Information Management, a sister publication of Health Data Management, recently interviewed Philip Fasano, CIO and executive vice president at Kaiser Permanente:

Uncertainty has become the norm with health care information management, but few entities have handled and risen to the challenge like health plan and health care provider Kaiser Permanente. The not-for-profit carries an operating revenue of approximately $42 billion yearly and serves more than 8.8 million members. CIO and EVP Philip Fasano joined Kaiser Permanente in 2007 and has lead a team of 6,000 IT employees  through a handful of sweeping implementations in the last few years, including the establishment of HealthConnect, the largest civilian electronic health record repository. Fasano recently discussed some of the high-level approaches he said need to be in order before any IT implementation goes out for a bid, and what, if anything, health agencies can do to plan for requirements and pools of new patients from federal health care reform.

Information Management: Your HealthConnect system is often held up as a model for the industry. Give me a synopsis of how you’ve been able to make it work and what you’re able to do with all of that patient data.

Fasano: Every one of our programs is very large, so they all have a large amount of data tied to them. I can tell you, when we look at our KP HealthConnect program and all the capabilities that it has given our organization, the data that resides in that system is a treasure trove and we’re always looking to leverage that in valuable and insightful ways. This is true for our physicians in particular, with some advanced analytics capabilities to manage chronic conditions of all of our patient population across our entire organization every single day. And it makes meaningful difference to those patients. We purchased Epic medical systems, which is our framework. As far as our data repository, we use products from Teradata and Oracle and IBM systems, and we go across all three of those vendors significantly and leverage their products and services deeply. As far as the outcomes, they often come from the simple things we do, like useing data to help diabetics manage their diabetes effectively. The impact of those types of things are shown in real simple ways, like a 50 percent reduction in hospitalization for our diabetic patients versus the general population. The outcomes that are received are really meaningful to the patient. The value is derived, obviously, by leveraging the data with some basic insights and capabilities that we put in there for our care teams.

What was the concept you had going in for the system? It certainly sounds like more than some IT team meetings and compliance checks.

Our organization has a very long history of focus on prevention and preventive care for our patients, which is a very different orientation than the larger health care market. That heritage has played right into our implementations of technology capabilities. We have about 15,000 physicians with that same heritage and when they look at IT, they value what we provide them in terms of information that helps them achieve their goals with prevention. We align our use of data, our creation of analytics andthe tools we put in place with that particular focus. It doesn’t matter the condition -- if it’s diabetes like in the example I gave you, or if its congestive heart failure -- there are significant preventative outcomes based on that work in IT and information.

Being out in front of some of these EHR matters, what advice would you give to a colleague a year or two behind where you’re at?

Quite frankly, when you’re doing this type of work, you have to connect it with the mission of your organization. Being mission driven – and health care is mission driven, anyone in health care is here because they want to make people’s lives better – technology that appeals to that premise and improves outcomes for patients. Physicians tend to clamor for it and really want to lead initiatives when it aligns with that purpose. Delivering a shared vision that is not just an IT vision on better health grounds the work in patient outcomes, which ultimately raises everything to a higher purpose. Every time we’re able to do that in our department, we end up collaborating in ways that have a major impact and an immense focus on bringing capabilities to our patients.

How do you hammer that home, especially to a team of your size?

It starts with the CIO. Any CIO in this industry really has the obligation to personally engage with mission of the enterprise. You have to be the sponsor for that direction and purpose and culture to the IT organization. It has to be taken on as a personal commitment to make sure the entire organization they lead, all the way into the data center, understands why they’re there. To the extent the CIO can do that and provide the messaging and engage their managers on a consistent basis … we’re always talking about delivering life-critical systems. When you align your work with a purpose of life-critical systems, all of a sudden, uptime, availability, your data centers, your physical assets and people align their work in those systems with that mission. You start to see progress toward achieving always-on environments that in turn support applications that back up physicians, clinicians and patients, and, ultimately, better outcomes.

There’s been no shortage of excitement recently in the health care space. How are you planning for responses to huge issues like health care reform and the related decision by the Supreme Court from earlier this summer?

All of us are feeling the effect of the Supreme Court ruling … that it’s the law of the land and all of us have to address it and make sure it’s part of our planning. If you look at what the court’s decision is and how that impacts the expansion of Medicaid coverage to millions of Americans, which isn’t planned to begin until 2014, is something our organizations are contemplating. I can tell you that at our organization, our technology and preventive focus works very well with covering both Medicare and Medicaid patients and hopefully any expansion to our members. But it doesn’t come without challenges. There is definitely work to be done to be able to support that. There are a number of systems initiatives across our organization. We are involved in pursuit of meaningful use … using our systems in accordance with meaningful use aspects of the Affordable Care Act, and to focus on that as a set of projects and priorities across the organization, and continuing to not only be compliant, but also raising the bar in terms of our capabilities. With the broader health care reform act, obviously we’re studying it just as anyone else is. What we have to do to address that is still in the planning stages and eventually we’ll communicate how we approach that, but I don’t think we’re there yet.

There has been no shortage of change in health care information management, more than maybe any other single industry over the last few years. What’s the next disruptive shot?

I’ll give you a forecast. I can’t tell you when, I wish I could. But the entire industry will have electronic medical records and that will change the stakes. The biggest opportunity, in my opinion, is when those records become connected across the country. You have the potential to share live patient information for physicians who are treating that patient. That’s a game changer. If we can get to that point in the country where every physician can have in front of them a complete and comprehensive medical record of their patient, and is able to treat that patient as a consequence of both their medical knowledge and their knowledge of the patient’s prior history, to me that changes the game forever in health care. There is the potential and I’d love to see the industry move toward that. At Kaiser Permanente, we’ve already achieved that across our entire system, and we’re advocating for that connectivity with our partners. … Medical records are the building block, they’re very important. But connected medical records across the country would be far better.

So, where to start? How do you deal with issues of different metadata definitions or entirely incompatible systems on the other side of the U.S.

We’ve implemented connected medical records across that group of five and we’re using open standards and they work. That obstacle [of data quality] is a little oversold, and the way I look at it, connecting those records is inevitable. The challenges are time, money and focus and the entire industry has to have the benefit of time, some sense of payoff from the benefit of the work and the focus on achieving these objectives.

Justin Kern is senior editor at Information Management and can be reached at

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