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Driving Total Health with Health IT and Health 2.0
Ted Eytan, MD                    Holly Potter
The Permanente Federation, LLC   Vice President of Public Relations,
twitter:@tedeytan                Kaiser Permanente
                                 twitter:@htpotter




                                                                       1
Conflict of Interest Disclosure
              Ted Eytan, MD • Holly Potter

• Salary
   – The Permanente Federation, LLC (Eytan)
   – Kaiser Foundation Health Plan (Potter)




                                              2
Our Story: 2006 - 2010


   Driving Total Health
      Health Information Technology
      as a tool
      Health 2.0 as a potentiator
      Measuring our efforts and
      moving ahead
                               Kaiser Permanente

                                               3
(Your) HIT will generate interest

For its potential to fail...




       Source: http://articles.latimes.com/2007/feb/15/business/fi-kaiser15

                                                                              Kaiser Permanente

                                                                                              4
(Your) HIT will generate interest

For its potential to succeed...




          Source: http://www.signonsandiego.com/news/2010/jan/06/a-medical-
          breakthrough-va-kaiser-to-share-records/                            Kaiser Permanente

                                                                                              5
We Stand for Total Health
 Integrated Health Care
      Easy, Excellent,
      Comprehensive
 Commitment to Prevention
      Address issues before they
      become problems
 Empowering of the whole person
      Beyond health care - mind,
      body, spirit
      What you eat, the air you
      breathe, the environment
      you live in
                                   Kaiser Permanente

                                                   6
Kaiser Permanente: By The Numbers
 Doctor office visits} 36.7 million
 Prescriptions filled} 129 million
 Surgeries} 547,338
 Mammograms (women ages 42 to 69 years)} 1.1 million
 Colorectal cancer screenings} 1.6 million
 Research and evaluation studies} 3,150
 Biobank DNA samples collected} 110,000+
 Peer-reviewed journal articles published} 700+
 Community grants awarded} 2,400+
 Environmental Leadership Awards} 27
 HIMSS Analytics Stage 7 Awards} 24

                                                   Kaiser Permanente

                                                                   7
KP HealthConnect® – Enabling Patient-Centered Care

My Health Manager, part of a
 comprehensive electronic health
 record
       Ambulatory deployment
       complete: 431 medical
       offices live
       Inpatient deployment nearly
       complete: 29 Inpatient complete
            March 2010: of 36 hospitals
                   36 hospitals live
       live
       24 HIMSS Stage 7 Hospitals



                                           Kaiser Permanente

                                                           8
My Health Manager – How big?


                                                                               4,000,000       Registered members




                                                                               3,000,000   40% signed on 11
                                                                                           or more times (in
                                                                                           2008)
                                                                               2,000,000


                                                                                           91% of members
                                                                           1,000,000       satisfied or very
                                                                                           satisfied with
                                                                                           kp.org (survey in
                                                                           0
1Q 072Q 07 3Q 07 4Q 07 1Q 08 2Q 08
                                         3Q 08 4Q 08 1Q 09 2Q 09 3Q 09
                                                                       4Q 09
                                                                                           2Q 2009)

  Source: Kaiser Permanente Internet Services Group Web Analytics
                                                                                                   Kaiser Permanente

                                                                                                                    9
Transforming, Streamlining a System
                              Kaiser Permanente, Hawaii: Visits per Member



                                                                                                                              In Person
                                                                                                              5               Telephone
                                                                                                                              Secure E-mail


                                                                                                             4

                                                                                                                     “For the majority of
                                                                                                                     (HEDIS Quality) measures
                                                                                                             3
                                                                                                                     that were comparable,
                                                                                                                     performance remained
                                                                                                                     stable during the study
                                                                                                             1       period.”


