© 2010 The Permanente Federation, LLC
Using Technology to Achieve Total HealthTED EYTAN, MD, MS, MPH • ALIGNING FORCES FOR...
Who’s a fan of the pedometer?
2
The first place to start is the starting point...
3
The first place to start is the starting point...
4
Who’s a fan of the patient?
Christine Abbott and Ted Eytan, 2008
5
The member experience attracts people
6
Even through harsh conditions….
7
Why Total Health? Why not?
Integrated Health Care
Easy, Excellent, Comprehensive
Commitment to Prevention
Address issues b...
In the words of a patient
(and we will all be patients one day)
“Kaiser Permanente HealthConnect® at Home - Empowering Peo...
Technology does not replace us...
“Where do you go for help with health or medical issues?
0%
25%
50%
75%
100%
Health Prof...
We use it to improve the care we provide
60%
68%
75%
83%
90%
2005 2006 2007 2008
Source: (Zhou YY, Kanter MH, Wang JJ, Gar...
And you will, too.
Jack Cochran, MD, Executive Director of The Permanente Federation
National Governor’s Association, Wash...
KP HealthConnect® – Enabling Patient-Centered Care
My Health Manager, part of a
comprehensive electronic health
record
Amb...
Kaiser Permanente physician : 2007
Victor Silvestre, MD
Oakland, CA
14
Kaiser Permanente Nurse : 2009
youtube.com/kaiserpermanenteorg
15
Kaiser Permanente Advice Nurses: 2010
Appointment and Advice Call Center, Vallejo, CA - KP HealthConnect enabled!
16
Kaiser Permanente members/caregivers : 2010
“Balancing Work and Family”
Kaiser Permanente YouTube Channel
http://www.youtu...
We connect with over 3 million members...
0
875,000
1,750,000
2,625,000
3,500,000
Q3 ‘03 Q1 ‘05
Q1 ‘07 Q1 ‘08
Q3 ‘10
Regis...
and, 275,000 caregivers
200,000
225,000
250,000
275,000
300,000
Jan, 2010
Aug 2010
Act for Child / Act for Adult
Source: K...
Who are experiencing significant job impacts
Source: Caregiving in the United States, 2009
http://www.aarp.org/relationshi...
We are involving members and families better
new My health manager pharmacy center - live in 2010-2011
Convenient dropdown...
Helping families grow
new My health manager Pregnancy center
New layout
Information and
organization
user -tested by
pregn...
Moving people from information to action
new My health manager Pregnancy center
Link members to prenatal
education, facili...
Why this matters
video courtesy Regina Holliday & Health 2.0
http://reginaholliday.blogspot.com | http://www.health2con.co...
We use social media to participate as people
May 28th, 2009 by Ted Eytan | Popularity: 36%May 28th, 2009 by Ted Eytan | Po...
“73 Cents”
A National Monument to Patient Empowerment, in Washington, DC
http://reginaholliday.blogspot.com
26
Failure to Notify, “significant results”
Lab results studied in community
practices - no improvement
with EHR
Imaging resu...
OpenNotes
myopennotes.org
28
We use social media to tell our story about quality
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009
Hawaii Region Georgia Reg...
“When I Grow Up”
(125,075 total views)
30
And our patients are telling it back to us
31
2005 was long ago in Internet time….
0%
25%
50%
75%
100%
AGE: < 30
30-50
50-64
65+
Social Networking Use Internet
Source: ...
0%
25%
50%
75%
100%
AGE: < 30
30-50
50-64
65+
Social Networking Use Internet
Source: Pew Internet & American Life Project ...
0%
25%
50%
75%
100%
AGE: < 30
30-50
50-64
65+
Twitter/Status Update Social Networking Use Internet
2009
Source: Pew Intern...
0%
25%
50%
75%
100%
AGE: < 30
30-50
50-64
65+
Twitter/Status Update Social Networking Use Internet
2010
Source: Pew Intern...
Support Systems
“If there was one common theme I
found in caring for my patients I
would say it was the importance of
supp...
“Direct
Message”
Followers
&
Following@ = “Reply”
Monitoring
37
Ideabook: KP’s Social Network
38
Our Social Media Policy
• Employees must not represent KP
views in social media channels,
at work or not, without prior
ap...
Home. Sort of.
40
Medical-Surgical Ward
41
Operating Room
42
Garfield Innovation Center
 Opened in 2006
 Sponsored by KP IT, National
Facilities Services, and Patient
Care Services
...
