Kaiser Permanente

Oakland, California

• Staff of 159,000
• More than 14,000 physicians
• Serves 8.6 million members
• Operates 36 hospitals with 34 in California, one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia
• As a large integrated care delivery system, Kaiser Permanente serves members with a full spectrum of needs, from sick care to well care. Reimbursement for care includes commercial health plans, individual health plans, Medicare, Medicaid, and charity care.

Stage 7 Award
Recognized hospitals in 2009: 12
Recognized hospitals in 2010: 12
Recognized hospitals in 2011: 11

Challenge: In 2002, after being well underway on the organization's second internal effort to build an enterprise-wide outpatient EMR, George C. Halvorson, the organization's chairman and CEO asked clinical, operational and IT leaders to re-examine the internal effort and look at external options that could also provide practice management, inpatient and patient portal options. Mr. Halvorson and the board of directors approved a 10-year, multi-billion dollar capital investment to support the implementation, staffing, technical infrastructure, clinical/administrative training and ongoing maintenance required to build a common electronic platform across the entire enterprise.

In 2003 organizational leaders released KP Care Delivery in 2015: Blue Sky Vision. The strategic planning outlined in this report laid the framework for using technology and service transformation to create a care delivery model that was more patient/consumer-centric, promising four characteristics to our members:

• Home as the hub
• Integration and leveraging
• Secure and seamless transitions and
• Customization

KP HealthConnect was designed to create the foundation for achieving this vision with specific objectives designed to align the development and implementation of KP HealthConnect with the overall organizational promise of quality, easy and affordable care and service.

To do so, KP HealthConnect would need to:

• Integrate outpatient/inpatient medical record with appointments, registration and billing;
• Serve as a complete health care business system; and
• Enable care coordination between the physician’s office, hospital and ancillary services (radiology, laboratory, pharmacy).

Implementation Solutions: A large portion of the costs incurred in deploying the Kaiser Permanente system was attributable to training and workflow re-design.

The user proficiency program measures how well users understand and use the system, a correlation that demonstrates the direct connection between proficiency and user satisfaction. Skill gaps are identified and clinicians receive targeted individual training. This coaching improves proficiency and saves significant time in providing care in ambulatory settings.

In the first round, Kaiser Permanente documented an 11 percent overall increase in proficiency for doctors. In some populations, the increase was as high as 39 percent. In addition, the more proficient physicians also report that they are spending less time documenting charts.

EMR Solution: Epic

Recognizing the ROI of EMR Implementation
It is important to note that this effort was undertaken to improve the quality of care delivered to patients of Kaiser Permanente.
Examples of return-on-investment follow.

• One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect. Another region saved more than $120,000 in dictation costs in just one year post-implementation.
• Saved costs for printed forms almost immediately after implementing the EMR with a $1.4 million decrease in one region on printing expenses of annual outpatient forms alone.
• Vacated more than 22,000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $0.4 and $3.3 million in 2001. Kaiser Permanente is now building new hospitals without medical record storage areas. Saved $200,000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space.
• Provide patients with test results within two days instead of a week or longer.
• Reduced the rate of medication errors by 57 percent one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration.
• Trimmed by 12 percent outpatient lab utilization two yearsafter the implementation of KP HealthConnect, illustrating the reduction in duplicate tests.

Lessons Learned

The right people at the table.
It's imperative that clinicians play a significant role in the planning, design and implementation of an EHR system. They use the system day in and day out, so they need to be involved in the decision-making process. If not, you end up with just a fancier version of the paper record. In our case, hundreds of stakeholders and IT experts worked together for months to figure out the functions our system needed to best serve its members.

Training is integral to success.
A large portion of our costs were attributable to training and workflow re-design. We spent a great deal of time and energy to accommodate the ramping up process after the system was implemented. We have continued with the training and exchanges of best practices and believe that it must be an ongoing process.

Don’t underestimate the desire to do the right thing.
It would be unrealistic to say that every doctor switched over to electronic records without any issue. The transition was much more of a culture shock for doctors who had been using paper records for 30 or 40 years. Some were more resistant to change than others, which can be expected in a project of this size. At the end of the day, though, our clinicians understood that what we were doing was in the best interest of the patient.

 

If you are a healthcare provider and would like more information on how to obtain your hospital’s EMR score, e-mail us or call us at 866-546-2900.