Meaningful mobile technology use...to achieve Total HealthTed Eytan, MD MS MPH • The Permanente Federation • twitter: tede...
Why Total Health? Why not? Integrated Health Care   Easy, Excellent, Comprehensive Commitment to Prevention   Address is...
Technology does not replace us...“The last time you sought help with health or medical issues, it was from…”        100%  ...
We use it to improve the care we provide: Blood Pressure                                                                  ...
We use it to improve the care we provide: Blood Pressure                            Significant? How                      ...
KP Health Manager, part of aMy HealthConnect® – Enabling Patient-Centered Care     comprehensive electronic     health rec...
KP Health Manager, part of aMy HealthConnect® – Enabling Patient-Centered Care     comprehensive electronic     health rec...
More : The relationshipKP HealthConnect® – Enabling Patient-Centered CareDeeper, with mobile m.kp.org   17 % of visits to ...
More : The relationship  Nine million Kaiser Permanente   members have 24/7 access to their   medical information anywher...
More : The relationship  © 2012 The Permanente Federation, LLC
More : The family  © 2012 The Permanente Federation, LLC
4 million members connected, via kp.org                                                                      5,000,000 mem...
4 million members connected, via kp.org                                                              5,000,000 members    ...
and, 430,000 caregivers                                                                                           500,000 ...
Highly meaningful use                                               Nonuser, kp.org                                       ...
Highly meaningful use                                                                                                     ...
Warm Greetings from                                        Colorado Springs Source: Ted Eytan, MD© 2012 The Permanente Fed...
Environmentally responsible, too                                     Health Affairs, May 2011: “Kaiser                    ...
MobilityCenter of Excellence
Brian GardnerExecutive DirectorMobility Center of ExcellenceKaiser Permanente@bg_gardnerBrian leads the Mobility Center of...
Be part of something big and boldWe’re hiring       Sr. iOS Developers       Sr. Android Developers       User Experience ...
kp.org/thrive© 2012 The Permanente Federation, LLC
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Meaningful mobile technology use to support Total Health (Kaiser Permanente)

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Presentation given on FierceHealthIT Webinar, September 26, 2012, broadcast from Washington, DC USA

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  • My name is Ted Eytan, MD, and I am a family physician. I work for Kaiser Permanente, within the Permanente Federation, which is the umbrella organization for the 9 medical groups of Kaiser Permanente and Group Health Cooperative.\n\nI took this photograph in Dupont Circle, Washington, DC, where I live, of people using our bikeshare system. Once you connect to your patients outside of the exam room, you’ll realize that your medical office is outside of the exam room, where your patients live. This is the ideal of meaningful use - meaningful to the people we serve so that they can achieve their life goals, rather than to use the technology well.\n\nFor our webinar guests, you won’t be able to read the small print at the bottom of each slide, they are source information for reference later on, if you access the PDF or slideshare online.\n\n\n
  • The way we speak about it at Kaiser Permanente is Total Health, which includes an integrated, prepaid health, non-profit health system, a commitment to prevention in our model, and thinking and action outside of medical care - from individual to family, community, and society, as well as mind, body spirit. \n\nI would normally be coming to you from a new facility that bears this namesake, the Kaiser Permanente Center for Total Health, which has been open for a year in the heart of Washington, DC. More than 3,500 people have come through in tours and events to date, I encourage listeners to come and learn as well. It is a place to have conversations and in some case, change the conversation about what health is and our aspirations of what we want it to be.\n
  • The background of being meaningful is knowing what people want. Friend to the internet, Susannah Fox, regularly publishes data about people’s access to health information, and time after time, Americans cite health professionals as the #1 place they have gone for help with health or medical issues. Friend/Family are #2, others with the same condition are #3. What’s also interesting about this survey, published in 2011, is that most of these connections are offline, across all 3 groups. For example, 65 of the 70 % for health professionals was offline consultation, 15 % of the 20 % of others with the same condition was offline as well.\n\nWhat this means, and what we’ve learned, is that technology continues to be a supplement of, not a replacement for, trusted relationships.\n\n
