How Kaiser Permanente Went Paperless

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved

By Rachael King

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When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

Obama's predecessor also made a big push for electronic recordkeeping, and many doctors and hospital administrators see upgrading recordkeeping as a good way to improve care. Yet, fewer than 2% of acute care hospitals have a comprehensive electronic health record system in place, with another 8% to 12% using a basic system, according to a study published by The New England Journal of Medicine in March. Adoption isn't much better among physicians. Only 4% have a comprehensive system in place, with another 13% using basic systems, according to a study published in the journal in July.

Kaiser Permanente is one of the few exceptions. Today, all of its medical clinics and two-thirds of its hospitals operate in a paperless environment and the rest are scheduled to be completely digitized by next year. Across the system, about 14,000 physicians access electronic medical records for 8.7 million patients in nine states and the District of Columbia.

E-Health Records Can Lead to Better Care

As Wiesenthal's lakeside workouts can attest, getting there hasn't been easy. Among those responsible for Kaiser's efforts are CEO George Halvorson, CIO Phil Fasano, and Louise Liang, senior vice-president for quality and clinical systems support. But Wiesenthal has been working on this project longer than just about anyone. A trained pediatrician specializing in infectious diseases, Wiesenthal is associate executive director at the Permanente Federation, an umbrella organization that oversees Kaiser's doctors.

Early efforts began more than 40 years ago and the path to electronic medical records has involved numerous detours, including a $400 million-plus project Kaiser developed with IBM (IBM) that was scrapped in 2003. Along the way, Kaiser has spent $4 billion and encountered disgruntled doctors, system outages, and a temporary decrease in productivity as physicians get accustomed to the new system.

Kaiser officials and patients say the overhaul was worth the headaches and costs, and industry experts say the upgrade has resulted in a higher quality of care in some cases. A 2002 report from a nonprofit organization called the National Committee for Quality Assurance indicated that in Northern California, Kaiser Permanente had reduced death from heart disease so significantly among the region's then-3 million members that it no longer was the leading cause of death in that population, though it remained so in the general population. The report gave partial credit to Kaiser's databases, reports, and tracking and reminder systems.

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