Blog & Bloggers

What is a ‘wired’ hospital — and what does it mean for patients?

Today’s post is authored by guest blogger Samantha DuPont, with the Kaiser Permanente Institute for Health Policy.

For the second year in a row, Kaiser Permanente’s California hospitals have been named “Health Care’s Most Wired” by Hospitals & Health Networks magazine. The honor recognizes our excellence in technology integration across the health care spectrum — infrastructure, procurement, human resources, security, clinical quality and safety, patient access, care continuum and health information exchange.

Kaiser Permanente has long been recognized as a leader in using technology to deliver high quality care. By 1970, we had implemented an electronic health record (EHR) for over 1 million patients. Today, our EHR, Kaiser Permanente HealthConnect®, connects 9.3 million members to their providers, and is one of the most advanced in the nation. By integrating comprehensive patient data, best practice research, treatment recommendations and other provider tools in one record, KP HealthConnect® ensures that patients receive the best care at every encounter.

We were also an early adopter of online health services for patients, as chronicled in an informative Kaiser Permanente Institute for Health Policy Story. In 1996 we began offering online prescription refills and appointment scheduling. Since then, our patient portal, My Health Manager, has grown a bevy of features, allowing patients to:

• view personal health information, including lab results, immunizations, past office visits,
• prescriptions, allergies, and health conditions;
• view, schedule, or cancel appointments;
• refill prescriptions;
• securely email doctors, pharmacists, and member services staff;
• take health assessments and programs that support healthy lifestyle changes and find information about health topics; and,
• manage health benefits, including viewing drug formularies and estimating the cost of treatments.

As of 2014, more than 4.4 million members are registered for My Health Manager on kp.org, nearly double the number in 2008. To learn more about how we’ve achieved success in getting patients online – and how that has improved health outcomes – read, “Engaging Patients Online with My Health Manager.”

Informing the Next Generation of Accountable Care Organizations

Some of the biggest buzz in health reform lies in the potential that Accountable Care Organizations (ACOs) have to help to reduce costs, improve care, and move away from fee-for-service to population-based payment.   But questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

Joy Lewis, MSW, MPH, of the Kaiser Permanente Institute for Health Policy, attended a July 13th convening in Washington D.C., hosted by the National Health Policy Forum, that highlighted some of the successes and challenges of early ACOs.

Kaiser Permanente has been supportive of this movement since the concept was first introduced in 2009.  While not technically an ACO, many elements of our care system – such as use of electronic health records, team-based care, and population management tools – ideally will be a part of ACOs.

Read the Kaiser Permanente Institute for Health Policy Observation describing Lewis’ highlights of the meeting, which include tactics for improving quality, increasing savings and overcoming the fee-for-service chassis.

More on Community Access to Healthy Foods with Elevation DC

On Tuesday, June 24, an panel came together for a discussion about food in our neighborhoods – where it comes from, what barriers keep healthy foods from some communities, and solutions that are working. Kaiser Permanente and Elevation DC hosted the discussion right here at the Center for Total Health.

Food writer Mary Beth Albright moderated a lively conversation among Laine Cidlowski, an urban sustainability planner for the D.C. Office of Planning; JuJu Harris, culinary educator with the Arcadia Center for Sustainable Food and Agriculture; and Ted Eytan, MD, physician director at the Center for Total Health. Panelists shared different perspectives about D.C.’s food system and considered the economics of good health.

This discussion was a prime opportunity to consider the consequences as well as the opportunities related to food in neighborhoods. According to Cidlowski, communities of high poverty that are more than a 10-minute walk or one bus transfer away from a full-service grocery store are considered food deserts. D.C. liquor stores and fast food restaurants dominate some of the most vulnerable communities where grocery stores have gone out of business or have never existed. This condition leaves residents wanting – and to a large extent, vulnerable to chronic illness and low quality of life.

Organizations such as Arcadia farms, with its mobile market, are filling the gap by bringing fresh produce to people where they live and teaching residents about food selection and meal preparation. Harris, Arcadia’s culinary educator and SNAP outreach coordinator, hosts cooking demonstrations at the markets to help engage customers about what to do with the produce once they get home. She shared that even a 10-minute walk can sometimes be too much for people living in poverty.

Community gardens, gardening plots and urban farms are also part of the solution, however Cidlowski shared that with so much demand, there are now wait lists – some as long as three years – to use some green spaces. But with revitalization efforts in the city, much consideration is being given to food access in the District.

