Implementing Health IT and HIE in Integrated Healthcare Delivery Systems: a National Perspective 2013 Puerto Rico Health IT Executive Summit San Juan, Puerto Rico – June 7, 2013 Walter G. Suarez, MD, MPH - Executive Director, Health IT Strategy and Policy, Kaiser Permanente

Copyright © 2013 Kaiser Permanente, Slide 2 Topics Our History, Model and Mission Health Kaiser Permanente Mission, Vision, and Strategy Health IT and HIE Opportunities and Challenges Mission, Vision, and Strategy Concluding Remarks

How Americans Receive Their Medical Benefits 149 M48 M 69 M 11 M49 M Employers Medicare Medicaid & State Individuals Uninsured - 6 M+ 6 M+ 15 M - 30 M TODAY 2016 Copyright © 2013 Kaiser Permanente, Slide 3

 Integrated health care delivery System  9+ million members  175,000+ employees  8 Regions Serving 9 states and the District of Columbia  17,000+ physicians, 48,000+ nurses  Nation’s largest nonprofit health plan  37 hospitals and medical centers  650+ medical offices  Pharmacies, Labs, Imaging Centers  $50+ billion 2012 revenue Kaiser Permanente by the Numbers Copyright © 2013 Kaiser Permanente, Slide 4  Founded in 1945 Mission: to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.

Copyright © 2013 Kaiser Permanente, Slide 5 Our Blue Sky Vision Integration and Leveraging IT functionality enables us to leverage scarce or specialized clinical resources - MDs, RNs and other clinical staff and make our processes more efficient. Secure and seamless transitions ‘Warm Handoffs’ - The human skill sets and operational processes to deliver care and service effectively, efficiently, and compassionately. Customization Occurs at any level of the members’ journey with KP Home as the Hub Focus on patient needs The home, and other settings, will grow significantly as a locale of choice for some care delivery Four Core Elements: Total health, patient-centered, connected care Integrated/coordinated vs independent/fragmented Prepaid vs Fee-for-service Common, interoperable EHR system vs incompatible/disconnected systems

Copyright © 2013 Kaiser Permanente, Slide 6 Health Kaiser Permanente

Kaiser Permanente HealthConnect® The world’s largest and one of the most advanced civilian deployments of an electronic health record KP HealthConnect was implemented specifically to transform care and service delivery Our greatest benefits are the resulting improvements in quality, effectiveness, efficiency, safety, and support for new health delivery model Kaiser Permanente Health IT:  Combination of tools, resources, processes and workflows working together in an integrated environment to deliver high-quality affordable health care  A program-wide system that integrates the clinical record with population management, patient/consumer interface, telehealth, administrative and consumer support systems “…the right information about the right patient available to the right provider all the time…” Our Investment in Health IT Copyright © 2013 Kaiser Permanente, Slide 7

Copyright © 2013 Kaiser Permanente, Slide 8 Kaiser Permanente HealthConnect  More than just an electronic medical record  A Program-wide system that integrates the clinical record with appointments, ancillary and specialty services, registration, and billing  A complete health care business and management system that enhances the quality of patient care  A personal health record for more than 4 million Kaiser Permanente members (60% of members over 13 with Internet access) Note: Return on investment was estimated at 8.5 years (but this was a strategic investment, not based on ROI) Linking across patient episodes, providers, settings Decision Support Tools System Modules

Access to library of KP knowledge and best practices at the point of care Tools and templates that facilitate the delivery of evidence-based medicine Dynamic decision-support tools that enhance quality and patient safety –Drug-Drug Interactions Alerts –Drug Allergy Alerts –Best Practice Alerts –Health Maintenance Reminders –Alternative Order and Medication Alerts Proactive alert and notification system Clinical Decision Support and Population Management Tools Copyright © 2013 Kaiser Permanente, Slide 9

Panel Support Features Tools to support the systematic analysis and management of all patients assigned to a providers using national guidelines Effective in managing and improving the health of predefined population and sub-population groups, the short- and long-term quality of services, and the improvement of service coordination and continuity of care Population Management and Panel Support Tools Copyright © 2013 Kaiser Permanente, Slide 10

Tools include interactive, real-time graphic display of ‘vital signs’ of a provider’s panel Comparative analysis of results Different levels of specificity of indicators Population Management and Panel Support Tools Copyright © 2013 Kaiser Permanente, Slide 11