  • With that in mind, this is what we use technology for.\nThis study, published in 2010, showed that the 90th percentile of blood pressure control (defined as < 140/90) was 70.3 %. The graph demonstrates what happened at Kaiser Permanente Southern California, with the advent of the comprehensive electronic health record in 2005. By 2008, blood pressure control for a Kaiser Permanente member was 80%, far surpassing the best health systems, to unheard of levels of control and ultimately prevention of heart disease.\n\nThis is especially significant considering that the CDC recently published data 2 weeks ago that of the 1/3 of Americans that have high blood pressure, only 46% have it controlled.\n\nIf you’re wondering what the connection is to mobile health, I’ll show you on the next slide, because this data is of Kaiser Permanente members who did NOT e-mail their physicians during the study period.\n
  • When our researchers compared blood pressure control among members who had e-mailed their doctor during this time, there was a statistically significant increase beyond the 80 %, to 84 %. What I am not showing here is the other measures they tested, including: glycemic control, nephropathy screening, cholesterol lowering, retinopathy screening, all of which demonstrated significant, positive improvement among members who used the kp.org personal health record to e-mail their doctor.\n
  • This is how those patients did it. \nIf you go to our home page at kp.org, you will see My Health Manager, which is a direct connection to our comprehensive electronic health record, KP HealthConnect. The deployment is complete as of 2010, connecting over 500 medical offices, and 37 hospitals across the United States. 36 of those hospitals are HIMSS Stage 7, which is the highest level of functionality a hospital can achieve using health information technology. 66 hospitals in the world are Stage 7. 36 of them are Kaiser Permanente’s. Kaiser Permanente also won the 2012 Davies Award, which marks achievement in the planning and implementation of health information technology.\n\nIn case you are still wondering how this connects to mobile health, here’s how.\n\n(HIMSS Stage 7 awards have been given to 66 of the nation’s 5,815 hospitals)\n
  • Now 9 million Kaiser Permanente patients can easily access their own medical information anywhere in the world on mobile devices through the mobile-optimized website and Android and iOS apps. This is the web-optimized version, that was released in January of this year. It requires no download, and can be reached by going to kp.org on a mobile device, or m.kp.org if you’d like the direct route.\n
  • Here is what we are seeing so far. 17 % of the visits to kp.org are now coming via the mobile site, and you can see application download numbers as well. We are very early in our mobile analytics journey, however, having 15 years of experience and a connection to a functioning care delivery system, is helping us understand this space for us, and for you, very quickly.\n\n\n
  • Here is what the iOS app looks like. You can email your doctor, check lab results, order prescription refills and manage appointments, which includes direct booking by time.\n\nLiterally. You can now e-mail your doctor from the baggage claim of your favorite airport. I know. I’ve done it.\n\n
  • On the left is the main navigation screen, on the right is the message center screen. As I mentioned, you can now email your own doctor from anywhere.\n\nI want to pause here and note the significance of this development to physicians and to the medical profession. About 10 years ago, we led health care in developing technology and workflows so that 100% of our physicians would be accessible to their patients via secure email. That was on the web. It was a long and intense process. I’ll also say that almost on day one, people asked whether patients would be able to IM or text their doctor. The security and usability of the smartphone was not yet available to us, though.\n\nNow, however, our physicians and nurses couldn’t imagine practicing with out it. Flash forward to 2012, and overnight, 17,000 physicians became even more available, where patients are, because of the breakthrough in smartphone technology. I’ll call that amazing.\n
  • Lastly, I want to point out that this is a family of applications, that’s growing. The type is too small to read here - the point I want to make is that the commitment is strong and we know that this is a whole new channel to deliver connections to health information and mostly people (remember the Pew Internet data), which is what people want. If you look at this chart later, you’ll see that there’s a push into preventive care, diet, and exercise, which is part of our Total Health approach.\n
