Technology to Achieve Total Health - Office of Health Information Technology and Quality • HRSA

Using Technology to Achieve Total Health
The Office of Health Information Technology and Quality • HRSA
December 18, 2012
Ted Eytan, MD MS MPH • The Permanente Federation • twitter: tedeytan

© 2012 The Permanente Federation, LLC

Photograph: Ted Eytan, MD, http://flic.kr/p/dqEMVH

Wednesday, December 19, 12 1

Using Technology to Achieve Total Health
The Office of Health Information Technology and Quality • HRSA
December 18, 2012
Ted Eytan, MD MS MPH • The Permanente Federation • twitter: tedeytan


Photograph: Ted Eytan, MD, http://flic.kr/p/dqEMVH


Why Total Health? Why not?

A state of complete
physical, mental and
social well-being for
individuals, families,
communities, society.




A state of complete
physical, mental and
social well-being for
individuals, families,
communities, society. Leonora Brogan - Kaiser Permanente Center for Total Health

http://kp.org/centerfortotalhealth




We are committed to helping our
members, our workforce, their
families, and our communities
achieve Total Health through the
services we provide and by
promoting clinical, educational,
environmental, and social actions
that improve the health of all people.
Kaiser Permanente Center for Total Health, Washington, DC

http://kp.org/centerfortotalhealth



We’re on a mission….



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



We use it to improve the care we provide
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].


We use it to improve the care we provide
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].


Here’s how we’re doing it

9
Source: Kaiser Permanente Care Stories Blog: http://kp.org/carestories



KP Health Manager, part of a
My 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



More : The relationship
KP HealthConnect® – Enabling Patient-Centered Care

Deeper, with mobile
m.kp.org
20 % of visits to kp.org
App downloads (Dec 2012)
203,195 - iOS
168,450 - Android

Source: Kaiser Permanente Web Analytics, updated 09/24/12


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



4 million members connected, via kp.org
5,000,000 members

2,500,000 members

20032005 2007
2009
2012 (3Q)


4 million members connected, via kp.org

5,000,000 members
In the 3rd Quarter 2012
3.3 million emails
8 million test results reviewed
2,500,000 members
2.4 million appointments made
34 % signed on 5 or more times
20032005 2007
2009
2012 (3Q)



The most HEDIS #1’s 2011

Effectiveness of Care Measures Kaiser Permanente #1’s

41

31

21

10 11
9

0
Medicare Commercial





41 • Comprehensive diabetes • Weight assessment for
care — LDL control less than children — body mass
100 mg/dl (Hawaii Region) index percentile
• Osteoporosis management • Counseling for nutrition
in women who had a fracture for children
(Northern California Region) • Counseling for physical
31 • Breast cancer screening,
age 42–69 (Northwest
Region)
activity for children
• Chlamydia screening in
women (ages 16–20,
• Pharmacotherapy 21–24 and total)
Management of chronic • Appropriate testing for
obstructive pulmonary children with pharyngitis
disease (COPD) • Appropriate use of
exacerbation — medications for people

21 bronchodilator (Northwest
Region)
• Cholesterol management
with asthma (ages 12–
50, total)
• Comprehensive diabetes
(coronary artery disease), care — LDL control less
LDL level less than 100 mg/ than 100 mg/dl
dl (Colorado Region) • Comprehensive diabetes
• Follow-up after care — medical attention

10
hospitalization for mental
illness — 30 days (Colorado 11 for nephropathy
• Antidepressant
9 Region)
• Controlling high blood
pressure — cardiovascular
medication management
(effective acute phase)
• Antidepressant
(Hawaii Region) medication management
• Potentially harmful drug- (effective continuation
disease interaction — total phase)
(Hawaii Region) • Annual monitoring for

0 • Weight assessment for patients on persistent
adults — body mass index medications —
percentile (Georgia Region) anticonvulsants

Medicare Commercial





41

31

21
16
13
10

0
Medicare Commercial
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



• Breast cancer screening
Effectiveness of Care Measures Kaiser Permanente #1’s care — blood pressure
control (<140/80)
• Breast cancer screening, • Comprehensive diabetes

41 age 42–69 (Southern
California)
• Use of Spirometry Testing in
care — blood pressure
control (<140/90)
care — medical attention
the Assessment of COPD
for nephropathy
(Hawaii Region)
• Pharmacotherapy • Antidepressant
Management of COPD
(effective acute phase)
Exacerbation —

