Health is the new HIT - Stanford Biomedical Informatics 207 | July 31 2014

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Using technology to enable a health system that supports total health and makes lives better. Kaiser Permanente Center for Total Health / guest lecture at Stanford School of Medicine : Digital Medicine: Designing IT Innovations that Improve Healthcare
Stanford University Biomedical Informatics 207
Summer Quarter 2014

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Health is the new HIT - Stanford Biomedical Informatics 207 | July 31 2014

  1. 1. Health is the new HIT
 Digital Medicine: Designing Innovations that Improve Healthcare: Stanford Biomedical Informatics 207 July 31, 2014 Ted Eytan, MD MS MPH • The Permanente Federation • twitter: @tedeytan © 2014 The Permanente Federation, LLC | Photograph: Ted Eytan, MD, http://www.flickr.com/photos/22526649@N03/14064117427
  2. 2. Health is the new HIT
 Digital Medicine: Designing Innovations that Improve Healthcare: Stanford Biomedical Informatics 207 July 31, 2014 Ted Eytan, MD MS MPH • The Permanente Federation • twitter: @tedeytan © 2014 The Permanente Federation, LLC | Photograph: Ted Eytan, MD, http://www.flickr.com/photos/22526649@N03/14064117427
  3. 3. “The Pulse of Health Care” Squawk Box with Andrew Sorkin • July 14, 2014
  4. 4. Build Your Best Life Total Health Festival, with Capital Pride, Washington, DC • Kaiser Permanente 2014 Gold Sponsor I’m an ally (also a family doctor, a Permanente physician, a Kaiser Permanente member, a Washington, DC resident) Hi. I’m Ted.
  5. 5. We’re here from the future Kaiser Permanente Center for Total Health,Washington, DC • @KPTotalHealth
  6. 6. are you? Kaiser Permanente Interchange API Code-a-Thon, June, 2013, Washington, DC
  7. 7. Innovation System: Kaiser Permanente “social innovation”
  8. 8. In the future, technology enables us to Lead in Total Health by – delivering excellent medical care – eliminating health disparities In a health system that – faces the community, not the hospital – heals by not harming – listens to the people it serves and as a result makes lives better Kaiser Permanente La Mesa Medical Offices, La Mesa, California 70% powered by the sun
  9. 9. …deliver excellent medical care KP member US 90th % 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. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010].
  10. 10. + email US 90th % Significant? How about p<0.0001 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. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010]. …deliver excellent medical care
  11. 11. © 2014 The Permanente Federation, LLC Source: Kaiser Permanente Web Analytics, updated 07/09/2014 4.5 million members connected, via kp.org
  12. 12. © 2014 The Permanente Federation, LLC Source: Kaiser Permanente Web Analytics, updated 07/09/2014 In 2014, per month 1.6 million emails 3.1 million test results reviewed 50% of the shared results 356 thousand appointments made 35 % signed on 5 or more times 26 % of visits via mobile device 4.5 million members connected, via kp.org
  13. 13. © 2014 The Permanente Federation, LLC Act for Child / Act for Adult Source: Kaiser Permanente Internet Services Group Web Analytics Updated 07/09/2014 and, 545,000 caregivers ! 756,000 subjects
  14. 14. © 2012 The Permanente Federation, LLC The most HEDIS #1’s Effectiveness of Care Measures Kaiser Permanente #1’s •Comprehensive diabetes care — LDL control less than 100 mg/dl (Hawaii Region) •Osteoporosis management in women who had a fracture (Northern California Region) •Breast cancer screening, age 42–69 (Northwest Region) •Pharmacotherapy Management of chronic obstructive pulmonary disease (COPD) exacerbation — bronchodilator (Northwest Region) •Cholesterol management (coronary artery disease), LDL level less than 100 mg/ dl (Colorado Region) •Follow-up after hospitalization for mental illness — 30 days (Colorado Region) •Controlling high blood pressure — cardiovascular (Hawaii Region) •Potentially harmful drug- disease interaction — total (Hawaii Region) •Weight assessment for adults — body mass index percentile (Georgia Region) •Weight assessment for children — body mass index percentile •Counseling for nutrition for children •Counseling for physical activity for children •Chlamydia screening in women (ages 16–20, 21–24 and total) •Appropriate testing for children with pharyngitis •Appropriate use of medications for people with asthma (ages 12– 50, total) •Comprehensive diabetes care — LDL control less than 100 mg/dl •Comprehensive diabetes care — medical attention for nephropathy •Antidepressant medication management (effective acute phase) •Antidepressant medication management (effective continuation phase) •Annual monitoring for patients on persistent medications — anticonvulsants 2011