  • All right. Let’s talk hockey sticks. This is one. It shows the adoption of the kp.org personal health record since 2003. Because mobile is now a channel of delivery to this tool, it shares in this adoption curve. We crossed 4,000,000 members registered for use in 2012.\n\nPeople who say that patients don’t want to access their physicians, nurses, and medical record information online should keep an image of this curve handy. My patient advocate friends would say that anyone who says that patients don’t want this access don’t really know people at all.\n\nThis curve represents 10 years of interacting with patients where they live, work, learn, pray, and play.\n\nWe know this because of its stickiness - 34 % of people signed on 5 or more times in just a 6 month period. Our members keep coming back, and our physicians and nurses are a big part of recommending use as well as actually using this system, which is totally and securely embedded in their day to day workflow.\n
  • All right. Let’s talk hockey sticks. This is one. It shows the adoption of the kp.org personal health record since 2003. Because mobile is now a channel of delivery to this tool, it shares in this adoption curve. We crossed 4,000,000 members registered for use in 2012.\n\nPeople who say that patients don’t want to access their physicians, nurses, and medical record information online should keep an image of this curve handy. My patient advocate friends would say that anyone who says that patients don’t want this access don’t really know people at all.\n\nThis curve represents 10 years of interacting with patients where they live, work, learn, pray, and play.\n\nWe know this because of its stickiness - 34 % of people signed on 5 or more times in just a 6 month period. Our members keep coming back, and our physicians and nurses are a big part of recommending use as well as actually using this system, which is totally and securely embedded in their day to day workflow.\n
  • All right. Let’s talk hockey sticks. This is one. It shows the adoption of the kp.org personal health record since 2003. Because mobile is now a channel of delivery to this tool, it shares in this adoption curve. We crossed 4,000,000 members registered for use in 2012.\n\nPeople who say that patients don’t want to access their physicians, nurses, and medical record information online should keep an image of this curve handy. My patient advocate friends would say that anyone who says that patients don’t want this access don’t really know people at all.\n\nThis curve represents 10 years of interacting with patients where they live, work, learn, pray, and play.\n\nWe know this because of its stickiness - 34 % of people signed on 5 or more times in just a 6 month period. Our members keep coming back, and our physicians and nurses are a big part of recommending use as well as actually using this system, which is totally and securely embedded in their day to day workflow.\n
  • One more hockey stick. Let’s not forget caregivers, whose work on behalf of the people they love is also made easier through “act for a child” and “act for Adult” features. There are almost 600,000 people being cared for online, whose accounts are managed securely by 430,000 people. Important statistic that about 16 % of the employed population is involved in caregiving, 69 % of them are experiencing “significant” job impacts. \n\n
  • And, last piece of data, which looked at meaningfulness in an important way - how does this access influence loyalty to a health system and because of our model, a physician practice? Significantly. On the bottom are different levels of Kaiser Permanente tenure, from less than a year, to over 10 years. The bars represent the percentage of people who voluntarily left their physician and Kaiser Permanente in a given year during the study period. The light blue bars are users of kp.org, the dark bars are not. Notice the huge difference for new members to Kaiser Permanente - 92 % of new members who experienced kp.org stayed, compared to 82 % of new members who did not. You can imagine what this means for successful onboarding to a new practice, creating a personal health action plan, and developing a relationship for health that could last a very long time. And, you can guess (correctly) that this data would stimulate any physician or health system to use these tools to increase bonding as much as possible throughout the health journey.\n
  • This is the overall number. 2.578 times greater likelihood that a member who uses kp.org will continue their care relationship. This is what we mean by highly meaningful - it’s central to the relationship itself.\n
  • I show this image because it demonstrates where this all comes together, where the rubber hits the road. If you were here with me I would ask you what in this photograph is the most toxic structure you can build. Since you’re not here, I’ll give you the answer. It’s the parking lot. And we’re building less of them, as well as smaller medical offices, with more space for the relationship, less or no space for medical records rooms and x-ray file rooms.\n\nIt’s estimated that United States healthcare produces 8% of the Carbon Dioxide emissions in this country. By choosing to use this technology to the fullest, we can also make the choice to support all the work we do inside the medical office, by supporting the environment around it in being conducive to health.\n