1 PROTOTYPING SPACE 2 HOSPITAL
4 HOME 3 CLINIC
44
Garfield Center Activities
Space Designs
Workflow Studies
 Technology Demos
 Training and Simulations
45
MedRite
“With our nurses as co-
designers, we learned
that the medication
administration process
is unclear, chaotic and
f...
Growing a healthier health care system
47
Where were you when….?
48
Building, buying, eating green
Energizing our facilities
with solar power
Eliminating unhealthy
materials from our
buildin...
Greenhouse Gas reporting
Source: KP 2008 GHG inventory for the NCAL, SCAL and Northwest regions, Joe Bialowitz, Environmen...
What people want
Sidney Garfield, MD
summed things up …
“The people of this
country ... donʼt want to
get sick.”
kaiserperm...
How we are delivering it today
youtube.com/kaiserpermanenteorg
52
© 2010 The Permanente Federation, LLC
“Keep Caring”
-Mike Linton, Coalition of Wisconsin Aging Groups
53
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Eytan - Aligning Forces for Quality

  1. 1. © 2010 The Permanente Federation, LLC Using Technology to Achieve Total HealthTED EYTAN, MD, MS, MPH • ALIGNING FORCES FOR QUALITY Kaiser Permanente: www.kp.org | twitter: tedeytan Photo: M.V. Jantzen, Washington, DC : http://flic.kr/p/8TuUgj 1
  2. 2. Who’s a fan of the pedometer? 2
  3. 3. The first place to start is the starting point... 3
  4. 4. The first place to start is the starting point... 4
  5. 5. Who’s a fan of the patient? Christine Abbott and Ted Eytan, 2008 5
  6. 6. The member experience attracts people 6
  7. 7. Even through harsh conditions…. 7
  8. 8. Why Total Health? Why not? 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 Photo: M.V. Jantzen, Washington, DC : http://flic.kr/p/8Ttx3g 8
  9. 9. In the words of a patient (and we will all be patients one day) “Kaiser Permanente HealthConnect® at Home - Empowering People” youtube.com/kaiserpermanenteorg 9
  10. 10. Technology does not replace us... “Where do you go for help with health or medical issues? 0% 25% 50% 75% 100% Health Professional Friend/Family internet books/print insurance provider other Source: Pew Internet & American Life Project: The Social Life of Health Information, June 2009, http://pewinternet.org/Reports/2009/8- The-Social-Life-of-Health-Information.aspx 10
  11. 11. We use it to improve the care we provide 60% 68% 75% 83% 90% 2005 2006 2007 2008 Source: (Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients. Health Affairs. 2010 ;29(7):1370-1375.) Didn’t use E-mail Used E-mail Kaiser Permanente Southern California % Members with high blood pressure under control 2005 - 2008 HEDIS 90th Percentile, 2008 70.3 % 11
  12. 12. And you will, too. Jack Cochran, MD, Executive Director of The Permanente Federation National Governor’s Association, Washington, DC 12
  13. 13. 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 complete: 36 hospitals live 24 HIMSS Stage 7 Hospitals 13
  14. 14. Kaiser Permanente physician : 2007 Victor Silvestre, MD Oakland, CA 14
  15. 15. Kaiser Permanente Nurse : 2009 youtube.com/kaiserpermanenteorg 15
  16. 16. Kaiser Permanente Advice Nurses: 2010 Appointment and Advice Call Center, Vallejo, CA - KP HealthConnect enabled! 16
  17. 17. Kaiser Permanente members/caregivers : 2010 “Balancing Work and Family” Kaiser Permanente YouTube Channel http://www.youtube.com/kaiserpermanenteorg 17
  18. 18. We connect with over 3 million members... 0 875,000 1,750,000 2,625,000 3,500,000 Q3 ‘03 Q1 ‘05 Q1 ‘07 Q1 ‘08 Q3 ‘10 Registered members August, 2010 946,273 e-mails sent by members • 9,600 physicians AND • 11,310 other providers responded 2,216,326 test results reviewed by members • 435,906 members reviewed test results Source: Kaiser Permanente Internet Services Group Web Analytics 18
  19. 19. and, 275,000 caregivers 200,000 225,000 250,000 275,000 300,000 Jan, 2010 Aug 2010 Act for Child / Act for Adult Source: Kaiser Permanente Internet Services Group Web Analytics 19
  20. 20. Who are experiencing significant job impacts Source: Caregiving in the United States, 2009 http://www.aarp.org/relationships/caregiving/info-12-2009/caregiving_09.html 2004 2009 62% 69% Job impact while caregiving 20
  21. 21. We are involving members and families better new My health manager pharmacy center - live in 2010-2011 Convenient dropdown box to refill prescriptions for “Act for a family member” Option to refill a prescription for someone else (prescription number needed) Add someone to your list 21