  15. 15. © 2012 The Permanente Federation, LLC The most HEDIS #1’s Effectiveness of Care Measures Kaiser Permanente #1’s •Breast cancer screening, age 42–69 (Southern California) •Use of Spirometry Testing in the Assessment of COPD (Hawaii Region) •Pharmacotherapy Management of COPD Exacerbation — Bronchodilator (Southern California) •Cholesterol management (coronary artery disease), LDL Screening (Hawaii) •Cholesterol management (coronary artery disease), LDL level less than 100 mg/ dl (Colorado) •Controlling high blood pressure — cardiovascular (Ohio) •Comprehensive diabetes care — HbA1c Testing (Hawaii) •Comprehensive diabetes care — LDL level less than 100 mg/dl (Northern California) •Comprehensive diabetes care — Medical Attention for Nephropathy (Colorado) •Comprehensive diabetes care — blood pressure control (<140/80) (Georgia) •Comprehensive diabetes care — blood pressure control (<140/90) (Colorado) •Osteoporosis management in women who had a fracture (Southern California) •Potentially harmful drug- disease interaction — Dementia (Hawaii) •Breast cancer screening •Comprehensive diabetes care — blood pressure control (<140/80) •Comprehensive diabetes care — blood pressure control (<140/90) •Comprehensive diabetes care — medical attention for nephropathy •Antidepressant medication management (effective acute phase) •Antidepressant medication management (effective continuation phase) •Weight assessment for children — body mass index percentile •Counseling for nutrition for children •Counseling for physical activity for children •Chlamydia screening in women (ages 16–20, 21–24 and total) •Appropriate treatment for children with upper respiratory infection •Avoidance of antibiotic treatment in adults with acute bronchitis •Use of spirometry testing in assessment & diagnosis of chronic obstructive pulmonary disease •Annual monitoring for patients on persistent medications — anticonvulsants •Medical assistance with smoking cessation — advising smokers to quit •Medical assistance with smoking cessation — discussing strategies Source: Kaiser Permanente Newe Center, http://xnet.kp.org/ newscenter/pressreleases/nat/ 2012/101012_ncqa_care_measures.html ; http://xnet.kp.org/ newscenter/pressreleases/nat/2012/112812-ncqa-medicare- measures.html 2012
  16. 16. The most HEDIS #1’s Effectiveness of Care Measures Kaiser Permanente #1’s •Adult BMI Assessment •Weight Assessment for Children •Counseling for Nutrition for Children •Counseling for Physical Activity for Children •Breast Cancer Screening •Cervical Cancer Screening •Chlamydia Screening in Women (Ages 16-20, Ages 21-24, and Total) •Use of Spirometry Testing in Assessmand & Diagnosis of COPD •Controlling High Blood Pressure •Comprehensive Diabetes Care - Eye Exams •Comprehensive Diabetes Care - Medical Attention for Nephropathy •Comprehensive diabetes care — blood pressure control (<140/80) •Comprehensive diabetes care — blood pressure control (<140/90) Source: KP Share, http://share.kaiserpermanente.org/article/kaiser-permanente-leads-the-nation-in-13-commercial-health-plan-quality-measures/ ; http:// share.kaiserpermanente.org/article/kaiser-permanente-leads-the-nation-in-16-health-plan-quality-measures/#sthash.ovQAKsbK.dpuf 2013 •Breast cancer screening (Southern California) Adult BMI assessment (Northern California) Use of spirometry testing in assessment and diagnosis of chronic obstructive pulmonary disease (Southern California) Pharmacotherapy management of COPD exacerbation — bronchodilator (Southern California) Cholesterol management CAD — LDL screening (Hawaii) Cholesterol management CAD — LDL level <100 (Hawaii) Persistence of beta blocker treatment after heart attack (Colorado) Comprehensive diabetes care — blood pressure control (<140/80) (Georgia) Comprehensive diabetes care — blood pressure control (<140/90) (Colorado) Comprehensive diabetes care — HbA1c testing (Hawaii) Comprehensive diabetes care — <100 (Hawaii) Osteoporosis management in women who had a fracture (Southern California) Antidepressant medication management — acute phase (Northern California) Antidepressant medication management — continuation phase (Northern California) Potentially harmful drug- disease interaction — dementia (Southern California) Use of high risk medications in the elderly — one drug (Northern California)
  17. 17. Why Total Health? Why not? Leonora Brogan - Kaiser Permanente Center for Total Health http://kp.org/centerfortotalhealth
  18. 18. Exercise as Vital Sign “I would suggest it makes more sense to stop measuring blood pressure at every visit than to ignore our patient’s exercise habits, because we know that being sedentary is a bigger risk factor for mortality than mild to moderate levels of hypertension” – Bob Sallis, MD Smith, John W Source: Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br. J. Sports Med. 2011;45(6):473–474. Available at: http://bjsm.bmj.com/content/45/6/473.short.
