Monday, 19 May 2014

HealthConnect: an electronic health record oriented to value

HealthConnect is Kaiser Permanentes’ name for their electroni health record (EHR), but first allow me to give you a brief presentation of this American insurance, so admired among health managers specially the European ones.

Brief overview of Kaiser Permanente

In 1933 Dr. Sydney Garfield established a prepaid health plan model for workers on an aqueduct in California’s desert. Later, in 1938, Henry Kaiser persuaded Dr. Garfield to extend the experience to other groups of workers, both in California and Washington. Immediately after the war ended, in 1945, the Kaiser-Garfield health plans opened to the general public. These health plans were based, in the beginning, on a reciprocal prepaid model, a care group practice, a population view of prevention and shared clinical information. This pattern contrasted sharply with other policies, in a country that represented and continues to represent the epitome of payment per service.

Today, Kaiser is an insurance that functions through a stable agreement with a doctors’ company called Permanente. It has 9 million members in 9 states, 36 hospitals, 533 health centres, 170,000 employees plus 16,000 physicians in Permanente, a budget of $48,000 M and $2,000 M of benefits (2011).

But these figures are not the ones calling the attention of this post. In fact, the Europeans’ interest in Kaiser Permanente was born from their results, especially when Chris Ham published in the British Medical Journal in 2003, an article in which he showed that for treating 11 common diseases (stroke, femur fracture, EPOC, asthma, heart failure, urinary tract infection, hip replacement, knee replacement, angina pectoris, myocardial infarction and coronary bypass), Kaiser Permanente used three and a half times less acute bed stays than the English National Health Service (Chris Ham 2003). The authors pointed out in the article’s argument the reasons they thought were the causes of Kaiser Permanente’s success:
  • Integrated Model (through levels)
  • Active management of patients
  • Specific programs for chronics
  • Use of intermediate resources
  • Empowerment of self-care
  • Leadership (and engagement) of the doctors
HealthConnect, a very powerful instrument in achieving Kaiser Permanente’s objectives

In 2003, Kaiser Permanente launched HealthConnect an integral information system that contains the most comprehensive clinical history model in the United States.

Because this is a block of advances in clinical management, this is not the appropriate place to emphasise the technical characteristics of HealthConnect. My interest in this technology platform is that its functions respond point by point to the main strategies of Kaiser Permanente, remember: integrated care model, active management of patients, specific programs for chronic and empowerment.

So, from my point of view, the best of HealthConnect is that it represents a unique digital tool that gives clinical support to all professionals involved in the continuing care of the patient from home, the care nurse, dentist, radiologist, to the emergency physician or nursing ward. This completeness is very commendable, although is not unique in the world of electronic health records, but given Kaiser Permanente’s way of working, this technology platform is proving very effective as much for prevention programs for populations at risk, as for monitoring chronic patients, all programs benefit greatly from the fact that the system is transversal.

Another of the strengths of the platform is the active management of patients, and today, half of Kaiser Permanente’s members are using the website “My Health Manager” to consult medical information in their own medical records to view their visit history, remember the outstanding preventive contacts, schedule and cancel visits and, if necessary, send messages to their reference care team or to the pharmacist; and for the empowerment of self-care, the system offers its members a service known as “Healthwise” for  online consultations.


Bibliography

Ham C, York N, Sutch E, Shaw R. Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare Programme: analysis of routine data. BMJ 2003;327:1257.

Jordi Varela
Editor

1 comment:

  1. Thanks for this interesting post. Do you know if there is any evaluation done on the impact of HealthConnect on patient health outcomes, or patient flow, or health care professionals' practice?

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