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CIO Leadership Series: Phil Fasano, Sr. Vice President & CIO, Kaiser Permanente

Phil Fasano
Following the announcement that Kaiser Permanente signed a $500M, 7-year data center outsourcing contract with IBM. WTN News sat down with Kaiser Permanente's, Senior Vice President and Chief Information Officer, Phil Fasano to discuss the rationale for this strategic decision. We also discussed his thoughts on Kaiser's vision for "real time health care delivery." Also covered were Fasano's vision on clinical transformation and adoption of Epic's electronic medical record, and accompanying KP HealthConnect, as well as patient to physician e-mail management. This is part one, of a two part series of an exclusive interview with WTN News.

WTN News: Was the decision to outsource Kaiser's Data Center a well researched and strategic decision for Kaiser?

Phil Fasano: We spent an awful lot of time and energy looking at our operations and looking at organizations around the world that had capabilities that could partner with us and help us to really accelerate the high performing IT function that we have at Kaiser. The goals of our data center project and outcomes we are hoping to achieve with IBM are really centered in this space and on ultimately improving a highly performing data center. IBM has expertise in that area we view as absolutely first rate. We also reviewed their capabilities as extraordinary in a lot of ways. IBM's partner capabilities along with our healthcare experience are unique in that it enhances our capabilities in our core operations. This will increase our overall performance that we are looking to achieve that are being defined as world-class.

WTN News: What is Kaiser Permanente's information technology (IT) vision of “real time health care delivery" and what specifically are you developing, implementing and deploying?

Fasano: Well we have used “real time health care delivery" at our company to define a portfolio of activities that include KP Health Connect which is Epic based.
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The work we do with respect to population care and care registries that have been implemented in every one of our regions are achieving outstanding results with respect to our primary care organizations and our physicians approach to preventive care relative to chronic diseases.

Now you may want to be a heart patient of ours in Northern California because the statistics show that in a very significant way your outcomes are substantially better than the community at large. You may also want to be in our diabetic care programs across the country because our population care tools enable us to manage your care and allow you to live to a higher standard as a diabetic patient than you would otherwise. Those are just two examples, but very dramatic statements obviously with respect to how health IT and Kaiser Permanente and our physicians come together to really be a proactive preventive care team in a way that really drives outcomes for our members that is specifically significant versus other healthcare systems around the country.

It's a combination of our integrated care model of extraordinary healthcare technologies that have been purchased as well as in house software development combined to deliver a comprehensive suite of capabilities that our members and our patients benefit from.

In addition, there are other elements of our system, everything from our hospitals to our laboratories, to our pharmacies and our medical imaging and other suites that have all been enhanced as a consequence of numerous systems investments. All of those systems are combined into a set of core capabilities that support our members and patients.

Our members have the opportunity to proactively manage their care with us by interacting with kp.org. During 2008 about 45 million visits were made through our kp.org websites where they did everything from e-mail their doctors, check lab results and renew their pharmaceuticals so every element of their care is managed and every element of the information that's supports their care is both available to our members and our physicians in real time. That's the way the phrase "real time health care delivery" developed from the transformative aspects of our program that we really believe leads the healthcare industry.

WTN News: How are you managing clinical transformation and adoption and how is that going?

Fasano: Everyone of our fourteen thousand physicians uses KP HealthConnect and everyone of our members has their health record managed in KP HealthConnect so the adoption challenge that most hospital based systems are now encountering are largely behind us. Although there are still a few hospitals in Northern California in our organization that are in the process of having KP HealthConnect rolled out, well over two thirds of our hospitals currently have it installed. The installation of EMR's and other health IT systems at a new Kaiser Permanente hospital takes between thirty and sixty days so our implementation cycle is quite short. Our physicians have embraced this tool in a way that is really delivering immediate benefits. We are going through a learning process like any other institution would with new technologies and that learning process is providing us quality outcomes. Our own expectations have been exceeded in a lot of respects and certainly exceed many of the HIPPA and other industry standards.

WTN News: How much of your vision is tied to clinical workflow and process transformation versus IT implementation?

Fasano: We have a lot of experience with clinical workflow with respect to our physicians. It has to be instituted in our systems and our systems need to support their workflow, their approach to managing care and KP HealthConnect is no exception. We have spent time modeling KP HealthConnect to support and enhance current workflow based on industry standards of care that have been developed at Kaiser Permanente and within our physicians groups across the country.

WTN News: Were there any specials programs that allowed you to achieve what you claim is one hundred percent physician adoption? We see still quite a few physicians doing dictation and when they first tried to use the transcription software and it didn't work very well for them, so they went back to transcription entered by humans into the electronic medical record. Would you say there still quite a few clinicians dictating notes?

Fasanao: Actually there are not. Because our physicians were actively engaged in both the design and the training elements of implementing KP HealthConnect across our organization and in many cases were part of the implementation teams, our approach to care which is fully integrated really does have the support and active participation among the leadership of our physician groups. The outcome has resulted in clinical transformation and how we use tools like the electronic medical record at Kaiser Permanente in a very innovative and industry leading way. Our physicians have adopted EMRs and have embraced them as their own. It's now their method of not only documenting care, but they use it as a tool of improving healthcare at the time of delivery.

WTN News: How are physicians dealing with the e-mail volume they are getting through KP HealthConnect? Are you using voice recognition for physicians so that they can respond by dictation and not have to type all the e-mail responses?

Fasano: There are a small number of pilots that are in use today that are using voice recognition in some of our physician groups, but that is actually quite a minor activity and you are absolutely right in terms of the inbox. This is a topic we discuss quite often and our physician leaders have communities of interest around how they are developing approaches to handle volume of e-mail. What we are doing is learning to prioritize elements of the inbox so that our physicians basically address the more critical e-mails first and then they also have support from clinical staff. Beyond that our population care tools prioritize for our physicians who of their patients are top priority for their attention and allow them to really attend to the needs of the most urgent patients first and allow them also to be proactive in outreaching through all of our mechanisms to our patients in a proactive way. Everything from a patient who misses an office visit or who doesn't fill a perscription are being monitored. We are equally aware of that and there is a solution for that. We can help clinicians with who have seen lab results and when its important for us to have an extra office visit with a patient and we like to schedule that for them. We have very proactive elements that are in place in our company that go beyond the electronic medical record, that we have developed which are proprietary to Kaiser that really focus on the chronic diseases and help support our physicians ability to address those patients that are of need of incremental care.

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