George Halvorsons respect for the importance of technology cameat least partlyout of Africa.
From 1997 to 2001, Halvorson,
now chairman and chief executive officer
of Kaiser Foundation Health Plan and Hospitals,
spent weeks at a time in Uganda. He was
helping the company he formerly headed,
HealthPartners, create health plan cooperatives
in which the local villagers paid for their healthcare
coverage in milk, tea leaves or coffee beans.
The monthly premium amounted to about
$1 per member.
We figured our administrative costs would
be about 10%, so that gave us a dime per member
per month to run the plan, Halvorson
recalls. Youve got to start thinking very differently
under those circumstances. The postage
on a check would wipe out your account.
So to get the most out of each healthcare
dime, Halvorsons team set up a paperless system
using computers that ran on generators
housed at the local hospital. In one instance, the
system identified malaria as the villages top
expense, prompting the co-op to buy mosquito
netting for the villagers to sleep under. That
effort alone cut the rate of malaria in half,
Back in this country, Halvorson is widely
credited with the successful rollout of Kaisers
sweeping, $3 billion information technology initiative.
The project is designed to take the
nations largest not-for-profit HMO fully paperless.
Halvorson focused and redefined Kaisers
technology efforts shortly after being named
CEO in May 2002. Its because of this foresight
and commitment to information technology
that Halvorson was chosen as a 2005 winner of
the CEO IT Achievement Award, co-sponsored
by Modern Healthcare and the Healthcare Information
and Management Systems Society.
I was greatly impressed by (Halvorsons)
leadership in advancing IT on every levelthe
business level, the clinical level, the patient
leveland by his emphasis on measuring and
improving quality, says G. Richard Hastings,
president and CEO of St. Lukes Health System,
Kansas City, Mo. Hastings was a member of this
years judging panel and one of three recipients
of the award last year.
To accomplish the electronic shift, Kaiser had
to abandon a decadelong effort to build such a
system from scratch. But when completed in
2007, the new system, dubbed KP HealthConnect,
will give Kaiser providers instant access to
patients medical files; flag potential adverse
events; generate treatment suggestions based on
the latest medical science; and link the companys
8.3 million members to their personal
healthcare information through the Internet.
Major portions of KP HealthConnect are
already up and running in each of the nine
states in which Kaiser operates. Implementation
will be complete in all regions outside California
by late 2006 and within the stateby far its
largest marketabout a year later, officials say.
The origins of KP HealthConnect date to
the early 1990s, when Kaiser teamed with software
engineers from IBM Corp. to develop its
own clinical-information system. The companys
Colorado, Ohio and Northwest regions
all developed their own versions. In 1999,
Kaiser opted to roll out Colorados system
nationally, starting with Hawaii. This ambitious
effort played a key role in Halvorsons
decision to join Kaiser.
But before leaving behind a 16-year career as
head of Minneapolis-based HealthPartners
which, at the time, was about five years ahead
of Kaiser on the automation frontHalvorson
made sure to secure a promise from the
HMOs board. I told them that information
technology was going to be a major part of my
agenda, he says. I said, If you cant give me
your full support on that, then Im not the right
person for you.
In his first day on the job, Halvorson ordered
a review of Kaisers IT strategy. Ultimately, his
management team concluded it could save
hundreds of millions of dollars and shave years
off the installation of a companywide information
system by using an outside vendor.
In 2003, Kaiser chose Epic Systems to develop
a computer system that incorporated
much of Kaisers original database and decision-support
functions into off-the-shelf software.
Halvorson also worked to prioritize and
streamline the HMOs technology needs to
minimize duplication among regions and prevent
units from vying for the same funding.
When it comes to information technology,
its as much about execution as it is vision,
says Molly Coye, founder and CEO of the
Health Technology Center, a research organization.
George Halvorson is responsible for
helping Kaiser find the best way to bring its
vision to reality.
As part of the project, Kaiser has been
installing desktop computers in all exam
roomas well as in nurses stations, conference
rooms and hallways in its 30 hospitalsso
providers can access a patients treatment history
at any time. Digital records allow for safer,
more coordinated care at a time when many
patients seek treatment from several providers,
most of whom otherwise have no easy way to
share information, Halvorson says.