Eytan offered the physician perspective. He highlighted the connection between food and health and why this issue is integral to Kaiser Permanente’s total health mission. “We want to provide health care, not just sick care,” said Eytan, who encourages patients to make time for physical activity and healthy meal preparation, but acknowledges that healthy choices are difficult to make in many neighborhoods.

Enjoy more food for thought—read Elevation DC’s full story.

Weighing in on the Impact of Obesity Interventions

Measuring obesity in an individual person is relatively simple: get out the tape measure, step on the scale, calculate body mass index.

Measuring the impact of interventions that aim to reduce rates of obesity? Not so easy.

For all the attention directed toward combating the obesity epidemic in the United States, policymakers, researchers, advocates, and public health practitioners struggle to develop and agree upon measures that indicate whether a particular intervention is working, and even more, whether it is scalable and generalizable.

Compounding this issue is that different stakeholders have different evidence needs. Some are not convinced that an intervention is working unless they see rigorous data collected from a randomized controlled trial – considered to be the “gold standard.” Others may set the bar lower, knowing that we may never get perfect evidence, because obesity prevention involves a complex web of social, economic, environmental and behavioral factors.

These were some of the issues raised in a session at AcademyHealth’s 2014 National Health Policy Conference titled, “Obesity Prevention: How Much Evidence Do We Need to Act?”

In this session, a diverse set of stakeholders – Jeff Levi, Executive Director, Trust for America’s Health; Bill Hoagland, Senior Vice President, Bipartisan Policy Center; Linda Belheimer, Assistant Director of Health and Human Resources, Congressional Budget Office; and Shiriki Kumanyika, Professor, University of Pennsylvania Perelman School of Medicine –– discussed the myriad of issues surrounding obesity prevention measurement, and offered some clear steps for moving forward.

“There was strong agreement that the obesity epidemic is real and that we need to be thinking about how to address it,” said panel moderator Murray Ross, vice president, Kaiser Permanente, and director, Institute for Health Policy. “”It will have–and is already having–major implications for Americans’ health and America’s health care spending.”

In this short clip, Ross gives us the highlights of this important and timely conversation.

Note: Panelist Linda Bilheimer’s comments are not included in this video, but you can view her full presentation slides online.

Secretary Hunt with NHS and Kaiser Permanante delegations

NHS and Secretary of State for Health, Jeremy Hunt, Visit the CTH

Representatives from the National Health Service of England, along with British Secretary of State for Health, Jeremy Hunt, paid a visit to the Kaiser Permanente Center for Total Health on June 2. This marks the second visit to Kaiser Permanente for the Secretary.

This time, he spent a half-day contemplating many issues in health care which we all acknowledge are global in nature. Representatives from Kaiser Permanente shared the health care organization’s deep knowledge and experience regarding topics such as management of complex patients with chronic disease, leveraging technology to augment care, and physician management.  The exchange was interactive and lively.

Taking part in the discussion from Kaiser Permanente were Kim Horn, president of the Mid-Atlantic States region; Bernadette Loftus, MD, associate executive director of The Permanente Medical Group; Philip Fasano, executive vice president and chief information officer; Murray Ross, vice president and director of the Institute for Health Policy;  Ted Eytan, MD, physician director for the Center for Total Health;  and Walter Suarez, MD, executive director of health IT policy and strategy.

Phil Fasano, CTO of Kaiser Permanante, leads discussion.

Philip Fasano, executive vice president and CIO of Kaiser Permanente, leads discussion.

We all agreed that we work for the patients and our decisions should be guided by that core belief. For our British colleagues, the afternoon session triggered new ways of thinking about and approaching the challenges faced “back home.”

Kaiser Permanente is committed to helping shape the future of health care globally. Sessions like this one and other international learning forums are coordinated by Kaiser Permanente International (KPI).

Connecting Health With Place

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Editor’s Note:  We often write pieces on the Center for Total Health blog about how important our surroundings can be to our health.  We’ve covered passionate discussions around built environments, and we’ve highlighted success stories.  What we haven’t been able to capture so far is the process.  We have invited Scott Kratz, director of 11th Street Bridge Park – a newly launched project – to share with us some of his experiences as he takes this vision of a shared community space that supports health from concept to reality.  This is his first post with us.

Can your zip code determine your health? Epidemiologists tell us that place – where we live and work – is one of the greatest factors in health outcomes. Urban planning decisions afect people’s health. We know there is a strong link between regular physical activity and lowered risk of obesity and chronic diseases. But what if there is no safe place to play? What if one’s home is located in a food desert, as it has been for many residents in Washington, DC, without access to healthy meal choices?

