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Interview LJ: Mr. Holt, let's begin by having you tell our readers a little about your past experiences and how you feel this has prepared you for the challenges of this new position. Mr. Holt: During my 25 years with Kaiser Permanente (KP), I have had the opportunity to work in a variety of roles and geographic settings. I started in the Colorado Region in the early 1970s (when it was essentially a "startup" operation), transferred to our largest regionNorthern Californiain the early 1980s, and then to the Northwest Region in 1989. During these years, my roles ranged from being a medical group business manager to regional controller. For the last five years, I have consulted at the program level in several areas, including strategic assessment of local markets, change management, and information technology (IT). Throughout my career, I have been included in a number of activities and projects involving IT, especially from the user's perspective. Most recently, I led a project to make recommendations to program leaders concerning our national strategy for clinical information systems (CIS). This work helped me and my team colleagues to understand the perspectives and thinking of KP physicians, managers, IT professionals, and many others involved with CISrelated efforts across our program. From my background and experience, I have gained an understanding of the physician's view of the IT world and, I hope, the skills for managing the changes we will want to make to ensure our future viability and success. LJ: What did you see as the main attraction offered by this position with the Federation? Mr. Holt: I saw a tremendous opportunity to help the Permanente Medical Groups collaborate on developing IT tools that will help differentiate Permanente clinical practices and processes from other managed care models. In addition to reducing variation through implementation of best practices which can improve quality outcomes, cost performance and member satisfaction simultaneously, Permanente "practice" can differentiate itself by emphasizing clinician and member autonomy in clinical decisions. I believe that the Permanente Medical Groups, and Kaiser Foundation Health Plan's national IT organization are uniquely positioned to come up with the most effective and successful solutions. The challenges are daunting, but the potential value to our members, physicians, and other health care professionals is enormous. I am really looking forward to working with our medical groups and national IT organization to make this happen. LJ: What are your initial strategies? Mr. Holt: We need to build on work which has been ongoing for some time across KP. For example, many of our medical groups have been participating in care redesign initiatives and in developing clinical information systems to support this redesign. In addition, studies in disease management and outcome have been going on for some time. Much of this work helped shape our national strategy regarding the CIS capabilities we need to invest in. These CIS capabilities will create value by providing universally available, uptodate medical records and by otherwise supporting new models of care evolving in our medical groups and helping providers to make decisions. We're now beginning to plan how to best build these CIS capabilities. We are trying to find ways which will allow the most skilled and knowledgeable people from our medical groups to work together with the National IT organization to build and deploy new CIS capabilities nationally. The economics and timeframes for completing this project must also be considered, given the market pressures which the nation is experiencing. However, CIS is not our only IT need. Our medical groups and health plan divisions also need support from increasingly sophisticated business systems. For example, the complexity of the health care benefits and products we market have increased considerably, requiring sophisticated techniques of data capture and analysis. In addition, some of our medical groups have been and are developing provider networks as alternative delivery models to meet local market demands, and strong relationships with network providers require effective systems support. More often than not, our current systems are inadequate, and efforts are underway to develop national solutions to meet current and future needs. As with CIS, we must ensure that our best people work together in responding to these needs. LJ: What will the IT solution look like for physicians? When will it be available to help them care for patients? Mr. Holt: At least for KP physicians, the IT solution most visible to them will be CIS. We are currently preparing to develop and deploy these tools. I expect that a detailed plan to accomplish these goals will be completed by the fourth quarter of this year. Implementation is tentatively scheduled to begin by the second half of 1998; our thinking concerning the timing and scope of what will be implemented is still preliminary. The urgency and priority for delivering CIS is high. LJ: Finally, Mr. Holt, could you share with us your vision for information technology throughout Kaiser Permanente?" Mr. Holt: I believe our medical groups collectively have clinical knowledge and insight into best practices which could make Kaiser Permanente medicine the benchmark of quality for the rest of health care. I would like to see us develop national IT systems and support which will bring that clinical knowledge to individual KP physicians at the most important momentwhen encountering a patientand in a manner which supports the best clinical decisions. LJ: Thank you, Mr. Holt, for taking the time to talk with us. We all wish you the very best in your new position with The Permanente Federation.
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