory—Epic’s electronic medical record—is “KP HealthConnect™ Clinicals—Ambulatory.” Within each module are operating functions that provide the tools needed to perform an array of tasks used to manage patients and deliver care.

For instance, operating functions within KP HealthConnect™ Clinicals—Ambulatory include Encounter Documentation, Computerized Physician Order Entry (or CPOE), In Basket Workflow Manager, MyPatients Interactive Patient List, and Episodes of Care Management (see table 1).

Table 1. The KP HealthConnect™ Clinicals—Ambulatory (EpicCare® Ambulatory) module components

• Problem List Management and Support
• Encounter Documentation
• Stuctured Clinical Documentation and Workflow Support
• Computerized Physician Order Entry (CPOE)
• Results Management and Communication
• Medication Management
• In Basket Workflow Manager
• E & M Coding and Support
• Telephone Support

KP HealthConnect frequently asked questions

What is KP HealthConnect?
Kaiser Permanente HealthConnect is a highly-sophisticated information management and care delivery system designed to enhance the quality of patient care. KP HealthConnect integrates the electronic medical record with appointments, registration and billing. The system will also link KP facilities across the nation and provide members, physicians and other authorized health care providers with online access to clinical information 24/7.

What is the EMR?
The EMR, or electronic medical record, was designed to help automate, streamline and improve patient care and optimize management, storage and security of patient data. With an EMR system, patient data (i.e. medical and office visit history, medication history, laboratory test results, radiologic findings, prescription orders, caregiver contact information) are collected and stored electronically, making them accessible 24/7 to authorized clinicians at multiple locations throughout the KP system. Beyond these capabilities, it also allows physicians to schedule follow up visits, schedule related visits with specialists and order laboratory tests and imaging studies. Results from such testing also is quickly entered into the EMR and is easily accessible from multiple locations. The EMR also gives KP physicians quick access to the best available evidence-based knowledge at the point of care and provides tools and templates to assist front-line practitioners in the documentation, diagnosis, treatment and management of patient health care needs.

How is the electronic medical record of phase II different from the current system of collecting and storing patient data and related information?
The KP HealthConnect initiative involves collecting patient data and related information and storing it electronically in a “centralized” location to optimize access and to ensure that it stays current. All patient exam rooms in a medical facility, for example, will be outfitted with computers. Rather than using paper and pen to record patient data, physicians will use a keyboard, monitor and computer. Once the data is saved to the electronic medical record system, it is accessible throughout the KP network, but only to authorized personnel. Back up of all patient data will occur on a daily basis.

How does an EMR system help streamline care?
In 1907, Dr. Henry Plummer invented the “dossier” medical records system, which today is widely used throughout the U.S. The theory behind the system is simple: all the data collected during the course of a patient’s care is kept in one folder, and that folder follows the patient from clinician visit to clinician visit. It’s a system that has served all of health care well for nearly 100 years.

But in today’s health care environment, patient care has grown complex. Many patients have conditions that take them to more than one physician (and possibly more than one facility), and many patients, particularly older ones, need two or more prescription drugs to manage chronic conditions. Managing and scheduling multiple office visits, frequent laboratory testing, radiology studies and follow up visits can be a daunting task. Patient records begin to bulge. Records and x-rays can be misplaced. Illegible handwriting can slow patient management or result in confusion. The other significant challenge for physicians is keeping abreast with the rapid pace at which new information is published in the medical literature. Computers and special software offer a means of managing all of this data more effectively.

Why is Kaiser Permanente investing $3.2 billion in KP HealthConnect?
Full implementation of KP HealthConnect will provide tangible benefits for both our patients and our business operations. KP HealthConnect will enhance quality of care, patient services, and enable KP to offer new health plan products - ultimately adding value to the communities we serve. As the operating platform for 80% of KP operations, the impact and benefits of KP HealthConnect are expected to be felt throughout all of KP and to set new standards for the health care industry as a whole.

