Kaiser Permanente

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Improving Placebo Effectiveness at Kaiser

August 16, 2011 in Medical Studies | 1 comment

I went to my first physician appointment as a member of Kaiser.  I received a primary care visit and got lab work done within 30 minutes.  The whole process was incredibly efficient.  I notice the Kaiser docs and nurses followed best practices.  Further, the check-in process was very organized and my doctor could access my medical record electronically.  Further, the next day I could access my lab results online.  Overall, it was a very efficient experience.

The process as completely different from the alternative medicine described in a recent Atlantic article, ‘The Triumph of New Age Medicine‘.  Consider the case of a 60-year-old retired firefighter who had come in for an acupuncture treatment.

“His wife, a nurse, urged him to try acupuncture, and in February, with the blessing of his doctor, he finally met with Lao, who had trained in his native China as an acupuncturist. Their first visit had lasted well over an hour, Corasaniti says, time mostly spent discussing every aspect of his injuries and what seemed to ease or exacerbate them, and also other aspects of his health—he had been gaining weight, he was constipated, he was developing urinary problems. They talked at length about his diet, his physical activity, his responsibilities and how they weighed on him. Lao focused in on stress—what was causing it in Corasaniti’s life, and how did it aggravate the pain?—and they discussed the importance of finding ways to relax in everyday life.”

Does acupuncture work?  Depends by what you mean by ‘work’.   This study found that acupuncture worked no better than a ‘sham acupuncture’.  However, acupuncture does work.  Although acupuncture is equally effective as sham acupuncture, sham acupuncture actually does help improve health.  Further, acupuncture is more effective than taking a sugar pill placebo.  Thus, the quality of the placebo–in terms of perceived cost and ritual surrounding the placebo–does improve health.

What can Kaiser learn from these findings?  Combining best practice medicine with better placebos such as more elaborate rituals of patient-provider interaction may improve the quality of care provided.

Creating a warmer, placebo-filled environment could put the patient in a better state of mind and better allow the patient to use positive thinking to heal themselves.

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Kaiser Permanente’s EHR System

December 20, 2010 in Healthcare IT | No comments

As of 2009, only 9 percent of America’s hospitals were using even a basic form of electronic medical records (EHR) and as of 2008 only 13 percent of practicing doctors were doing so.  Yet one private health insurer has integrated EHR for hospitals, physicians, outpatient and other services.  I am of course talking about Kaiser Permanente.

Today I will review the book Connected for Health, which details how Kaiser implemented EHR in their system.  The book is not an objective evaluation in that it is written by the people who participated in Kaiser EHR implementation.  The lack of objectivity, however, is more than offset by the “insider” point of view the authors offer.  This is not a book for people interested in a fun read or general health policy.  However, if you are interested in implementing EHR in your organization, this book will likely prove invaluable.

Kaiser Overview

Kaiser Permanente is an enormous organization. It employs 14,000 physicians, 45,000 nurses, and thousands of other clinicians and staff.  It has nine regions: Northern California, Southern California, Colorado (Denver), Colorado (Southern), Georgia, Hawaii, DC/Maryland/Virginia, Ohio, Oregon/Washington.

Kaiser EHR Functionality

Kaiser’s electronic health records system, KP HealthConnect, is based primary on software from Epic Systems of Wisconsin. The KPHealthConect system has the following functionalities:

  • A personal health record,
  • Outpatient practice management
  • Outpatient clinicals (e.g., physician order entry, clinical documentation),
  • Inpatient billing,
  • Inpatient pharmacy,
  • Inpatient administrative systems,
  • Inpatient clinicals,
  • Non-Epic Systems and Pre-existing applications that integrate with KPHealth Connect.

Of particular interest is the personal health record.  Patients can view most parts of their medical record such as lab results, immunizations, past office visits, prescriptions, and more.  Patients can send secure messages to providers and view, schedule or cancel appointments.  Members can also view information on health risk assessments, drug encyclopedias, and use health insurance management tools.

Read the rest of this entry »

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In Support of Corporate Medicine

March 15, 2009 in Supply of Medical Services | 1 comment

Arnold Kling and Michael Cannon believe that the idea of the physician as a lone independent craftsment is out-of-date.  The authors contend that healthcare quality would improve and costs would drop if physicians adopted a more corporate environment.  Larger organizations, such as the Mayo Clinic, Kaiser Permanente and Veterans Affairs all benefit from economies of scale and a team-based medical approach.  Nevertheless, physicians generally are loath to accept this organizational structure, because they do not want their own authority and decision-making abilities undermined by a larger corporate structure.  Below are some excerpts from their article “Does the Doctor Need a Boss?”

  • “Medicare’s payment system generally does not reward coordination. Instead, Medicare and other fee-for-service payers tend to favor technologically intensive specialist services over those of general practitioners who might be best suited to play the role of project manager. The mismatch between payment systems and patients’ needs can be seen in the fact that the supply of gerontologists is not increasing, in spite of the obvious demographic basis for greater demand and the value gerontologists can add as project managers for those who are least able to coordinate their own care.”
  • “…the markets for legal and accounting services are dominated by corporate providers that can hire, coordinate, and monitor the services of those specialists. In medicine, transaction costs include the costs of soliciting input, sharing information, and coordinating treatment among multiple clinicians, often across space and time. Thus it is not unreasonable to think that delivering health care effectively, particularly for complex patients, could require a corporate model of organization.”
  • “In a corporate setting, a doctor would not have a business or administrative function. The doctor would not worry about what is billable and what is not. Instead, the doctor’s job would be to serve patients according to corporate standards. The doctor would be paid a salary, with increases, bonuses, and other incentives that take into account direct observation of the doctor as well as patient satisfaction and peer evaluations.”
  • “There is nothing magical about a corporation as an organization. Corporate bureaucracies are inherently inflexible, imperfect, and unimaginative. Competitive market pressures force corporations to overcome those limitations and are therefore essential to improving medical care. If corporations risk losing customers when they fail to keep pace with market standards for excellence, they will find a way to improve—or go out of business.”

Citation

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