31 Bronchodilator (Southern • Antidepressant
California)
(effective continuation
• Cholesterol management phase)
(coronary artery disease),
LDL Screening (Hawaii) • Weight assessment for
children — body mass
• Cholesterol management index percentile
(coronary artery disease),
LDL level less than 100 mg/ • Counseling for nutrition

21
for children
dl (Colorado)
• Controlling high blood • Counseling for physical
activity for children
pressure — cardiovascular
(Ohio)
• Comprehensive diabetes 16 • Chlamydia screening in
women (ages 16–20,

13
21–24 and total)
care — HbA1c Testing
(Hawaii) • Appropriate treatment for
children with upper
• Comprehensive diabetes respiratory infection

10 care — LDL level less than
100 mg/dl (Northern
California)
• Avoidance of antibiotic
treatment in adults with
acute bronchitis
• Comprehensive diabetes • Use of spirometry testing
care — Medical Attention for
in assessment &
Nephropathy (Colorado)
diagnosis of chronic
• Comprehensive diabetes obstructive pulmonary
disease

0
control (<140/80) (Georgia)
• Comprehensive diabetes • Annual monitoring for
patients on persistent
medications —
control (<140/90) (Colorado)
anticonvulsants
• Osteoporosis management
Medicare in women who had a fracture
(Southern California)
• Potentially harmful drug-
Commercial • Medical assistance with
smoking cessation —
advising smokers to quit
Source: Kaiser Permanente Newe Center, http://xnet.kp.org/ disease interaction — • Medical assistance with
smoking cessation —
newscenter/pressreleases/nat/ Dementia (Hawaii)
discussing strategies
2012/101012_ncqa_care_measures.html ; http://xnet.kp.org/
newscenter/pressreleases/nat/2012/112812-ncqa-medicare-
measures.html



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 member
Source: Turley M, Garrido T, Lowenthal A, Zhou YY. Association between personal health record enrollment and patient loyalty. The American
journal of managed care. 2012;18(7):e248–53. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22823553.



Nonuser, kp.org User, kp.org
All p < 0.001

100%

Voluntary retention
90%

80%

70%






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%
member who does not use
kp.org.




Health doesn’t happen here



It happens here



Back to Opower...


To heal, you have to not harm

52
million
people
9
million
members
178,000
employees
37
hospitals
611
medical
oﬃce
buildings

607
other
faciliGes
NHS England

KP

0.8675
MtCO2e 5.04
MtCO2e

(energy
only)
MtCO2e : Metric Tonne (ton) Carbon Dioxide Equivalent, 2010 Reporting Year
Source: http://www.theclimateregistry.org/ ; http://www.sdu.nhs.uk/sd_and_the_nhs/


Why.

“Dream Grounds for a Dream Hospital”

Source: http://kasierpermanentehistory.org ; Joe Bialowitz, MS, HEM, Senior Environmental Stewardship Consultant, Kaiser Permanente


Why.

“Showcases of modern, green hospital design”

Source: http://xnet.kp.org/centralvalley/pages/green_features/green_features.html ; http://xnet.kp.org/newscenter/pressreleases/scal/
2012/011712sandiegosolar.html


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 Source: 2009 EPA Pacific Southwest Environmental
Awards, http://www.epa.gov/region09/awards/09/

farmer’s markets index.html; “Healthy Health Care Leader - Kaiser
Permanente,” http://blog.epa.gov/blog/2009/10/15/
healthy-health-care-leader-kaiser-permanente/;

§ Green Resource Center: http://xnet.kp.org/newscenter/
aboutkp/green/index.html


Health Affairs, May 2011: “Kaiser
Permanente Study Finds Use of
Electronic Health Records
Reduces Carbon Emissions,
Waste and Water Consumption”

PotenGal
CO2
emissions
reducGons
as

much
as
1.7
million
tons
across
the
enGre

U.S.
populaGon

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].


Our ancestors opened doors, and minds


Our ancestors opened doors, and minds
§ “We believe any
group of physicians
can easily duplicate
the Kaiser
Permanente
success.”
§ “Medical school
faculties should point
out the advantages
and disadvantages of
all methods of
practice to these
young men* so that
they can choose Nurse Elise Cook and Dr. Sandy MacColl
Group Health Cooperative
wisely.”
*(this was 1970) Sidney Garfield, MD


kp.org/hivchallenge


believe in ELIMINATION of disparities


kp.org/thrive


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Technology to Achieve Total Health - Office of Health Information Technology and Quality • HRSA