Skip to main content

Q&A: Kaiser Permanente's CIO on Predictive Analytics and Other Challenges

 |  By smace@healthleadersmedia.com  
   April 30, 2013

Sepsis-free hospitals? Predictive analytics is making them a reality. In the second part of a conversation with Kaiser Permanente CIO and executive vice president Phil Fasano, he discusses ' real-time healthcare', Meaningful Use, ICD-10, the CommonWell Alliance, and the shortage of skilled health IT staff. Fasano has written a book, Transforming Health Care, The Financial Impact of Technology, Electronic Tools, and Data Mining.

HealthLeaders: How does your book treat the topic of analytics? Do you get into it at all?


HealthLeaders: What's the message of your book?

Fasano: I get into it a little bit, and I can tell you, as we're looking at the world of this space of healthcare and data, big data particularly, and the use of medical analytics—population care tools, chronic care management tools—[that] we've used them extensively at Kaiser Permanente.

And the forecast I'd make, and I believe I make in my book, is that the healthcare industry is just in its infancy in both getting and using data, and then analyzing that data sufficiently, so that we can get all the learnings from it. I believe that the largest medical breakthroughs are truly ahead of us, and not behind us.

HealthLeaders: I even hear the term "near-real-time analytics," defined as anything you can get before the patient is discharged.

Fasano: Yes. There's this concept of real-time healthcare, which is what the industry is moving toward, and predictive health, predictive analytics. [It's] basically looking at patients' current conditions, if they're in a hospital, and predicting they're going to get sepsis, and then treating them before they get sepsis.

At Kaiser Permanente, we've done that. Some of our hospitals have had no cases of sepsis for over a year, and that's great work to do, because obviously sepsis cases have really bad outcomes for patients.

That said, [there are] many conditions [to which you can apply] information technology, coupled with phenomenal caregivers who are focused on those conditions, to improve patient health, everything from cardiac patients to diabetic patients, to folks who are sitting in hospitals who could develop something like sepsis.

HealthLeaders: How do you feel about Meaningful Use Stage 2 at this point? Are you feeling good about it? Kind of tense?

Fasano: I think, like any other leader of an IT organization in healthcare, Meaningful Use as a topic is a substantial amount of work, and is not without challenges. Our organization is facing the same challenges as every other, in terms of getting to the level of performance Meaningful Use Stage 2 requires.


See Also: Q&A: Kaiser Permanente's CIO on Technology's Role in Redefining Healthcare


That said, within Kaiser Permanente, I'm quite confident in the many teams we have working on this particular effort, the way they're focused on the effort, and frankly, the progress they've made. That gives me comfort that we'll make the deadline and we'll certainly, reasonably well, if not comfortably, clear the hurdles that Meaningful Use Stage 2 has put in front of us.

HealthLeaders: How about ICD-10?

Fasano: We're equally focused on ICD-10, and I can tell you from the health plan standpoint, as we're thinking about our ICD-10 work—even in the world of just claims systems, that have to be augmented for ICD-10—we're in the throes of creating our next-generation claims systems at Kaiser Permanente, so we will go and do what's called a wrapper around our current legacy claims systems to allow them to meet the ICD-10 deadlines of 2014.

Our expectation is that all of our claims systems will do that. During the course of 2013 to 2016, we'll be replacing our current claims systems with new claims systems, a common platform across the entire institution, all of which will be ICD-10 functional, compatible, and organized. So from our standpoint, we'll meet it today, and we'll have our next generation of claims systems, which will meet the requirements as well.

HealthLeaders: And the technology is there? Epic is on board?

Fasano: They are. They absolutely are. I'll say this: I'm highly confident of Epic's ability to meet ICD-10.

HealthLeaders: I was just speaking with a small practice, and they were talking about ACOs and shared savings, and how one of their challenges was just getting claims data from that universe of other providers who work with their population. It took them three to six months to get claims data out of some payers. You have to respond to some of those requests as people go into ACOs, because some of them might be seen at a Kaiser facility. How is that going?

Fasano: In some communities, we're an end-to-end health system, so we own everything, including the hospitals. In other communities across the country, we're not, and we do use community physicians, community specialists, community hospitals.

In those situations, a lot of our contracts include interacting and coexisting with medical records between the hospital and us, and we clearly integrate our claims process, so we have relationships already in place that allow us to bring a lot of the data together between claims and the medical record, and do that across all of our operations across the country.

HealthLeaders: What is your perspective on interoperability efforts such as the CommonWell Alliance, and what Farzad Mostashari is trying to do with the Direct Project and Nationwide Health Information Exchange?