                                                                                                            0
          Jan 2006

                                                                                              August 2008
Source: Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: Transforming And Streamlining
Modalities Of Care [Internet]. Health Aff. 2009 Mar 1;28(2):323-333.[cited 2009 Mar 11 ] Available from: http://content.healthaffairs.org/cgi/
content/abstract/28/2/323
                                                                                                                                 Kaiser Permanente

                                                                                                                                                 10
...while prioritizing quality
        Breast Cancer Screening • HEDIS 2009

 100%


 90%


  80%

                                                               NCQA
  70%                                                          2009 90th
                                                               Percentile
  60%


  50%
             2006             2007             2008

          Hawaii Region               Georgia Region

        Source: Kaiser Permanente Integrated Analytics; Data
        is for commercial enrollees only; When I Grow Up
        (Hawaii) - Kaiser Permanente YouTube Channel -
        http://www.youtube.com/kaiserpermanenteorg



                                                                            Kaiser Permanente

                                                                                           11
“Performance gets you the podium”




Jack Cochran, MD, CEO of The Permanente Federation
National Governor’s Association, Washington, DC


                                                     Kaiser Permanente

                                                                    12
Providing care is inherently social




                        “Balancing Work and Family”
                    Kaiser Permanente YouTube Channel
               http://www.youtube.com/kaiserpermanenteorg


                                                            13
Care delivery should be social, too




                                      Kaiser Permanente

                                                     14
A future social workspace



         “A Dashboard to
             My Job”




  Heather Heart,
  IT Support Manager, CO




                            Kaiser Permanente

                                           15
Health 2.0 = Participation
“Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or
create, we the patients can be effective partners in our own healthcare, and we the people can participate in
reshaping the health system itself.” - http://www.tedeytan.com/2008/06/13/1089




                   Dave                           Kate
                 (Patient)                     (Physician)                                   Kaiser Permanente

                                                                                                                16
Our Converging Paths
                                             Ted                                                                                         Holly
                                         (Washington)                                                                                 (California)
        Informatics-Blog
        Group Health Cooperative Informatics



        HOME                                                                 { 2006 04 14 }

                                             The Andon Cord and Patient Safety in EpicCare
        RECENT POSTS
     1 . Seeing the Impact: New York                                           “At any time during the production process at a
        Times Journalism Institute                                             Toyota plant, any team member who spots a
     2 . Medication Reconciliation, at
                                                                               problem can stop production by pulling the
        37,000 feet
                                                                               “andon cord” located next to the assembly line.
     3 . QISTS ’07 Begin Today –
                                                                               An andon board (left) lets supervisors know the
        Nephrology
                                                                               location of the problem with a blinking light and a
     4 . Radiology Orders Default
                                                                               distinct musical tone.”
        Screen
     5 . EnROL - Enhanced Record
                                           This approach empowers employees to highlight defects and bring attention to their
        Lookup Information Guide
                                           solution without being penalized. When the line stops, everyone must stop what
                                           they are doing and attend to the fix.
        SEARCH
                                           We have created a similar setup for EpicCare at Group Health. We now have
                                           clinicians on call 24 hours a day, 7 days a week, to respond to any questions about
          Find                             the functioning of EpicCare that are concerning for patient safety. In consultation
                                           with the on call clinician, the “andon cord” will be pulled. When the cord is pulled, an
        BASICS                             emergency response team will be assembled, which will do rapid analysis of the
        About this Blog                    problem and make decisions about next step.
        Subscribe to updates
                                           The analogy here is the code team in a hospital, who will bring a code cart and
        through e-mail                     preparation to diagnose the patient and act quickly. Pulling the andon cord does not
                                           mean that Epic will be shut down; it simply means that a team will be assembled
        RECENT COMMENTS                    quickly and other work will stop.
        "As it so happens, we
                                           The goal of this new process is “door to doc in 45 minutes.” We have had the
        received a legal opinion
                                           occasion already to use it in real time, and have been able to achieve this goal.
        today..." (Ted Eytan on
        The iPod as a Continuing              Posted by Ted Eytan on Friday, April 14th, 2006, at 6:31 am, and filed under
        Education device; and                                          Safety. Popularity: 18%
        allowance within CME                             Follow any responses to this entry with the RSS 2.0 feed.
        budgets for purchase)                                           You can post a comment.