Linking place and health is a key goal of the 11th Street Bridge Park – an innovative project in the nation’s capital to transform an old freeway bridge into a new civic space. As the 11th Street bridges across the Anacostia River have reached the end of their lifespan, the DC Office of Planning and a local non-profit, Building Bridges Across the River, will use part of the remaining infrastructure to build the 11th Street Bridge Park, a new park above the river.

We have led an extensive public outreach campaign asking local residents for their programming suggestions and have received many inspired ideas and wonderful support. The community has suggested innovative play spaces, urban agriculture, an environmental education center and kayak / canoe launches on the river below.

Community outreach continues with a brainstorming session on Tuesday, March 25 at Kaiser Permanente’s Center for Total Health with presentations by 11th Street Bridge Park’s team. All of these ideas will inform a nationwide design competition launched in March to imagine the new park.

But we need to be more than aspirational. We need results. To understand the ways that access to green space, farmers markets, planting festivals and kayak launches may improve health outcomes, we are implementing a Health Impact Assessment. This baseline data of residential health will enable a comparative analysis after the 11th Street Bridge Park opens in 2017/2018. If we’re successful, we can make a solid link between health and place — and build a bridge to a healthier Washington, DC.

A Healthy Beginning for Babies and Their Moms

CEX12d041Last week’s annual “Building a Healthier Future” Summit put on by the Partnership for a Healthier America provided an opportunity to highlight what many organizations across the country are doing to address the underlying causes of childhood obesity.

For Kaiser Permanente, that meant not only a chance to show that we could and did deliver on our commitment to the highest levels of exclusive breastfeeding within our hospitals, but also the opportunity to showcase how Kaiser Permanente is building upon those successes by rolling out a comprehensive “Healthy Beginnings” effort to address the health of mother and child throughout the first years of life.

Robert Riewerts, MD, regional chief of pediatrics for Southern California Permanente Medical Group and clinical lead for childhood obesity for Kaiser Permanente presented an overview of the Healthy Beginnings work at a breakout session at the Summit. We had the opportunity to interview Dr. Riewerts alongside Jocelyn Audelo, RN, senior consultant at Kaiser Permanente’s Care Management Institute who coordinates Kaiser Permanente’s interregional work around Healthy Beginnings.

CTH Blog: Why is Kaiser Permanente focused on supporting a program of “Healthy Beginnings?”

Dr. Robert Riewerts: As an integrated health care system, Kaiser Permanente has been very interested in providing the best support we can to breastfeeding mothers. In our system, we deliver nearly 90,000 babies each year, so we have an incredible opportunity to make an impact on the lives of those babies.

Childhood obesity is a serious problem in America, and we’ve learned from research and from the care of our own patients, that if we support breastfeeding effectively, we’re going to produce a population of children that start out healthy. With effective breastfeeding support, those babies will get the important nutrients they need as young babies and they’ll be more likely to be healthy children later on.

Jocelyn Audelo, RN: Pregnancy is also a critical time in the development of healthy habits. As a new family is coming into being, we have the opportunity as a health care system to help support some of the habits – like breastfeeding, healthy diet patterns, and plenty of movement – that can translate to a pattern of well being over time for a family.

CTH: What can you tell us about the recent research showing trends in obesity reduction in children age 2 – 5?

RR: There’s been a lot of excitement around the recent article in the in the Journal of the American Medical Association that showed a 43% reduction in obesity in early childhood, ages 2 – 5, range. This research gives us hope that the work that we’re doing is effectively reducing the rate of childhood obesity. One of the factors quoted in the article is the fact that early breastfeeding and the support of breastfeeding may be an effective reason why we are seeing this reduction in obesity.

Although we are hopeful that this is a trend for the future, we still have a whole lot of work to do. And Kaiser Permanente’s relationship with the Partnership for a Healthier America and our commitment to the Partnership represents a road that we will be staying the course on, in order to make greater progress in addressing childhood obesity.

CTH: What would a comprehensive Healthy Beginnings program look like?

JA: At Kaiser Permanente, we feel that there is an opportunity to broaden our approach beyond just breastfeeding in support of a healthy weight trajectory throughout life, that really has its beginning in the pregnancy and early childhood time frame. Healthy Beginnings is our Kaiser Permanente approach to support healthy weight, active living and good nutrition from the time before a woman becomes pregnant, throughout her pregnancy and throughout the early life of the child. Examples might include things like helping women to get healthy and fit before conceiving, supporting women and families in emotional and behavioral health, helping pregnant women to stop using tobacco and other harmful substances, and teaching how families can incorporate a pattern of healthy foods – with plenty of vegetables and fruits – for babies and young children.