Fasano: We're an enormous supporter of NwHIN. I really think the ONC and HHS have done a great service in creating capabilities. They're focus on Direct is really important for the industry, and it's a first step.

In addition to that, and frankly coexisting with that, Kaiser Permanente, along with other very leading care providers, founded the Care Connectivity Consortium [CCC] two years ago, and we all focused on interoperability of medical records to treat patients, and set the technology up to seamlessly allow us transfer of medical records on behalf of patients being seen in five different systems, and the systems are Mayo, Geisinger, GroupHealth, Intermountain, and Kaiser Permanente.

HealthLeaders: How is that effort going?

Fasano: It's actually going really, really well. In February we had a press release with Healtheway. We've organized a coalition between us and CCC and Healtheway, which now brings the CCC capabilities and Healtheway's capabilities together. [This allows] us collectively to now participate with their efforts to support an additional 40 providing organizations, and I understand Healtheway has a pipeline of almost 100 other providing organizations.

So I would expect this activity of connecting electronic medical records and health information exchange to start accelerating and accelerating as a consequence of the technologies that have been created at CCC.

The desire of all of us [is] to do what we think is absolutely critical, and I'll just sum it up in one statement: Every citizen of this country should have the right to have their medical record present when being treated by a physician, and that shouldn't be a privilege. Currently, it is a privilege. So by connecting medical records in the fashion I think a lot of us are focused, [we] will actually fulfill that vision of medical records being available.

HealthLeaders: I take it you were supportive of the governance role the government is playing.

Fasano: I think the government has a real responsibility to create guardrails. I think the healthcare industry has the responsibility to really connect. Connected health is better than discrete health. Connected health allows every physician to practice to the best of their ability, because they have all the information about all the patients all the time.

Lacking that, physicians [are doing] doing the best they can. It's a best effort, but it's not to the best of their ability, because they just don't have all the information. It's only what you can remember when you sit in front of your physician, and you manage to tell them about your health history, if you and they have a new relationship at that moment.

HealthLeaders: What are the other takeaways from your book and calls to action?

Fasano: This whole concept of mobile health has emerged, but the concept of digital health, which is in my opinion a broader topic—that is really bringing together the clinical devices, the mobile devices, at a price point that just about every consumer over time will be able to afford.

In my opinion [that] will start to enable this monitored life, if that's something we choose, where we can fully embrace our responsibility[for] our own health, but also have the benefit of having physicians, [and] clinical staff following some of our conditions, so that they can help keep us of track as well.

HealthLeaders: So the call to action is to be more involved in mobile health? I know a number of providers are becoming entrepreneurial. Kaiser has some of its fingers in that too.

Fasano: We do.

HealthLeaders: If there's innovation going on, you're going to help foster that?

Fasano: We are, and I'd say the call to action is really for the healthcare system and the information technology community to really get going on this work.

I really believe that this industry is at a tipping point, and over the next five years, can truly transform, to where we [have] used information technology to make healthcare as convenient as your banking relationship, as convenient and accessible as any other relationship you have as a consumer.

And now your expectations have been heightened by all the apps that are available to you. Healthcare should be just like that. It should be a simple, convenient experience that satisfies you. A phrase I like to use in our organization is, 'delight our members, delight our customers, delight our patients.'

Healthcare should be delightful. It would be nice if it [were] at every touchpoint. I think the technology and the healthcare industry now [have] a responsibility to come together and really create a delightful experience that not only is delightful, but also benefits everyone's health.

HealthLeaders: To what extent is shortage of talent resources an issue? There are only so many trained people out there to build some of this stuff. Doctors only have so much time to devote to sitting down with the technologists and sharing what they have, because they're busy treating patients. To what extent is that an impediment?

Fasano: The talent challenge in health IT is a significant issue for the United States today. As an industry, the demand for really high-quality information technology skilled professionals is going to be a key turning point for the industry's ability to go through this kind of a transformation.

That said, the great thing about being in Kaiser Permanente is [that] we have 17,000 physicians who are a part of our system, and their passion is for better health, and their passion is for innovation.

So they're oriented exactly right to really drive the future that I'm describing in this book. I'm thankful to have that as a great resource to partner with in the organization. But I would say that my only concern is that we as an industry need to be thoughtful about leveraging the technology capabilities that are being built, because there is a finite resource in terms of numbers of people who will be available to us.

HealthLeaders: Just think what you could do if you had twice as many.

Fasano: For sure.

Pages

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

Tagged Under:


Get the latest on healthcare leadership in your inbox.