Sources: Group Health Cooperative Informatics Blog (internal); The Health Care Blog: A Permanente Group Executive speaks

                                                                                                                                                     Kaiser Permanente

                                                                                                                                                                    17
“Owning my own health care”




        “Kaiser Permanente HealthConnect® at Home - Empowering People”
                        Kaiser Permanente YouTube Channel
                   http://www.youtube.com/kaiserpermanenteorg          Kaiser Permanente

                                                                                      18
Why social media?

•   Protect and promote the brand
•   Extend the impact of traditional media
•   Improve organic search results
•   And ultimately, create brand
    champions



                                   Kaiser Permanente

                                                  19
News Center – kp.org/newscenter



                                  On Twitter:
                                  @KPNewsCenter

                                  Also
                                  @KPNorCal
                                  @KPColorado
                                  @KPNorthwest
                                  @KPHawaii
                                  @KPGANews
                                  (Georgia)


                                          Kaiser Permanente

                                                         20
Total Health Brand - kp.org/thrive



                                     On Twitter:
                                     @KPThrive &
                                     @KPVivaBien




                                        Kaiser Permanente

                                                       21
Kaiser Permanente Blogs




                          22
Facebook: Community & Employees




                                  facebook.com/kpthrive
                                          Kaiser Permanente

                                                         23
You Tube




youtube.com/kaiserpermanenteorg

                                  24
Twitter: A Sampling of Active PR Team Members




                                          Kaiser Permanente

                                                         25
Engaging MDs and Other Leaders




                                 Kaiser Permanente

                                                26
Our Twitter Community: Preparing for a Tsunami




                                            Kaiser Permanente

                                                           27
Our Social Media Policy

                          • Employees must not represent
                            KP views in social media
                            channels, at work or not, without
                            prior approval
                          • Aligns with Principles of
                            Responsibility
                          • Covers all social media channels
                          • Is a “living document” and will be
                            updated/revisited regularly
                          • http://tinyurl.com/kpsocialmediapolicy




                                                      Kaiser Permanente

                                                                     28
Changing Conversations

•   Monitoring
•   Responding
•   Pitching
•   Participating




                         Kaiser Permanente

                                        29
Monitoring




 • Weekly blog report since 2007
 • Conducted baseline audit of multiple
 platforms June-December of 2008
 • Begun real-time monitoring and
 database tracking 2009
                                          Kaiser Permanente

                                                         30
Pitching: Unleashing the power of Twitter




(Good old-                                  400 media stories
fashioned PR work)                          about the study
                                                   Kaiser Permanente

                                                                  31
Reached @ 2 million more via Twitter

Estimated 800 Tweets/RTs (in 8
languages), including LA Times,
Washington Post, CNN,
Huffington Post




                                       Kaiser Permanente

                                                      32
Responding: service recovery via Facebook

                                      Before




                                       After




                                               Kaiser Permanente

                                                              33
Participating as people . . .

 Ted Eytan, MD                               e-Health. Patient empowerment. Washington, DC.                                 Home    Content


 Home      About     Portfolio   Contact     Subscribe to Updates     Discussion




                                                                                                                            LATEST TWEET
 Is it meaningful if patients can’t use it?                                                                                 No public Twitter messages.
                                                                                                                            Follow me on twitter
 May 28th, 2009 by Ted Eytan | Popularity: 36% | Edit this entry                    20 comments | show/add »
                                                                                                                            PREVIOUS ENTRY
                                                                                                                            Photo Friday: Jane and Bob at NCVHS
 I attended a smallish get together yesterday organized by Christine Kraft to think about Health
                                                                                                                            Testimony
 2.0 / DC in the epicenter type things, where we thought about some of the trends in social
                                                                                                                            NEXT ENTRY
 media use, social media use by physicians and medical groups (I got a lot of help on this one),
                                                                                                                            Few are using HMSA’s Online
 journalists, and finally, a real story about a patient’s experience, here in DC, that really brings to                     Care | HonoluluAdvertiser.com |
 light a problem with a meaningful use definition that doesn’t include “and the patients can see                            The Honolulu Advertiser

 the data.”
                                                                                                               SIMILAR POSTS
 I’ve been thinking about the idea that meaningful use must include “patients can see everything”              73 Cents : A New Monument to Patients, in Washington,
 since ARRA came out, and see my first mention of it in the Twittersphere around April 22. I have              DC
 noticed since then that the idea seems to be picking up steam – initially I was told by some that             Meaningful Meaningful Use
                                                                                                               Photo Friday: Return Expectations to the Upright Position
 this would be a “distraction” to the conversation. Now I’m sure that it’s not. Read on…
                                                                                                               Moderating a Dream Panel at WHIT 5.0
 This is the story of Regina Holliday – it’s really worth a read, and I’ll quote some of it here:              How would you counsel this patient?