Panel Support Tools for Specialists Copyright © 2013 Kaiser Permanente, Slide 12

Copyright © 2013 Kaiser Permanente, Slide 13 kp.org and myHealthManager Health Services More Accessible  Appointment Manager  Renew prescription orders  Access to lab results  Special conditions (i.e., allergies, medications)  with providers  Access to medical record information (problem lists, medical history, immunizations, tests, etc)  Download health record (“Blue Button”)  Tools to select providers, locate services  24x7 Call Center Wellness and Engagement  Health encyclopedia online  Access to HealthWise Manual  Health Calculator  Tools for self-evaluation of health conditions  Announcements  Educational programs  Healthy Living educational modules

KP and the HITECH Meaningful Use EHR Incentive Program We believe meaningful use of EHRs can lead to numerous improvements in health care: reducing or eliminating medication errors, improving clinical decision making, enabling coordination across care teams, and developing new ways to engage patients in their care, including online communications. The MU financial incentives are resulting in rapid, important increases in national health care system's adoption of EHRs Kaiser Permanente actively prepared for MU, and has completed Years 1-2 of Stage 1. We are currently completing Year 3 of Stage 1 and preparing for MU Stage 2 Because Kaiser Permanente has invested heavily in health IT over the past several years, we are well-positioned to meet meaningful use objectives -- but not without hard work and dedicating significant resources Like other health care providers, we have had to match our current technology and adjust clinical workflows to align with MU requirements We believe the meaningful use of EHRs has the potential to positively transform the way each and every American receives health care in the future. Copyright © 2013 Kaiser Permanente, Slide 14

Copyright © 2013 Kaiser Permanente, Slide 15 Health IT and HIE Challenges and Opportunities

Copyright © 2013 Kaiser Permanente, Slide 16 Where is the US in the Health IT Adoption?

Copyright © 2013 Kaiser Permanente, Slide 17 U.S. EHR Adoption by Practice Setting, 2011

Health IT and HIE Challenges and Opportunities (1)  Meaningful Use and EHR Adoption – achieving full EHR adoption, using more mature, robust applications, reaching true semantic interoperability, supporting seamless transitions of care  Health Information Exchanges – sustainability; expansion of information exchange technologies, tools, applications to support clinical care, administrative processes, public health and research  Big Data and Data Analytics – significant increase in the volume, velocity, and variety (the 3 ‘V’s) of health information Copyright © 2013 Kaiser Permanente, Slide 18

 Quality and Safety – Health IT-enabled advances in quality measurement and improvement  Virtualization of Health Information – advances in the application and use of virtualized hardware, software and networks (cloud computing)  Mobile Health – explosion of advanced mobile devices that creates an opportunity to true anywhere, anytime, real-time health interactions  Telehealth – significant growth in the use of ICTs to support remote health encounters, including telediagnostics, teleradiology, teleconsultation, telemonitoring, etc Health IT and HIE Challenges and Opportunities (2) Copyright © 2013 Kaiser Permanente, Slide 19

 Genomics – revolution in the ability to map, analyze and use personal genetic information to assist in disease prevention, diagnosis and treatment  Learning Health Systems – maturity in technology, science and medicine are allowing the development of true ‘learning health systems’ in which progress in science, informatics and care culture align to generate new knowledge as an ongoing, iterative process, and to seamlessly refine and deliver best practices for continuous improvement in health Health IT and HIE Challenges and Opportunities (3) Copyright © 2013 Kaiser Permanente, Slide 20

 Personalized Medicine – assessing each person’s unique genetic, clinical, history, and environmental information and applying that data, information and knowledge to tailor the care and services to an individual  Health Social Media – Social media has transformed the way we communicate and interact locally, regionally and globally; and it is transforming the way we understand health and interact with health care  Clinical Research – Accelerate translation of research and knowledge to clinical practice and health services; increase patient-centered outcomes research Health IT and HIE Challenges and Opportunities (4) Copyright © 2013 Kaiser Permanente, Slide 21

 Convergence of Public Health and Clinical Care – as more granular data is captured electronically, public health and population health will get closer to an individual’s health; similarly, clinical care will increasingly need more population health information in personalizing care to an individual  Privacy and Security – as more granular information is being collected about an individual, and more information is being exchanged and maintained in larger number of big databases and systems, there are increased global concerns about privacy and security of health information Health IT and HIE Challenges and Opportunities (5) Copyright © 2013 Kaiser Permanente, Slide 22

CONTACT: Walter G. Suarez, MD, MPH Executive Director, Health IT Strategy and Policy Kaiser Permanente Thank You!