  • On that note, I want to point you to one more study, which is about the impact of electronic health records and communication on CO2 emissions. \n
  • Now the fun stuff. How do we do this, and how can you be a part of it. This is the mobility center of excellence. Kaiser Permanente now has one. It’s more than a brand, it’s 19 people in 4 areas, that synchronize the best of Kaiser Permanente with this channel. I’m going to say that I’m really impressed with what this team has accomplished in so short a time. Not too long ago, mobility was a twinkle in our eye. Now it’s point, click, download, connect, with all of the security, workflow, and other infrastructure that we’ve accumulated over the last 70 years. In terms of innovaiton, this team regularly involves physicians, nurses, and members from across Kaiser Permanente in code-a-thons in imagining the future and creating apps on the fly that can be tested and improved for better health and health care.\n
  • And...it’s not me doing this. I am not the Mobility Center for Excellence person. I am the passionate about patient and family involvement and Total Health person, which is how I intersect with this work. Brian Gardner, however, is the Executive Director of the Mobility Center of Excellence. There’s his twitter handle so you can follow him. And his bio is up there as well. I got to meet Brian for the first time when Kaiser Permanente’s mobility program was first starting, and I was so glad he was here with us. I connected with him again last week in preparation for today, and I am still very glad he is here with us. One of the best things he said to me was...\n
  • That you can be here with us, too. Brian wants me to tell you that we’re hiring, which I am happy to do, especially in a space where I am regularly contacted by people who want to work with us. The list is up there, which includes iOS and Android developers, U/X designers, Visual Designers and Project managers. Send your resume to kpmobile@kp.org. I will put in an additional 2 cents here which is that Kaiser Permanente is a great place to work, and the thing that draws people to this organization is that you can be a best in class physician, nurse, technologist, developer, designer, in your field, and visibly contribute to the health of the people and community around you. Enough said. Call me, text me, mail me, tweet me, if you want to know more about this.\n
  • We’re here to improve the ability of people to achieve their life goals. It doesn’t matter if the technology works well, and to an extent if it helps our doctors and nurses, unless it helps the people we serve also. This part of the health information technology landscape - patient and family access to people they trust and their medical information, is the most important one for me by far - it is the “it’s only meaningful if the patients can use it.” Thanks for listening.\n
  • This is the last image, from our 2012 advertising campaign. I’m showing it because it’s how I feel. We’re not here to improve health care, we’re not even here to improve health. We’re here to improve the ability of people to achieve their life goals. It doesn’t matter if the technology works well, and to an extent if it helps our doctors and nurses, unless it helps the people we serve also. This part of the health information technology landscape - patient and family access to people they trust and their medical information, is the most important one for me by far - it is the “it’s only meaningful if the patients can use it.” Thanks for listening.\n
  • Meaningful mobile technology use to support Total Health (Kaiser Permanente)

    1. Meaningful mobile technology use...to achieve Total HealthTed Eytan, MD MS MPH • The Permanente Federation • twitter: tedeytanSeptember 26, 2012Photograph: Ted Eytan, MD, http://flic.kr/p/bvY388 © 2012 The Permanente Federation, LLC
    2. 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, Kaiser Permanente Center for Total Health, Washington, DC the environment you live in http://kp.org/centerfortotalhealth © 2012 The Permanente Federation, LLC
    3. Technology does not replace us...“The last time you sought help with health or medical issues, it was from…” 100% 75% 50% 25% 0% Others with condition Friend/Family Health Professional Source: Fox S. The Social Life of Health Information, 2011. Washington, DC; 2011. Available at: http://www.pewinternet.com/Reports/ 2011/Social-Life-of-Health-Info.aspx © 2012 The Permanente Federation, LLC
    4. We use it to improve the care we provide: Blood Pressure 85% KP member 73% US 90th % 60%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. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010]. © 2012 The Permanente Federation, LLC
    5. We use it to improve the care we provide: Blood Pressure Significant? How 85% about p<0.0001 + email 73% US 90th % 60%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. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010]. © 2012 The Permanente Federation, LLC
    6. KP Health Manager, part of aMy HealthConnect® – Enabling Patient-Centered Care comprehensive electronic health record Ambulatory deployment complete all medical offices live Inpatient deployment complete 37 hospitals live 36 HIMSS Stage 7 © 2012 The Permanente Federation, LLC