 We will fight the good fight. Regina’s USA medical advocacy 2009                                              PHOTO

  Why do we have more transparency in special education law then in medical care? Why do
  we have more access to information on a box of Cheerios then on a medical chart? Why isn’t




                                                                                                                                                                           Kaiser Permanente

                                                                                                                                                                                          34
...and creating real relationships




                                     Kaiser Permanente

                                                    35
The full spectrum of engagement




                                  Kaiser Permanente

                                                 36
The power of shared knowledge




                             “Connected”
                  Kaiser Permanente YouTube Channel
             http://www.youtube.com/kaiserpermanenteorg


                                                          37
Thank you




            Kaiser Permanente

                           38

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Driving Total Health with Health IT and Health 2.0

  • 1. Driving Total Health with Health IT and Health 2.0 Ted Eytan, MD Holly Potter The Permanente Federation, LLC Vice President of Public Relations, twitter:@tedeytan Kaiser Permanente twitter:@htpotter 1
  • 2. Conflict of Interest Disclosure Ted Eytan, MD • Holly Potter • Salary – The Permanente Federation, LLC (Eytan) – Kaiser Foundation Health Plan (Potter) 2
  • 3. Our Story: 2006 - 2010 Driving Total Health Health Information Technology as a tool Health 2.0 as a potentiator Measuring our efforts and moving ahead Kaiser Permanente 3
  • 4. (Your) HIT will generate interest For its potential to fail... Source: http://articles.latimes.com/2007/feb/15/business/fi-kaiser15 Kaiser Permanente 4
  • 5. (Your) HIT will generate interest For its potential to succeed... Source: http://www.signonsandiego.com/news/2010/jan/06/a-medical- breakthrough-va-kaiser-to-share-records/ Kaiser Permanente 5
  • 6. We Stand for Total Health Integrated Health Care Easy, Excellent, Comprehensive Commitment to Prevention Address issues before they become problems Empowering of the whole person Beyond health care - mind, body, spirit What you eat, the air you breathe, the environment you live in Kaiser Permanente 6
  • 7. Kaiser Permanente: By The Numbers Doctor office visits} 36.7 million Prescriptions filled} 129 million Surgeries} 547,338 Mammograms (women ages 42 to 69 years)} 1.1 million Colorectal cancer screenings} 1.6 million Research and evaluation studies} 3,150 Biobank DNA samples collected} 110,000+ Peer-reviewed journal articles published} 700+ Community grants awarded} 2,400+ Environmental Leadership Awards} 27 HIMSS Analytics Stage 7 Awards} 24 Kaiser Permanente 7
  • 8. KP HealthConnect® – Enabling Patient-Centered Care My Health Manager, part of a comprehensive electronic health record Ambulatory deployment complete: 431 medical offices live Inpatient deployment nearly complete: 29 Inpatient complete March 2010: of 36 hospitals 36 hospitals live live 24 HIMSS Stage 7 Hospitals Kaiser Permanente 8
  • 9. My Health Manager – How big? 4,000,000 Registered members 3,000,000 40% signed on 11 or more times (in 2008) 2,000,000 91% of members 1,000,000 satisfied or very satisfied with kp.org (survey in 0 1Q 072Q 07 3Q 07 4Q 07 1Q 08 2Q 08 3Q 08 4Q 08 1Q 09 2Q 09 3Q 09 4Q 09 2Q 2009) Source: Kaiser Permanente Internet Services Group Web Analytics Kaiser Permanente 9