RR: Kaiser Permanente has a wealth of employees involved in all sectors of health care. We want all of our physicians, our nursing staff, our doctors who are delivering babies and caring for mothers during pregnancy to be aware of the importance of breastfeeding and to really start that infant out on a good healthy lifestyle.

JA: We know there are lots of things that we can do clinically to support a healthy beginning, but we know it needs to be much bigger than that. It needs to involve our community partners, our built environment to support physical activity and good nutrition, and numerous areas that we need to continually develop capacity in.

Since we know that what happens during pregnancy and the early childhood timeframe is critically important for a life course of Total Health, we’re focusing intensely on this Healthy Beginnings work. We are very excited about the journey we’re on, to support women and children and their families on a trajectory of Total Health from the beginning.

The Way to Healthy Living: ‘Collective Resolve’ for a ‘Global Revolution’

The World Economic Forum today published a powerful blog post authored by Raymond J. Baxter, senior vice president for Community Benefit, Research and Health Policy at Kaiser Permanente.  In it, he talks about the obesity and inactivity epidemics in the United States and the chronic conditions they can cause – as well as what they cost us at home and across the globe.

“Indeed, we know that chronic conditions such as diabetes, obesity, coronary artery disease and depression account for 75% of the nearly $3 trillion we spend on healthcare every year in the United States alone,” Baxter writes in his blog post.  “Worldwide, these conditions are projected to cost our global economy a staggering $47 trillion per year.”

While acknowledging the role of personal responsibility in improving an individual’s health, Baxter points out that chronic conditions hit minorities and the poor the hardest.  These are communities where fresh, healthy food options aren’t available, and where safety determines whether or not someone chooses to go for a walk or if kids can play outside.  He writes:

“When high-fat, high-sodium, high-sugar, low-nutrition, cheap, packaged snacks from a tiny corner store are convenient; when watching television behind locked doors is the safest, easiest choice; when cheap tobacco and alcohol are readily available to “ease” the stress of a toxic environment, that becomes an infectious lifestyle that breeds chronic health conditions.”

Luckily, change is afoot.  Baxter describes the Healthy Eating, Active Living (HEAL) Cities Campaign – a partnership between the California Center for Public Health Advocacy and the League of California Cities to increase the availability of healthy food and encourage physical activity.  The goal of the campaign is simple, yet profound:  Make the healthy choice the easy choice.

“Personal responsibility is certainly central to improving individual health,” says Baxter. “But collective resolve can be the catalyst that sparks a global revolution to place healthy living at the heart of every individual, family and community…”

Read Baxter’s post in its entirety at the WEF blog.

New Years Resolutions from the CTH Team

Like many people around the world, members of the Center for Total Health team have set a few total health resolutions for 2014:

Ted Eytan, MD, Medical Director
1. Connect the health care system to health even more in 2014
2. Make #activetransportation hashtag of the year
3. DRINK MORE WATER

Erin Meade, Meeting & Event Consultant
1. Continue to bike to work, including on less-than-ideal weather days
2. Spend more time with family

Trish Doherty, Editor for the Center for Total Health Blog
1. Take classes in things I love learning about and doing, like drawing, painting and dancing.
2. Spend more time in nature.
3. Learn to meditate, and then do it regularly.

We would love to hear about your own resolutions — please share in the comments.  Here’s to a happy, healthy year!

Photo of the Day: Danish HealthBridge Visits the Center for Total Health

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On Monday, December 9, Kaiser Permanente International (KPI) welcomed a Danish delegation to the Center for Total Health to learn about Kaiser Permanente. The group included leaders from local and regional government, hospitals, Ministry of Health, leading research organizations and other company executives.

Kaiser Permanente was one stop for the delegation, which is touring sites in the U.S. to learn about how health systems are leveraging technology and telemedicine to improve quality of and access to care for patients.

The group learned about Kaiser Permanente from Joy Lewis (KP International), Yevgeniy Gincherman, MD (Mid-Atlantic Permanente Medical Group), Joan Grand, RN (Capitol Hill Medical Center Administrator), and the Center for Total Health Staff.

Kaiser Permanente International offers a forum for sharing Kaiser Permanente’s knowledge and experience with the global health care community. For more information about KPI offerings visit www.kp.org/international.

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