FAQs About Kaiser Permanente’s Electronic Health Record System, KP HealthConnect

Kaiser Permanente's co-leaders of KP HealthConnect, Louise Liang, MD, senior vice president for Quality and Clinical Systems Support, and Andrew Wiesenthal, MD, SM, associate medical director of Clinical Information Support, answer some frequently asked questions about the project:

What kind of care and service improvements are you seeing with KP HealthConnect?

KP HealthConnect's built-in treatment guidelines are helping us improve the management of common/chronic conditions such as diabetes and hypertension. We are also improving patient safety by increasing the accessibility of the patient medical record. Industry studies show that a paper medical record is missing up to 30 percent of the time for an office visit and paper medical records are almost never available for patient care in an emergency room. With KP HealthConnect, the electronic health record is available when and where it is needed.

In addition, because KP HealthConnect includes more comprehensive patient information, it is helping caregivers address multiple problems or the provision of multiple services in a single visit, reducing the need for additional follow-up appointments. And our new online features (e.g., secure e-mail to your doctor’s office) have brought our members unprecedented access to Kaiser Permanente care.

By logging on to kp.org, members now have the ability to address some of their needs online, instead of coming in for an office visit or spending time playing phone tag. Preliminary surveys are showing high satisfaction with these opportunities to save both time and co-payments. A recent survey of our Hawaii kp.org users shows that members believe that the use of kp.org features improves quality, improves their relationship with their doctor, makes them a partner in care and is a reason to select and keep Kaiser Permanente as their health care provider.

Members are showing their satisfaction with online health care tools available through kp.org by logging on in increasing numbers.

What are some of the challenges you have faced?

No comparable scale electronic health record has ever been deployed so rapidly. As is expected with a project this large and an organization as diverse as Kaiser Permanente, we have had to overcome our share of obstacles. For the first time, all eight of our regions are operating on a common technology platform through KP HealthConnect. A change of this magnitude required significant IT infrastructure upgrades, as well as a level of cross-regional collaboration that had not been required to date.

In addition, this conversion has had a profound impact on the day-to-day  work of our physicians, clinicians and staff. More than moving from paper to electronic processes, we did extensive examinations of workflows and care practices to optimize the care our members receive throughout our system. This has required significant training and support.

We have always been honest and forthcoming regarding our success as well as the challenges we have faced and overcome. We know that these challenges of infrastructure, deployment, and adoption are not atypical for an IT implementation of our size and scope. Given that, we are extremely proud of our progress to date.

How are KP-IT and KP HealthConnect related?

At Kaiser Permanente, we have adopted the mantra that “there are no IT projects.” Though KP HealthConnect is an information technology deployment, its primary purpose is to support patient care and service. Therefore, the project is not overseen by KP-IT, but instead by us as part of the Quality and Clinical Systems Support department for Kaiser Foundation Health Plan/Hospitals and The Permanente Federation's Clinical Information Support program. However, KP-IT is a valued partner, managing the technical infrastructure of the system.

Why did you choose an external vendor for this project?

Our core competency is not in writing computer programs, it is in providing health care. In 1999, Kaiser Permanente initiated a proprietary clinical information system (CIS) strategy enterprise wide. However, the scope of the internal development of the CIS project was limited, focusing solely on an outpatient medical record.

In reviewing external vendor options, we found that software companies specializing in health care IT could provide an expanded application portfolio including outpatient clinicals, inpatient clinicals and practice management application, as well as a Web interface for members and providers and reporting capability. Moving to an external vendor allowed us to develop a comprehensive system that leverages many facets of our integrated care delivery system.

Though Epic Systems is our primary vendor in the deployment of KP HealthConnect, the system actually integrates a number of different applications, beyond Epic’s product offerings, including applications provided by IBM, Vignette, Right Fax, Ingenix, and PerSe.

Why did you select Epic as your primary vendor?

After an extensive review of integrated health care IT options available at the time, we determined that Epic provided the best solution for our organization. Among the deciding factors:

• Epic’s solution ranked highest in our technology review.
• Epic had the best track record for implementation and partnering.
• Epic was already in use in certain regions, providing us with internal understanding of how the applications could be integrated within the Kaiser Permanente system.
• Epic’s system was chosen as the most user-friendly by our own physicians.
• Epic’s application integration eliminates redundant entry, thus eliminating more work steps, increasing operational efficiencies and improving customer service.
• Epic had (and continues to have) the highest industry rankings for relationships and commitment.
• Epic’s corporate philosophy was the most closely aligned with Kaiser Permanente’s program strategy.

After more than three years of implementing Epic software, these original assumptions hold true. We remain confident in the reliability and scalability of Epic’s products and their ability to help us care for our 8.6 million members.

Was scalability a concern in selection of Epic?

As the largest civilian deployment of an electronic health record, KP HealthConnect system represent many "firsts" in terms of scalability for both the Epic applications that make up the system as well as our internal IT network infrastructure that supports it. We have worked closely with Epic to ensure system scalability and reliability, and our internal IT network infrastructure has been continually upgraded to support the growing number of users and applications going live each month.

Today, we have multiple KP HealthConnect applications deployed in the 400 medical office buildings and 37 medical centers we have geographically dispersed across our eight regions. The current system scale includes:

• Outpatient electronic medical records for more than 4 million Kaiser Permanente members.
• Outpatient billing applications live in all 8 regions.
• 95% of our members have access to online functionality via kp.org.
• Inpatient pharmacy, registration and admission, discharge and transfer (ADT) applications are live in 24 hospitals.
• Full inpatient functionality, including computerized physician order entry (CPOE), is live in two hospitals.

Our goal is to have KP HealthConnect available for use everywhere and every time it is needed to provide care and service to our members. Our technical goal for system availability is 99.7 percent.  We currently average 99.2 percent and we are aggressively working to meet our ultimate availability goal. In the case that the system is not available, we have backup systems and documented downtime procedures in place to ensure we can continue to care for our members.