Eytan - Aligning Forces for Quality

© 2010 The Permanente Federation, LLC

Using Technology to Achieve Total HealthTED EYTAN, MD, MS, MPH • ALIGNING FORCES FOR QUALITYKaiser Permanente: www.kp.org | twitter: tedeytan

Photo: M.V. Jantzen, Washington, DC : http://flic.kr/p/8TuUgj

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Who’s a fan of the pedometer?

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The first place to start is the starting point...

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The first place to start is the starting point...

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Who’s a fan of the patient?

Christine Abbott and Ted Eytan, 2008

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The member experience attracts people

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Even through harsh conditions….

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Why Total Health? Why not?

Integrated Health CareEasy, Excellent, Comprehensive

Commitment to PreventionAddress issues before they become problems

Empowering of the whole personBeyond health care - mind, body, spiritWhat you eat, the air you breathe, the environment you live in

Photo: M.V. Jantzen, Washington, DC : http://flic.kr/p/8Ttx3g

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In the words of a patient(and we will all be patients one day)

“Kaiser Permanente HealthConnect® at Home - Empowering People”

youtube.com/kaiserpermanenteorg

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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

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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 %

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And you will, too.

Jack Cochran, MD, Executive Director of The Permanente FederationNational Governor’s Association, Washington, DC

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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

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Kaiser Permanente physician : 2007

Victor Silvestre, MDOakland, CA

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Kaiser Permanente Nurse : 2009

youtube.com/kaiserpermanenteorg

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Kaiser Permanente Advice Nurses: 2010

Appointment and Advice Call Center, Vallejo, CA - KP HealthConnect enabled!

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Kaiser Permanente members/caregivers : 2010

“Balancing Work and Family”Kaiser Permanente YouTube Channelhttp://www.youtube.com/kaiserpermanenteorg

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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 ‘08Q3 ‘10

Registered members

August, 2010946,273 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

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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

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Who are experiencing significant job impacts

Source: Caregiving in the United States, 2009http://www.aarp.org/relationships/caregiving/info-12-2009/caregiving_09.html

2004 2009

62%

69%

Job impact while caregiving

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We are involving members and families betternew 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

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Helping families grownew 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

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Moving people from information to actionnew 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

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Why this mattersvideo courtesy Regina Holliday & Health 2.0http://reginaholliday.blogspot.com | http://www.health2con.com

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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/add 20 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 TWEETNo public Twitter messages.

Follow me on twitter

PREVIOUS ENTRYPhoto Friday: Jane and Bob at NCVHSTestimony

NEXT ENTRYFew are using HMSA’s OnlineCare | HonoluluAdvertiser.com |The Honolulu Advertiser

SIMILAR POSTS73 Cents : A New Monument to Patients, in Washington,DCMeaningful Meaningful UsePhoto Friday: Return Expectations to the Upright PositionModerating a Dream Panel at WHIT 5.0How 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

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“73 Cents”A National Monument to Patient Empowerment, in Washington, DC

http://reginaholliday.blogspot.com

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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

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OpenNotes

myopennotes.org

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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

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“When I Grow Up”

(125,075 total views)30

And our patients are telling it back to us

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2005 was long ago in Internet time….

0%

25%

50%

75%

100%

AGE: < 3030-50

50-6465+

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.aspxDenominator is all adults for both data points; data is for “ever have” done this activity

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0%

25%

50%

75%

100%

AGE: < 3030-50

50-6465+

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.aspxDenominator is all adults for both data points; data is for “ever have” done this activity

2008

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0%

25%

50%

75%

100%

AGE: < 3030-50

50-6465+

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.aspxDenominator is all adults for both data points; data is for “ever have” done this activity

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0%

25%

50%

75%

100%

AGE: < 3030-50

50-6465+

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

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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/

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“Direct Message”

Followers&Following@ = “Reply”

Monitoring

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Ideabook: KP’s Social Network

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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

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Home. Sort of.

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Medical-Surgical Ward

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Operating Room

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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

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1 PROTOTYPING SPACE 2 HOSPITAL

4 HOME 3 CLINIC

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Garfield Center ActivitiesSpace Designs

Workflow Studies

Technology Demos

Training and Simulations

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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

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Growing a healthier health care system

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Where were you when….?

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Building, buying, eating green

Energizing our facilities with solar power

Eliminating unhealthy materials from our buildings

Zero exporting of e-wasteSourcing 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/;

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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 electricityStationary combustion (incl. boilers emergency power generators)Medical gases (N2O CO2 SF6)RefrigerantsMobile combustion (fleet vehicles landscaping equipment)

Estimated Total: 0.621 Megatons of CO2eCalifornia, Oregon, Washington Operations, 2008

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What people want

Sidney Garfield, MD summed things up …

“The people of this country ... donʼt want to get sick.”

kaiserpermanentehistory.org

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How we are delivering it today

youtube.com/kaiserpermanenteorg

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© 2010 The Permanente Federation, LLC

“Keep Caring”

-Mike Linton, Coalition of Wisconsin Aging Groups

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