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Kaiser Permanente’s Online Care System: A Model For Us All?

At Health 2.0, Ted Eytan, MD, and I talked for a bit about why Kaiser Permanente’s “virtual health care system” has had such great success. According to his bio, Ted is a family doc from DC with a background in “working with large medical groups, patients, and technologists to bring health care consumers useful information and decision-making health tools, to ensure that patients have an active role in their own health care.”

Ted is Permanente’s Medical Director for Delivery Systems Operations Improvement. Permanente’s online system strives to bring the doctor and patient together online via the electronic health record (EHR), decision making tools and communications tools such as email. It further empowers the patient to be an active participant in the health care system by having access to the EHR and being able to book appointments online, renew prescriptions, contact health providers, and see labs and tests. Eytan has a wonderful summary of the system and the demonstration they did at Health 2.0 on his blog here.

Here are the highlights of our chat:

Dr. Gwenn: What makes Kaiser work so well compared to other areas of the country, for example Massachusetts?

Dr. Eytan: The key difference between Kaiser and here (MA) is adoption.

Dr. Gwenn: Why is that?

Dr. Eytan: The important point to teach doctors is the customer service approach. We do things because the members want it. That should be the reason for all change in health care. If places focus on quality not customer service, the system won’t work well and nothing will change.

Dr. Gwenn: What has helped Kaiser be so successful?

Dr. Eytan: Three major points that have worked well in Kaiser’s system: accountability, physician leadership and valuing members.

1. At Kaiser we have 100% accountability over everything. We own up to mistakes when they occur and help physicians learn from them.

2. Kaiser encourages physician leadership to spark reform and help IT departments facilitate change: Physicians do have value and can create the clinical vision. They work with IT to facilitate the technological changes that need to occur to make the doctor-patient encounter work better and to make the physician’s work life more manageable.

3. Kaiser listens to members… members have advisory groups, teen groups: they are involved and their voices are heard at all levels and all ages.

Dr. Gwenn: How do you oversee the online world with patients?

Dr. Eytan: The patients are the customers and the EHR must be usable to them – that is the MO of the entire system. In addition, there is an online, full time medical director responsible for the patient interface. There is no other way to have a patient-involved online system without a dedicated staff overseeing that system lead by a physician.

Dr. Gwenn: What problems do you help the clinical staff anticipate with online care?

Dr. Eytan: With virtual care, patients will see lab results and parts of the EHR they are not used to seeing and that could prompt questions or concerns. There has to be commitment from everyone to be ready to answer those questions fro the system to work well for the patient. They provide a great deal of training and support so the clinical staff will be prepared for questions from patients they may not have had when patients were not so involved in their care and seeing so much of their EHR.

Dr. Gwenn: How does virtual care help the system?

Dr. Eytan: There are a number of important ways virtual care helps the system on many levels:

1. It builds confidence in the doctor patient relationship by fostering conversation.

2. There’s a database to give patient’s article-based information (Permanente uses the “healthwise knowledge base”).

3. They use true medical terms with patients and in the EHR that patients will Google. This helps patients be more savvy in the health care system and know what terms to search for should they seek more information or have questions to ask of the clinical staff.

Dr. Gwenn: What are the benefits of virtual care for the patients and the physicians?

Dr. Eytan: There are three primary benefits:

1. Online care helps empower the patients to be part of their care and shapes use with guidance from the staff.

2. Patients become so involved they become invested in making sure the EHR is accurate and often point out mistakes they note, such as typos.

3. Doctors can be more efficient by using pre-visit emails to organize their time.

Dr. Gwenn: What’s your take on the Health 2.0 vs. Ix (Information Therapy) debate during this conference?

Dr. Eytan: Useful, accurate information is the goal. Give people what they want, when they want it. All systems need to use more health 2.0 tools member to member. Ultimately the goal is to connect to the doc.

Dr. Gwenn: How can docs be more health 2.0 savvy?

Dr. Eytan: All docs should ask patients if they use the internet. It’s the 6th vital sign.

Dr. Gwenn: Many patients don’t live in a virtual health care system like Kaiser, how can they get from their system what you offer at Kaiser?

Dr. Eytan: Ask and demand! Most electronic medical record systems have the tools in place, like email, and just have to start using them. Patients need to ask for what they want. Physicians want to do a great job and hate waste.

My final thoughts:

With such great models such as Permanente in many areas of our country, it’s frustrating we can’t get similar systems everywhere. Perhaps it is not just the patients who have to “ask and demand” for what they want in the health care system. Perhaps it’s time docs everywhere stood up and demanded a system where docs were compensated well, treated respectfully, and had a system that actually supported good care.

*This blog post was originally published at Dr. Gwenn Is In*

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