Jan 31 2012
I’ve just switched my health insurance back to Kaiser Permanente Southern California. Our children were born in Kaiser hospitals, and we were always very happy with the services they provided. We moved to another system for about 15 years, but due to a complicated string of circumstances, our group plan administration forced us to switch back to Kaiser, which we wanted to do anyway.
I have been hearing very good things about Kaiser – from docs who like the working conditions, predictable salary, and ability to focus on health care, not business. We have also heard very good things from current members. So, we are excited to be back as Kaiser members, both as patients, but also to see more of their model from a patient perspective, chatting up fellow members in the waiting room, and asking employees what they think of their computer system, and the Kaiser model.
They use the Epic Systems Electronic Health Record, which is a first cousin to the VA VistA system which has been my briar patch for the past three decades. The CEO of Epic, Judith Faulkner, was active at the MUMPS Users’ Group meetings while still a graduate student. She formed Epic, and I went off to join the VA to do what is now VistA. Here is an paper from 1979 describing some of her ideas.
I chose a physician from a nearby clinic, and got my initial appointment with him within about 10 days. I was very impressed with how efficient things were. I was very confident that he was on my side, and not calculating his billing codes per diagnosis, nor pushing drug samples that he got from pharma reps. (I recall one appointment I had with a doc at Scripps Clinic where the posted a sign saying that, due to the fact that the doc was just returning from vacation, he would not be seeing pharma reps. A woman dragging a cart full of drugs wearing stiletto heels, a blouse that wasn’t fully buttoned, and very tight skirt walked right in past the waiting patients. )
I was referred me to 4 other services at Kaiser; I got appointments with them that afternoon. One class that was scheduled a month later, but I got two specialty services 2 and 9 days later. He referred me to the travel clinic for an upcoming trip to Costa Rica, and they called me back within two days with full information about vaccination, advisories about malaria areas, etc.
I went in for my lab tests, waited only 10 minutes in the waiting room, and started getting my results online before I got home. The pharmacy automated kiosk was closed, so there was quite a line at the pharmacy, but other than that, I didn’t have to wait for any of my appointments past the scheduled time.
This was all delightfully efficient. Everyone I met was cheerful and a pleasure to deal with. So far, an A+ for organizational efficiency.
I liked the online access to my medical information. It is a bit hard to navigate, and it is still coming from a design ethic of “automating the organization chart” rather than reflecting what a patient wants to see. There’s no “what’s new” feature; I have to drill down each branch of the departmental tabs, then scan the lists for information of interest. It’s nice to have access to this information, but it is still pretty hard to navigate sensibly from the patient’s perspective.
I wrote the Opening Chapter (with Dr. Rob Kolodner, former head of the Office of the National Coordinator (ONC) for health IT at HHS ) in a book : Person-Centered Health Records : Toward HealthePeople, called “Inverting our Perspective” – calling for a generalized move to personalization in health care. I was also one of the first to call for the personal health record in 1999: in Concepts of the Health Data Vault.
I suspect that Kaiser is working on this in the background – it will be curious to see how they balance their centralized model (which has many benefits) with the personalization of health care that I advocated in my Senate Hearing on the Future of Health IT.
Clinical genomics is still at the early stages of development; perhaps the equivalent of the Wright Brothers at Kitty Hawk. But the rate of acceleration of the technology behind it is breathtaking. My fear is that the EHR folks are still going to be building biplanes out of bicycle parts while clinical genomics needs a 747.
I really like the Kaiser “Thrive” tag line… it is energizing when I come in to the offices, and I think it creates a positive framework for health care. This is similar to Jonas Salk’s vision that we need to create an Epidemic of Health. I think that a key difference between Kaiser’s Thrive campaign is that it is a top down campaign: Kaiser is the organization supporting their patients to thrive. An epidemic of health model, such as proposed by James Fowler from UCSD, would be more of a viral, peer-to-peer, social network kind of thing. Again, this might be a shift for a centralized organization like Kaiser to make, as it would necessary to reach outside to non-Kaiser patients. Kaiser, like all health care organizations, call themselves “Patient Oriented” – and Kaiser makes good on the promise, I think. But the subtext is still “Only if you are one of OUR patients.” So, it’s still a “you come first after me” kind of model. To trigger the epidemic of health “viral” model, we need a broader framework, I think.
Getting my medical records transferred from Scripps is still a hassle. I’m still trying to figure out the results from a colonoscopy at Scripps from 6 years ago. Maybe I’ll get the results in in 4-6 weeks. The were just converting to an Allscripts system when I was leaving, which the docs hated. The Medical records department said I could NOT get my information from their EHR in computer form, but only by printed copy. HIPPA regulations require that they transfer the records in the format that they were recorded in, but Scripps is just blowing me off on this.
I went into the Scripps medical record room, where they would let me look at my paper medical record under their careful eye. I asked if I could take copies of my medical record with my iPhone, and they gasped like I was asking to commit an act of espionage. I had to pay them per page (I think the price was $2.50/page) and it would take several weeks for the company to come in to copy them. They explained that this was all for my protection. The also told me 18 mos ago that my EHR information on Allscripts system was not available for my review, due to “Security” regulations. I suppose I could have made a ruckus and thrown the HIPPA regulations at them, but I have more important windmills to tilt, (I think).
Speaking of HIPPA, the Kaiser medical record system will send me a message that new data exists on my personal portal, but I have to log on to the portal to see the data. This is all well and good for privacy, but I really don’t care if folks hack my email and get my fecal sample results or urine PH… I would like the option to have the results sent to me via email. That way, I could file my medical information under a Gmail label, and have a permanent record of it. For example, if I had gotten my cholesterol levels via email from both Kaiser and Scripps, it would have been a simple process to just do a Gmail query to get the results in seconds. No, they would not be semantically interoperable. And no, they would not support advanced AI decision support. But still, it would have been “good enough” to get started… and probably create a market for some smart widget designer to make them more compatible. But at least, it would allow me to connect the dots, rather than have the connections lost in space somewhere.
Email with my physician is excellent. Very efficient, and it gives me great confidence that I can maintain a close connection with him and his advice, without having to go through the whole appointment process.
All in all, I’m delighted with Kaiser’s services and approach so far.
I worked on a proposal to install the VA VistA system at Kaiser back in the 1990′s. I’m digging out my notes that I wrote back then, and will see what I was thinking back then.