In an information-dependent profession,
there is still too often an alarming lack of access
to needed information, says the 58-year-old
father of four sons. Its not that doctors dont
want to deliver the best care. ... Its just that they
cant always remember or have no way of
knowing whether a particular test was run by
another doctor or if a patient has been prescribed
a certain medication.
KP HealthConnect aims to strengthen the
doctor-patient relationship by giving members
access to their own medical files online. Members
will be able to check recent test results, see
their complete immunization history, review an
after-visit summary of all their doctor visits,
send messages to physicians, request refills and
referrals, pay their bill, and download educational
informationall from their home computers.
The goal is to help members become
more proactive partners in their own healthcare,
says Louise Liang, Kaisers senior vice president
of quality and clinical systems support.
Physicians provide the consultation and
treatment, but at the end of the day, its the
patient who makes the final decisions about
their healthcare, says Liang, who co-manages
the KP HealthConnect project.
Perhaps the most cutting-edge facet of KP
HealthConnect, however, is its best-practices
database, a vast repository of pharmacy and outcomes
data, treatment guidelines, study results
and the latest research findings culled from medical
By crunching this data, the system can spot
potentially dangerous prescribing trends, ferret
out members at risk of chronic conditions who
could benefit from preventive care, and even
recommend the most effective treatment for a
patient based on medical history and demographics.
Because of Kaisers integrated structure
and large membership, it can amass mountains
of data in a fraction of the time it typically
takes researchers, Halvorson says.
Meanwhile, health officials from dozens of
countries have visited Kaiser for tips on
improving care delivery through IT. Even
David Brailer, HHS national coordinator of
health IT, checks in regularly on the progress of
KP HealthConnect. And while its too early to
gauge the full effect of the project on Kaisers
operations, the companys technology efforts
have already produced documented declines in
patient deaths, reduced unnecessary office visits
and improved prescribing patterns.
In 1993, Kaisers Ohio region began using an
early version of the system to identify patients
at risk of heart disease and remind its physicians
about appropriate care, such as monitoring
cholesterol levels and prescribing aspirin or
statins. The result: Kaiser saw a 31% drop
in patient deaths from heart disease and a 25%
decline in heart-disease-related hospital admissions
within the first five years. Kaiser has since
expanded the effort to generate improvements
elsewhere, says Andrew Wiesenthal,
associate executive director of the Permanente
Federation, which represents the HMOs eight
regional medical groups. He co-manages the
KP HealthConnect project with Liang.
In California, heart disease is no longer the
No. 1 cause of death among our patients, as it is
throughout the rest of the country, he says.
Kaisers California HMO, which covers 75%
of the companys members, already spends just
3.2% of its revenue on administrative costs
the lowest percentage of all the states major
insurers, some of whom are grappling with
administrative cost ratios as high as 15%.
By and large, providers remain eager to go
digital, Liang adds. In Kaisers Colorado region,
electronic medical records are already being
accessed about 1 million times a month, compared
with 90,000 monthly paper chart deliveries
before the system was installed.
These days, although Halvorson was one of
the first desktop computer users in the U.S.
his friend was a developer for Apple Computer
Halvorson admits that hes far from
an authority on computing. I dont presume
to be a technical expert by any stretch of the
imagination, Halvorson says. But I do think
its important that Im a strategic-use expert.
Halvorson makes IT a part of every board,
management and physician meeting, often
arranging educational demonstrations to convey
the value of KP HealthConnect. He even
recently restructured Kaisers executive compensation
to link pay directly to the companys
technology goals, says Cliff Dodd, Kaisers chief
information and administrative officer.
Halvorson also co-authored a book, titled
Epidemic of Care: A Call for Safer, Better, and
More Accountable Health Care, which devotes a
chapter to ways in which the technology can
empower patients and improve physicians
effectiveness. Writes Halvorson: Architects,
engineers, lawyers and other professionals
already use computer support technology.
Its almost ready for use by physicians. Care will
definitely improve and become more consistent
when those tools are in place. <<