  19. 19. The Obesity Paradox14,345 men , average 7 year follow-up Source:Lee D, Sui X, Artero EG, et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation. 2011;124(23):2483–90. Available at: http://circ.ahajournals.org/content/124/23/2483.abstract [Accessed October 8, 2013]. Image © American Heart Assocation men who became fit or remained fit had approximately 40– 50% lower risks of all-cause and CVD mortality ! BMI status change was not significantly associated with either all- cause or CVD mortality
  20. 20. If physical activity were a drug... activated activated activated deactivated it works bettertm Source: Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nature Reviews. Neuroscience. 2008;9(1):58–65.. Slide created by Ted Eytan, MD | @tedeytan | December, 2012
  21. 21. Powered by
  22. 22. With upload to the cloud
  23. 23. “Do You Really Want an iWatch?” Apple Byte with Brian Tong • July 24, 2014
  24. 24. #activetransportation Source: Ted Eytan, MD, Star Magazine,September 23, 2013, Partnership for Active Transportation
  25. 25. Source: Bikesharing Trip Visualizer: http://mvjantzen.com/tools/visualizer/
  26. 26. Source: Bikesharing Trip Visualizer: http://mvjantzen.com/tools/visualizer/
  27. 27. Bird’s Eye View of Bikesharing Source: A Bird’s Eye View of Bikesharing -http://www.mvjantzen.com/blog/?p=4513
  28. 28. © 2012 The Permanente Federation, LLCSource: Community Health Needs Assessment http://chna.org
  29. 29. 2013 obesity rate: 19.1%
  30. 30. 2013 obesity rate: 12.5%
  31. 31. 2013
  32. 32. 1992
  33. 33. 2013
  34. 34. © 2012 The Permanente Federation, LLC
  35. 35. © 2012 The Permanente Federation, LLC 2238 Geary Street, San Francisco, July 30, 2014
  36. 36. ….face the community “Bike-friendly Arlington County, which works closely with the National Park Service, has placed the newest sensor, an expensive, state-of-the-art, French-made device, on the trail near Reagan National Airport.” Part of TMAP - Trail Modeling and Assessment Platform http://www.washingtonpost.com/local/counting-commuters-on-a-bucolic-trail/2013/09/02/0da4700a-054e-11e3-9259- e2aafe5a5f84_story.html ; http://www.railstotrails.org/ourWork/promotingTrailUse/mapping/TMap.html
  37. 37. Annual Adult per Capita Cigarette Consumption and Major Smoking and Health Events – US 1900-1998 Year Thousands per year 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 Great Depression End of WW II 1st Surgeon General’s report Broadcast advertising ban Federal cigarette tax doubles Fairness Doctrine messages on TV and radio Nonsmoker’s rights movement begins 1st smoking cancer concern Surgeon General’s report on environmental Tobacco smoke Master settlement agreement Nicotine medications Available over the counter 1st World Conference on smoking and health 1998 1st Great American smokeout Is this our our generation’s 1968? Source: http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/Obesity-Roundtable/1_Dietz.pdf
  38. 38. Site Design – Designed from the start with green strategies in mind. – Recycled 90+% of building materials from demolition of existing buildings – Storm Water Handling – Designed landscape areas and swales to treat storm water flows – Increased amount of landscaped area compared to previous site Water – Increased plantings of drought-resistant landscaping – Used water-saving plumbing features – 36% in domestic water savings - result of water efficient fixtures and non-chemical water treatment for the cooling towers Energy – Designed to use 10% less energy than CA title 22 allows – 50% annual, mechanical energy savings resulting in $65,000,000 in energy savings over a 50 year life for Kaiser Oakland hospital, 620,000 sf. (energy savings were verified by an independent third party, Energysoft who performed the 3rd party review for PG&E, the local utility). – 33% reduction in chiller central plant size as a result of our energy saving design strategy. – Used high-efficiency glass, sunshades, and blinds to allow natural light while minimizing hot afternoon sunlight – Used fluorescent lights