Who is managing the development and implementation of KP HealthConnect?
Development of KP HealthConnect is an interregional effort. All eight regions and all groups within KP have come together to launch this integrated, nationwide system. From technical development to hands-on training and support, this collaborative effort of regional and national staff, clinicians and physicians is well on its way to transforming the way we deliver care.

Executive sponsors for KP HealthConnect are Louise Liang, MD, Senior Vice President for Quality and Clinical Systems Support; Andy Wiesenthal, MD, Associate Executive Director for Clinical Information Support; and Bruce Turkstra, Vice President and Program Director for KP HealthConnect.

For a complete list of KP HealthConnect Program team members and associated organization charts, please visit the KP HealthConnect pages.

What is the "system" that runs KP HealthConnect?
The KP HealthConnect system is made up of several integrated applications based on "off-the-shelf" software products produced by Epic Systems Corporation. The applications share a single database that allows every user to instantly access relevant patient information through a single user interface. Components of KP HealthConnect include:

• Inpatient (Clinicals and Decision Support)
• Outpatient (Clinicals and Decision Support)
• Patient Billing (Inpatient and Outpatient)
• Registration/ADT (Inpatient and Outpatient)
• Scheduling (Patient, Provider, Equipment)
• Web Portals (Member, Affiliate, Provider)

KP HealthConnect milestones, facts, “footnotes”

1. Phase I launched in July 2004.
Scheduling, Registration and Patient Billing also known as Practice Management was fully implemented across the Ohio region July 2004. The Member Service Center met their service level agreement in August 2004 and has continued to meet or exceed it each month since.

2. Official launch date for Phase II. Target for full implementation.
KP HealthConnect Ambulatory was launched November, 2004. It takes 12 months from launch to the first go live. The process includes 8 validate design build sessions over 24 weeks with participation from all clinical departments and their KP-IT and KPHC counterparts with close to 70 people per session Between the sessions, staff met with individual interest groups to address their specific needs ( primary care, E.D.) began to configure the system, as well as making decisions on the needed interfaces between ancillary applications (laboratory, imaging services, pharmacy as well as transcription, and other systems like EKG. There were other meetings regarding how much clinical information needed to be converted to KPHC.

Ambulatory implementation will be fully implemented in Ohio by the middle of May with the exception of the new E.D. and CDU at Cleveland Heights which opens the end of June.

3. Number of staff enlisted to develop KPHC.
The Ohio effort enlisted more than 100 employees working specifically on KPHC as application coordinators, business process analysts, trainers, testing, programmer analysts, PC placement and support. All members of clinical operations are involved in extensive planning sessions that start 14 weeks before they go live on the system. In addition, supporting OH are dozens of people on the national team who have been working closely with Ohio.

Other interesting facts:

• Processing more than 26 million radiologic images.
• The 1.2 million prescriptions KP fills each year will now be processed electronically via KPHC.

4. Ohio's role with regard to the national KPHC effort.
While KP HealthConnect is a national initiative it is being rolled out by the regions. Each region has its own deployment schedule; some implemented ambulatory before practice management. Each of the regions participates in interregional meetings and works closely with their national counterparts. KP HealthConnect was designed as a collaboration between national and the eight regions; 25 % of the decisions were made at the national level (i.e. diagnoses codes, zip codes, language codes) and cannot be changed; another 25% of the codes were built at the national level but the regions have the option to make changes; the remaining 50% are made at the regional level.

As each region has deployed they have shared best practices as well as lessons learned. Ohio has been recognized nationally as a best practice for its scheduling implementation and service levels at its Member Service Center and for its Benefits Tracking system which populates KPHC and keeps it in sync with the Claims system.

One of the benefits of the system is its ability to flag potential Patient Safety Incidents such as drug drug interactions. The regions work together when a Potential Patient Safety Incident is identified to identify problem and put a plan to resolve it in place.