    7. KP Health Manager, part of aMy HealthConnect® – Enabling Patient-Centered Care comprehensive electronic health record Ambulatory deployment complete all medical offices live Inpatient deployment complete 37 hospitals live 36 HIMSS Stage 7 © 2012 The Permanente Federation, LLC
    8. More : The relationshipKP HealthConnect® – Enabling Patient-Centered CareDeeper, with mobile m.kp.org 17 % of visits to kp.org App downloads (Aug 2012) 132,434 - iOS 140,605 - AndroidSource: Kaiser Permanente Web Analytics, updated 09/24/12 © 2012 The Permanente Federation, LLC
    9. More : The relationship  Nine million Kaiser Permanente members have 24/7 access to their medical information anywhere in the world from their mobile devices  Patients can – email their providers – check lab test results – order prescription refills – manage appointments © 2012 The Permanente Federation, LLC
    10. More : The relationship © 2012 The Permanente Federation, LLC
    11. More : The family © 2012 The Permanente Federation, LLC
    12. 4 million members connected, via kp.org 5,000,000 members 2,500,000 members20032005 2007 2009Source: Kaiser Permanente Web Analytics, updated 08/03/2012 2012 (2Q) © 2012 The Permanente Federation, LLC
    13. 4 million members connected, via kp.org 5,000,000 members In first half of 2012 6.8 million emails 16.7 million test results reviewed 2,500,000 members 1.6 million appointments made 34 % signed on 5 or more times20032005 2007 2009 2012 (2Q)Source: Kaiser Permanente Web Analytics, updated 08/03/2012 © 2012 The Permanente Federation, LLC
    14. and, 430,000 caregivers 500,000 Act for Child / Act for Adult 425,000 594,870 delegates 350,000 275,000Jan, 2010 Dec 2010 200,000 Dec 2011 Jun 2012 Source: Kaiser Permanente Internet Services Group Web Analytics Updated 9/24/2012 © 2011 The Permanente Federation, LLC
    15. Highly meaningful use Nonuser, kp.org User, kp.org 100% All p < 0.001 Voluntary retention 90% 80% 70% < 1 year 1 -3 years > 3-10 years > 10 years Time as Kaiser Permanente memberSource: Turley M, Garrido T, Lowenthal A, Zhou YY. Association between personal health record enrollment and patient loyalty. The Americanjournal of managed care. 2012;18(7):e248–53. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22823553. © 2012 The Permanente Federation, LLC
    16. Highly meaningful use 2.578 times 100% Voluntary retention 90% The greater likelihood that a 80% member who uses kp.org will continue their care relationship, compared to a 70% < 1 year 1 -3 years > 3-10 years > 10 years member who does not use kp.org. Time as Kaiser Permanente memberSource: Turley M, Garrido T, Lowenthal A, Zhou YY. Association between personal health record enrollment and patient loyalty. The Americanjournal of managed care. 2012;18(7):e248–53. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22823553. © 2012 The Permanente Federation, LLC
    17. Warm Greetings from Colorado Springs Source: Ted Eytan, MD© 2012 The Permanente Federation, LLC
    18. Environmentally responsible, too Health Affairs, May 2011: “Kaiser Permanente Study Finds Use of Electronic Health Records Reduces Carbon Emissions, Waste and Water Consumption” Potential CO2 emissions reductions as much as 1.7 million tons across the entire U.S. populationSource: Turley M, Porter C, Garrido T, et al. Use of electronic health records can improve the health care industry’s environmentalfootprint. 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]. © 2012 The Permanente Federation, LLC
    19. MobilityCenter of Excellence
    20. Brian GardnerExecutive DirectorMobility Center of ExcellenceKaiser Permanente@bg_gardnerBrian leads the Mobility Center of Excellence, a group responsible for thedevelopment and delivery of all Kaiser Permanente mobile offerings:consumer, clinician and workforce. Through the Mobility Center of Excellence,nearly 9 million Kaiser Permanente members can access their personal healthrecords via mobile devices.Brian has more than 17 years of software product development experiencefocusing on mobile and Web-based applications for health care and healthinsurance industries. He joined Kaiser Permanentes Internet Services Group in2001, where he managed the development of Kaiser Permanente’s Webpresence supporting sales, account management and broker relations. Healso led the work to support direct online sales and enrollment for KaiserPermanente’s Medicare, individual and family plans. Prior to joining theorganization, he created consumer-based mobile applications for companiesincluding eBay, NBC Sports, ESPN, Disney, and Lockheed Martin.Brian is a member of several product management organizations includingmHIMSS, Certified Scrum Product Owners and 280 Group.
    21. Be part of something big and boldWe’re hiring Sr. iOS Developers Sr. Android Developers User Experience designers Visual designers Project Managers Contact: kpmobile@kp.org DIGITAL HEALTH
    22. kp.org/thrive© 2012 The Permanente Federation, LLC

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