with low wattage per square foot and occupancy shut off sensors Building Products – Chose rubber flooring, which uses no PVCs and reduces need for maintenance chemicals – Specified high fly ash content in concrete foundations and walls – Chose carpet with no PVCs – Used cotton building insulation in walls Transportation Management – Employee parking incentives – Designated carpool parking – Web site to assist set up of carpools – Designated, locked bicycle parking and showers – Free shuttle service from BART – Guaranteed ride home program for carpooling staff – PROVIDE SMART CAR FOR WORK USE ON CHECK OUT BASIS Source: http://kp.org/oakland
  39. 39. “Dream Grounds for a Dream Hospital” Why Source: http://kasierpermanentehistory.org ; Joe Bialowitz, MS, HEM, Senior Environmental Stewardship Consultant, Kaiser Permanente
  40. 40. Why Source: http://www.businesswire.com/news/home/20130819005270/en/Mazzetti-Congratulates-Kaiser-Permanente-Opening-Westside- Medical ; http://xnet.kp.org/newscenter/pressreleases/scal/2012/011712sandiegosolar.html “Showcases of modern, green hospital design” Follow: @KPThrive
  41. 41. Health Affairs, May 2011: “Kaiser Permanente Study Finds Use of Electronic Health Records Reduces Carbon Emissions, Waste and Water Consumption” Poten&al  CO2  emissions  reduc&ons  as   much  as  1.7  million  tons  across  the  en&re   U.S.  popula&on   !Source: Turley M, Porter C, Garrido T, et al. Use of electronic health records can improve the health care industry’s environmental footprint. Health affairs (Project Hope). 2011;30(5):938-46. Available at: http://content.healthaffairs.org/cgi/content/abstract/30/5/938 [Accessed January 3, 2012].
  42. 42. © 2013 The Permanente Federation, LLC To heal, you have to not harm NHS England KP 0.8025  MtCO2e 4.07  MtCO2e     (building  energy  use  &  direct  emissions) 9  million  members   178,000  employees   37  hospitals   611  medical  office  buildings     488  other  facili&es 53  million  people MtCO2e : Metric Tonne (ton) Carbon Dioxide Equivalent, 2012 Reporting Year Source: http://www.theclimateregistry.org/ ; http://www.sdu.nhs.uk/sd_and_the_nhs/
  43. 43. Speaking of roots… Center for Total Health, Washington, DC, April 1, 2014
  44. 44. kp.org | Spanish
  45. 45. Source: Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. J. Am. Med. Informatics Assoc. 2013. Available at: http://jamia.bmj.com/content/early/ 2013/04/29/amiajnl-2012-001472.full [Accessed May 1, 2013].
  46. 46. Being a Transgender Ally and Unconscious Bias
 Kaiser Permanente 2nd Annual LGBTQI Symposium: Advancing LGBTI Health Equity May 2, 2014 | Universal City, California, USA Ted Eytan, MD, MS, MPH • The Permanente Federation, LLC • @tedeytan with April Soto, MD & Prudence (Kaiser Permanente member) © 2014 The Permanente Federation, LLC Desert Center, 1933
  47. 47. Washington, 2013
  48. 48. 52 Paul de Kruiff, Kaiser wakes the Doctors, 1943
  49. 49. We all have a condition called “me.” Personalizing Leadership: Awareness, Humility, and Courage, Jack Cochran, MD, FACS, Kaiser Permanente National Diversity & Inclusion: Mastering Difference to Make a Difference, San Francisco, CA, November 22, 2013, http://diversity.kp.org/news/news-nd-conference-2013.html
  50. 50. Make Lives Better… by Listening
  51. 51. Why Gilbert Salinas, BS, MPA Director of Patient and Community Relations, Rancho Los Amigos National Rehabilitation Center 2013 Kaiser Permanente Safety Net Fellow, Institute for Healthcare Improvement Permanente Executive Leadership Summit • June 10, 2014
  52. 52. © 2012 The Permanente Federation, LLC Walking Gallery IV, Baltimore, MD, USA #ARTSCAPE2014, July 18, 2014
  53. 53. Being There “Bouncing a Ball Alone: Grokking Failure” - Henry Ford Health System, Detroit, November, 2012
  54. 54. The Walking Gallery Regina Holliday | @ReginaHolliday Source: http://vimeo.com/24857924
  55. 55. © 2012 The Permanente Federation, LLC Casa Ruby LGBT Center 2nd Anniversary, Washington, DC 6/3/2014
  56. 56. kp.org/thrive

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