KP HealthConnect Ohio user preparation schedule
Getting the KP HealthConnect Ambulatory Clinicals up and running involves a systematic process of education, training, testing, software activation, follow up and fine tuning, all of which occur within a proposed time frame on a staggered schedule. This whole process is sometimes referred to as the “roll out.” Overall, the roll out schedule for the KP Ohio region spans 11 months, from August 2005 to June 2006.

A key component of the roll out is user preparation. This is the first phase of the roll out, during which leader and implementation planning meetings are held, KP HealthConnect information is disseminated (including implementation schedules) and hands-on training and dress rehearsals occur (see details below). The other key component of the roll out is the “go live” phase, which refers to the actual activation of KP HealthConnect Phase II for use by clinicians.

A key player in user preparation is the change management team (CMT), whose overall function is to ensure that labor, management and physician employees get education and training that will enable them to confidently and comfortably use KP HealthConnect Ambulatory Clinicals. The CMT, for instance, oversees leader planning and implementation planning meetings, which are explained below:

• Leader planning meetings: Prepare and educate physician, labor and management leaders to guide their staff through critical steps of the implementation. Initial meetings lay the groundwork for the implementation of KP HealthConnect, Phase II. Areas of focus include:
  • Overview of the implementation schedule and meeting content
  • Training schedule and curriculum
  • Workflow planning
  • Access management
  • Member communications
    Proposed number of sessions: 3 over a period of 4 weeks.
• Implementation planning meetings: Introduce KP HealthConnect to team members as well as educate them on critical content necessary for a successful go-live. Areas of focus include:
  • Critical topics from the Leader Planning Meetings
  • System demo
  • Targeted presentations
  • Clinician-patient communication training
  • On site support during the go live phase
    Proposed number of sessions:7 over a period of 9 weeks
• Hands-on training: The training format consists of web-based (online) and instructor-led sessions that introduce staff to the KP HealthConnect system and train them on specific functionality within the system.
  Proposed number of sessions: Varies; can include between 2 to 7 sessions, beginning approximately 1 month prior to go live.
• Dress rehearsal: Dress rehearsals are used to test hardware and to review the steps involved in a workflow.
  Proposed time allotted: approximately 3-4 hours

Workload reductions
To ensure that service and patient care remain optimal during the roll out and go live phases, clinical workloads will be deliberately reduced. For instance, clinical staff will see fewer patients. A workload reduction of 10% will occur during the implementation planning meetings and a reduction of 50% will occur during the go live week and for one week after. Then workloads will be notched back up gradually (i.e., to 75% at 3 weeks post go live, then to 90% during post go live weeks 4 through 8).

Sponsors will guide and troubleshoot conversion to KP HealthConnect
More than 130 management staff representing KP, Ohio Permanente Medical Group and labor will play a key role in helping shepherd the KP HealthConnect initiative by serving as “sponsors.” These individuals—physician chiefs and leads, health plan managers and leads, and labor leads—began their training on the KP HealthConnect application in mid September. They will be on hand throughout staff training and the go live and post go live periods to assist staff and problem solve.

Additional KP HealthConnect sponsors include:

• Senior leaders in the Ohio Permanente Medical Group and the Kaiser Permanente health plan
• Patricia Kennedy Scott, President, Kaiser Foundation Health Plan of Ohio
• Ronald Copeland, MD, president and executive medical director, Ohio Permanente Medical Group.

About Kaiser Permanente
Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a not-for-profit; group practice prepayment program headquartered in Oakland, Calif. Kaiser Permanente serves the health care needs of more than 8.7 million members in nine states and the District of Columbia. Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 156,000 technical, administrative and clerical employees and caregivers, and more than 13,000 physicians representing all specialties.

In Northeast Ohio, Kaiser Permanente addresses the health care needs of nearly 150,000 members in a nine-county area. Services are provided by more than 180 Ohio Permanente Medical Group physicians, 3,000 network affiliated physicians and more than 1,900 non-physician employees. In 2007, Kaiser Permanente of Ohio celebrated 43 years of providing care in Northeast Ohio.