  22. 22. Helping families grow new My health manager Pregnancy center New layout Information and organization user -tested by pregnant women Relevant health messages, linked to My health manager kp.org/pregnancy 22
  23. 23. Moving people from information to action new My health manager Pregnancy center Link members to prenatal education, facility services and baby care classes Link members to appointments, e-mail, labs, visit summaries kp.org/pregnancy 23
  24. 24. Why this matters video courtesy Regina Holliday & Health 2.0 http://reginaholliday.blogspot.com | http://www.health2con.com 24
  25. 25. We use social media to participate as people May 28th, 2009 by Ted Eytan | Popularity: 36%May 28th, 2009 by Ted Eytan | Popularity: 36% || Edit this entryEdit this entry 20 comments | show/add20 comments | show/add »» Is it meaningful if patients can’t use it? I attended a smallish get together yesterday organized by Christine Kraft to think about Health 2.0 / DC in the epicenter type things, where we thought about some of the trends in social media use, social media use by physicians and medical groups (I got a lot of help on this one), journalists, and finally, a real story about a patient’s experience, here in DC, that really brings to light a problem with a meaningful use definition that doesn’t include “and the patients can see the data.” I’ve been thinking about the idea that meaningful use must include “patients can see everything” since ARRA came out, and see my first mention of it in the Twittersphere around April 22. I have noticed since then that the idea seems to be picking up steam – initially I was told by some that this would be a “distraction” to the conversation. Now I’m sure that it’s not. Read on… This is the story of Regina Holliday – it’s really worth a read, and I’ll quote some of it here: We will fight the good fight. Regina’s USA medical advocacy 2009 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 PHOTO LATEST TWEET No public Twitter messages. Follow me on twitter PREVIOUS ENTRY Photo Friday: Jane and Bob at NCVHS Testimony NEXT ENTRY Few are using HMSA’s Online Care | HonoluluAdvertiser.com | The Honolulu Advertiser SIMILAR POSTS 73 Cents : A New Monument to Patients, in Washington, DC Meaningful Meaningful Use Photo Friday: Return Expectations to the Upright Position Moderating a Dream Panel at WHIT 5.0 How would you counsel this patient? Home ContentTed Eytan, MD e-Health. Patient empowerment. Washington, DC. HomeHome AboutAbout PortfolioPortfolio ContactContact Subscribe to UpdatesSubscribe to Updates DiscussionDiscussion 25
  26. 26. “73 Cents” A National Monument to Patient Empowerment, in Washington, DC http://reginaholliday.blogspot.com 26
  27. 27. Failure to Notify, “significant results” Lab results studied in community practices - no improvement with EHR Imaging results studied at the VA, with advanced EHR 11 times (out of 92), imaging results that were not relayed to patients after 4 weeks were of an abnormality that turned out to be cancer. 7.1% 92.9% Lab Sources: Singh H, Thomas EJ, Mani S, Sittig D, Arora H, Espadas D, Khan MM, Petersen LA. Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting: Are Electronic Medical Records Achieving Their Potential? [Internet]. Arch Intern Med 2009 Sep;169(17):1578-1586.[cited 2009 Sep 29 ]; Casalino LP, Dunham D, Chin MH, Bielang R, Kistner EO, Karrison TG, Ong MK, Sarkar U, McLaughlin MA, Meltzer DO. Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results [Internet]. Arch Intern Med 2009 Jun;169(12):1123-1129.[cited 2009 Jun 26 ] 7.7% 92.3% Imaging Failure to Notify Notification 27
  28. 28. OpenNotes myopennotes.org 28
  29. 29. We use social media to tell our story about quality 50% 60% 70% 80% 90% 100% 2006 2007 2008 2009 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 NCQA 2010 90th Percentile Breast Cancer Screening • HEDIS 2010 29
  30. 30. “When I Grow Up” (125,075 total views) 30
  31. 31. And our patients are telling it back to us 31
  32. 32. 2005 was long ago in Internet time…. 0% 25% 50% 75% 100% AGE: < 30 30-50 50-64 65+ Social Networking Use Internet Source: Pew Internet & American Life Project Tracking Survey, September, 2005; Pew Internet & American Life Project: Older Adults and Social Media, August 2010, http://pewinternet.org/Reports/2010/Older-Adults-and-Social-Media.aspx Denominator is all adults for both data points; data is for “ever have” done this activity 32
