Hard-Learned Lessons About e-Medical Records from Kaiser Permanente


IT Business Edge reader and consultant Frank Millar suggested that if the U.S. government wants to succeed with a national electronic medical records (EMR) system, it should study Kaiser Permanente's work in this field:


"Their internally-built healthcare systems seem to be advanced and impressively successful. I attribute at least part of this success to Kaiser's effective use of architecture practices."


Millar was responding to last week's post, "Is IT Capable of Building a National Electronic Health Records System?," which summarized Burton Group analyst Joe Bugajski's concerns about the data integration barriers to President Obama's national EMR system.


Certainly, if any EMR project can serve as a starting point for a national model, it would be Kaiser Permanente. Earlier this month, the Healthcare Information and Management Systems Society recognized 12 of Kaiser's hospitals with its Stage 7 award, which is "the highest level of recognition for hospital-based EMR implementation." And the health care system's EMR-with its to-date $4 billion price tag - was even recently profiled by Business Week.


Unfortunately, the Business Week article does not specifically address the integration challenges of Kaiser's EMR system. However, there are still plenty of relevant takeaways from this special report on Kaiser Permanente's efforts:


  1. It seems the integrated system did lead to better, more efficient health care. The article offers statistical and anecdotal evidence, including the results of a nonprofit report crediting, in part, Kaiser's databases, reports, tracking and reminder system with reducing heart disease in Northern California, "so significantly among the region's then-3 million members that it no longer was the leading cause of death in that population, though it remained so in the general population." EMR translated into 7 percent fewer patient visits to Kaiser's doctors' offices, clinics and ER.
  2. Better health care - yes, but cost savings? No. EMR didn't save Kaiser money. The article quotes one Kaiser Permanente doctor who has been involved in the project from the beginning as saying "We like what we get for the money but we're not going to save any money. Nobody is going to save any money." Within 18 months, patient visits fell by 7 percent in doctors' offices, clinics and ER departments.
  3. That said, it seems to me the article paints a more favorable financial picture for a closed health care system, such as the U.S. military. EMR did make the health care system more efficient and effective on a macro level. It also may bode well for the government and individual patients, both of whom gain if overall health care costs are reduced and are-theoretically - less concerned with the impact on health care revenue. One Dartmouth study calculated that as much as 30 percent of health care costs are spent on ineffective or redundant care. Consider the savings if you could recoup even 30 percent of what the U.S. spent on health care in 2008 -- $2.4 trillion.
  4. Assuming we can solve the technology challenges, there are definitely cultural and financial barriers to adoption. Kaiser Permanente's story is riddled with situations that made its doctors very unhappy. And while the article notes that "most doctors don't want to go back to a paper-based system once the new approach is in place," you still have to convince them to devote their time to installing and learning the system.
  5. Adoption is particularly a problem when you look at small, private-practice doctors, where the costs of EMR and the resulting reduced office visits may actually create a financial disincentive for adoption. Ultimately, a national system would have to find a way to bring those individual practitioners on board.
  6. Even Kaiser didn't get it right the first time around. They've been working on it for 40 years and in 2003, they scrapped a more than $400 million project Kaiser developed with IBM, opting to buy a solution rather than build.


Millar said he saw Bugajski's experience as proof that we needed a national EMR system. I don't think Bugajski would disagree, considering he wrote this in response:


"A national HIT network is feasible if we take time to conceive, design, build, and test it starting with smallish steps. ... As IT professionals, we have an obligation to sound the alarm and provide meaningful solutions."


Bugajski even recently expanded his thoughts on a national EMR project to include a post about lessons we can learn from a similar project in the UK, called the National Health Service program.


Clearly, a national EMR system could be a wonderful technology contribution to the nation's health care. But it could also be a disaster if we ignore the potential pitfalls. I agree with Bugajski: Let's discuss the problems now, in the hopes of solving them in the planning stages, before these missteps can cost lives.