  • 10. Transforming, Streamlining a System Kaiser Permanente, Hawaii: Visits per Member In Person 5 Telephone Secure E-mail 4 “For the majority of (HEDIS Quality) measures 3 that were comparable, performance remained stable during the study 1 period.” 0 Jan 2006 August 2008 Source: Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: Transforming And Streamlining Modalities Of Care [Internet]. Health Aff. 2009 Mar 1;28(2):323-333.[cited 2009 Mar 11 ] Available from: http://content.healthaffairs.org/cgi/ content/abstract/28/2/323 Kaiser Permanente 10
  • 11. ...while prioritizing quality Breast Cancer Screening • HEDIS 2009 100% 90% 80% NCQA 70% 2009 90th Percentile 60% 50% 2006 2007 2008 Hawaii Region Georgia Region Source: Kaiser Permanente Integrated Analytics; Data is for commercial enrollees only; When I Grow Up (Hawaii) - Kaiser Permanente YouTube Channel - http://www.youtube.com/kaiserpermanenteorg Kaiser Permanente 11
  • 12. “Performance gets you the podium” Jack Cochran, MD, CEO of The Permanente Federation National Governor’s Association, Washington, DC Kaiser Permanente 12
  • 13. Providing care is inherently social “Balancing Work and Family” Kaiser Permanente YouTube Channel http://www.youtube.com/kaiserpermanenteorg 13
  • 14. Care delivery should be social, too Kaiser Permanente 14
  • 15. A future social workspace “A Dashboard to My Job” Heather Heart, IT Support Manager, CO Kaiser Permanente 15
  • 16. Health 2.0 = Participation “Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.” - http://www.tedeytan.com/2008/06/13/1089 Dave Kate (Patient) (Physician) Kaiser Permanente 16
  • 17. Our Converging Paths Ted Holly (Washington) (California) Informatics-Blog Group Health Cooperative Informatics HOME { 2006 04 14 } The Andon Cord and Patient Safety in EpicCare RECENT POSTS 1 . Seeing the Impact: New York “At any time during the production process at a Times Journalism Institute Toyota plant, any team member who spots a 2 . Medication Reconciliation, at problem can stop production by pulling the 37,000 feet “andon cord” located next to the assembly line. 3 . QISTS ’07 Begin Today – An andon board (left) lets supervisors know the Nephrology location of the problem with a blinking light and a 4 . Radiology Orders Default distinct musical tone.” Screen 5 . EnROL - Enhanced Record This approach empowers employees to highlight defects and bring attention to their Lookup Information Guide solution without being penalized. When the line stops, everyone must stop what they are doing and attend to the fix. SEARCH We have created a similar setup for EpicCare at Group Health. We now have clinicians on call 24 hours a day, 7 days a week, to respond to any questions about Find the functioning of EpicCare that are concerning for patient safety. In consultation with the on call clinician, the “andon cord” will be pulled. When the cord is pulled, an BASICS emergency response team will be assembled, which will do rapid analysis of the About this Blog problem and make decisions about next step. Subscribe to updates The analogy here is the code team in a hospital, who will bring a code cart and through e-mail preparation to diagnose the patient and act quickly. Pulling the andon cord does not mean that Epic will be shut down; it simply means that a team will be assembled RECENT COMMENTS quickly and other work will stop. "As it so happens, we The goal of this new process is “door to doc in 45 minutes.” We have had the received a legal opinion occasion already to use it in real time, and have been able to achieve this goal. today..." (Ted Eytan on The iPod as a Continuing Posted by Ted Eytan on Friday, April 14th, 2006, at 6:31 am, and filed under Education device; and Safety. Popularity: 18% allowance within CME Follow any responses to this entry with the RSS 2.0 feed. budgets for purchase) You can post a comment. Sources: Group Health Cooperative Informatics Blog (internal); The Health Care Blog: A Permanente Group Executive speaks Kaiser Permanente 17
  • 18. “Owning my own health care” “Kaiser Permanente HealthConnect® at Home - Empowering People” Kaiser Permanente YouTube Channel http://www.youtube.com/kaiserpermanenteorg Kaiser Permanente 18