  33. 33. 0% 25% 50% 75% 100% AGE: < 30 30-50 50-64 65+ Social Networking Use Internet Source: Pew Internet & American Life Project Tracking Survey, May, 2008; Pew Internet & American Life Project: Older Adults and Social Media, August 2010, http://pewinternet.org/Reports/2010/Older-Adults-and-Social-Media.aspx Denominator is all adults for both data points; data is for “ever have” done this activity 2008 33
  34. 34. 0% 25% 50% 75% 100% AGE: < 30 30-50 50-64 65+ Twitter/Status Update Social Networking Use Internet 2009 Source: Pew Internet & American Life Project Tracking Survey, April 2009; Pew Internet & American Life Project: Older Adults and Social Media, August 2010, http://pewinternet.org/Reports/2010/Older-Adults-and-Social-Media.aspx Denominator is all adults for both data points; data is for “ever have” done this activity 34
  35. 35. 0% 25% 50% 75% 100% AGE: < 30 30-50 50-64 65+ Twitter/Status Update Social Networking Use Internet 2010 Source: Pew Internet & American Life Project Tracking Survey, May 2010; Pew Internet & American Life Project: Older Adults and Social Media, August 2010, http://pewinternet.org/Reports/2010/Older-Adults-and-Social-Media.aspx Half of internet users ages 50-64 and one in four users age 65 and older use social networking sites 35
  36. 36. Support Systems “If there was one common theme I found in caring for my patients I would say it was the importance of support systems. Healthcare facilities don’t always provide optimal support systems. We don’t necessarily have to wait for facilities to revolutionize themselves; support systems can be developed in spite of the limitations of the healthcare industry itself. This is where social media becomes interesting.” -@PhilBaumann “Why a Registered Nurse is Interested in Social Media,” http://philbaumann.com/2008/06/12/why-a-registered-nurse-is-interested-in- social-media/ 36
  37. 37. “Direct Message” Followers & Following@ = “Reply” Monitoring 37
  38. 38. Ideabook: KP’s Social Network 38
  39. 39. 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 39
  40. 40. Home. Sort of. 40
  41. 41. Medical-Surgical Ward 41
  42. 42. Operating Room 42
  43. 43. Garfield Innovation Center  Opened in 2006  Sponsored by KP IT, National Facilities Services, and Patient Care Services  37,000 square feet  Full-scale medical-surgical ward; Labor and Delivery; Operating Room; Emergency Department  Home environment  Open prototyping space; IT lab; conference rooms 43
  44. 44. 1 PROTOTYPING SPACE 2 HOSPITAL 4 HOME 3 CLINIC 44
  45. 45. Garfield Center Activities Space Designs Workflow Studies  Technology Demos  Training and Simulations 45
  46. 46. MedRite “With our nurses as co- designers, we learned that the medication administration process is unclear, chaotic and full of interrupts. The evidence-based design is simple, elegant, and safe. We call this innovation KP MedRite.” xnet.kp.org/innovationconsultancy 46
  47. 47. Growing a healthier health care system 47
  48. 48. Where were you when….? 48
  49. 49. Building, buying, eating green Energizing our facilities with solar power Eliminating unhealthy materials from our buildings Zero exporting of e-waste Sourcing food locally; creating hospital based farmer’s markets Green Resource Center: http://xnet.kp.org/newscenter/ aboutkp/green/index.html Source: 2009 EPA Pacific Southwest Environmental Awards, http://www.epa.gov/ region09/awards/09/index.html; “Healthy Health Care Leader - Kaiser Permanente,” http://blog.epa.gov/blog/2009/10/15/healthy- health-care-leader-kaiser-permanente/; 49
  50. 50. Greenhouse Gas reporting Source: KP 2008 GHG inventory for the NCAL, SCAL and Northwest regions, Joe Bialowitz, Environmental Stewardship Does not yet include all impacts of care delivery, including travel or procurement 66% 25% 4% 3%2% Purchased electricity Stationary combustion (incl. boilers emergency power generators) Medical gases (N2O CO2 SF6) Refrigerants Mobile combustion (fleet vehicles landscaping equipment) Estimated Total: 0.621 Megatons of CO2e California, Oregon, Washington Operations, 2008 50
  51. 51. What people want Sidney Garfield, MD summed things up … “The people of this country ... donʼt want to get sick.” kaiserpermanentehistory.org 51
  52. 52. How we are delivering it today youtube.com/kaiserpermanenteorg 52
  53. 53. © 2010 The Permanente Federation, LLC “Keep Caring” -Mike Linton, Coalition of Wisconsin Aging Groups 53

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