The Single Largest Civilian Deployment of a Health Record Anywhere in the United States

At Kaiser Permanente, we now have 100 percent of our clinicians documenting 100% of their outpatient work using automated tools. This includes all documentation, communication, order/entry, results reporting and decision support. In addition we have fully automated seven of our twelve hospitals, including San Diego, and our clinicians are also doing 100 percent of their inpatient work using automated tools. Peter Taft, MD, leads the San Diego deployment, and Bill Cory, MD, is leading the inpatient planning. We will complete deployment in our remaining hospitals by October of this year. We use a highly integrated suite of applications that covers the spectrum of not only inpatient and outpatient, but also all billing, scheduling, and related practice management functions. We have trained over 40,000 users with over one million hours of training classes. In addition, we have over 40 live interfaces with 10 million interface messages weekly. These milestones represent the single largest civilian deployment of a health record anywhere in the United States.

We describe our current state as “day zero,” meaning that we have everyone up on the platform, and now the real work begins. Our “optimization strategy” has two key components: 1) improving the skills sets of every clinician for fully leveraging the tools; and 2) further improving the clinical outcomes for all our members using these tools to advance clinical decision support. Andy Golden, MD, is leading the optimization efforts in San Diego.

We have already seen an acceleration of our ability to improve both reporting metrics, such as our HEDIS scores, as well as clinical outcomes across our member population. One of the key tools that we are utilizing is self-service over the web. Our KP.org portal allows patients to perform a multitude of self-service functions. We have 500,000 members who have signed up for web access, with 7,500 daily visits to the site, and well over one million emails exchanged to date. In addition to secure messaging, our patients now have real-time online access to their test results, list of allergies, immunizations, past encounters, healthcare reminders, future appointments, eligibility, benefits, clinical flowsheets, and patient alerts. Additional features will be added this year.

We are building a sophisticated informatics team, and one of our core strategic goals is to merge discrete data (e.g., ICD, CPT and other coded terms) with free text using natural language processor (NLP) engines and the clinical document architecture (CDA) of HL7. The international standard represented by CDA was pioneered by two San Diego physicians, John Spinoza, MD, of Scripps Memorial, and myself. It has become invaluable for both interoperability and the ability to combine (a.k.a., normalize) both discrete and free text data so that we can have comprehensive machine-readable information on all patients as a substrate for both outcomes analysis and decision support. This R&D effort is already yielding benefits and will be moving into full production later this year. We view this as a key component of a comprehensive strategy to support how physicians leverage their investment in the health record and extract the value for efficiency and patient care.

Having a health record in place can be merely “paving the cowpath” unless and until there is an orchestrated effort to extract the value. We are encouraged that we have already achieved some of these goals but far more opportunity lies ahead of us.