  • 19. Why social media? • Protect and promote the brand • Extend the impact of traditional media • Improve organic search results • And ultimately, create brand champions Kaiser Permanente 19
  • 20. News Center – kp.org/newscenter On Twitter: @KPNewsCenter Also @KPNorCal @KPColorado @KPNorthwest @KPHawaii @KPGANews (Georgia) Kaiser Permanente 20
  • 21. Total Health Brand - kp.org/thrive On Twitter: @KPThrive & @KPVivaBien Kaiser Permanente 21
  • 23. Facebook: Community & Employees facebook.com/kpthrive Kaiser Permanente 23
  • 25. Twitter: A Sampling of Active PR Team Members Kaiser Permanente 25
  • 26. Engaging MDs and Other Leaders Kaiser Permanente 26
  • 27. Our Twitter Community: Preparing for a Tsunami Kaiser Permanente 27
  • 28. Our Social Media Policy • Employees must not represent KP views in social media channels, at work or not, without prior approval • Aligns with Principles of Responsibility • Covers all social media channels • Is a “living document” and will be updated/revisited regularly • http://tinyurl.com/kpsocialmediapolicy Kaiser Permanente 28
  • 29. Changing Conversations • Monitoring • Responding • Pitching • Participating Kaiser Permanente 29
  • 30. Monitoring • Weekly blog report since 2007 • Conducted baseline audit of multiple platforms June-December of 2008 • Begun real-time monitoring and database tracking 2009 Kaiser Permanente 30
  • 31. Pitching: Unleashing the power of Twitter (Good old- 400 media stories fashioned PR work) about the study Kaiser Permanente 31
  • 32. Reached @ 2 million more via Twitter Estimated 800 Tweets/RTs (in 8 languages), including LA Times, Washington Post, CNN, Huffington Post Kaiser Permanente 32
  • 33. Responding: service recovery via Facebook Before After Kaiser Permanente 33
  • 34. Participating as people . . . Ted Eytan, MD e-Health. Patient empowerment. Washington, DC. Home Content Home About Portfolio Contact Subscribe to Updates Discussion LATEST TWEET Is it meaningful if patients can’t use it? No public Twitter messages. Follow me on twitter May 28th, 2009 by Ted Eytan | Popularity: 36% | Edit this entry 20 comments | show/add » PREVIOUS ENTRY Photo Friday: Jane and Bob at NCVHS I attended a smallish get together yesterday organized by Christine Kraft to think about Health Testimony 2.0 / DC in the epicenter type things, where we thought about some of the trends in social NEXT ENTRY media use, social media use by physicians and medical groups (I got a lot of help on this one), Few are using HMSA’s Online journalists, and finally, a real story about a patient’s experience, here in DC, that really brings to Care | HonoluluAdvertiser.com | light a problem with a meaningful use definition that doesn’t include “and the patients can see The Honolulu Advertiser the data.” SIMILAR POSTS I’ve been thinking about the idea that meaningful use must include “patients can see everything” 73 Cents : A New Monument to Patients, in Washington, since ARRA came out, and see my first mention of it in the Twittersphere around April 22. I have DC noticed since then that the idea seems to be picking up steam – initially I was told by some that Meaningful Meaningful Use Photo Friday: Return Expectations to the Upright Position this would be a “distraction” to the conversation. Now I’m sure that it’s not. Read on… Moderating a Dream Panel at WHIT 5.0 This is the story of Regina Holliday – it’s really worth a read, and I’ll quote some of it here: How would you counsel this patient? We will fight the good fight. Regina’s USA medical advocacy 2009 PHOTO Why do we have more transparency in special education law then in medical care? Why do we have more access to information on a box of Cheerios then on a medical chart? Why isn’t Kaiser Permanente 34
  • 35. ...and creating real relationships Kaiser Permanente 35
  • 36. The full spectrum of engagement Kaiser Permanente 36
  • 37. The power of shared knowledge “Connected” Kaiser Permanente YouTube Channel http://www.youtube.com/kaiserpermanenteorg 37
  • 38. Thank you Kaiser Permanente 38