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E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT, Second Stanza

Posted on July 7, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As some of you may recall, I recently wrote a positive review of Kaiser Permanente’s use of consumer-facing health IT. (Kaiser Permanente is both my health insurer and provider.) Their offerings have a number of strengths including:

  • Interfaces: The kp.org site is decent, and the KP app highly usable
  • Access to care: Booking medical appointments is easy, as is cancelling them
  • Responsiveness: Physicians are quick to replay to email via the Kaiser portal
  • Connectedness: Thanks to being on a shared Epic platform, every provider knows my history (at least for the time I’ve spent within the KP system, which is pretty useful)

At the time, I also noted that I had a few minor concerns about the portal features and whatnot, but I was still a fan of KP’s setup.

By and large, my perceptions of Kaiser’s consumer health IT strengths haven’t changed. However, after a couple of months in the system, I’ve gotten a good look at its weaknesses as well. And I thought you might be interested in the problems Kaiser faces in connecting consumers, particularly given its use of best practices in many cases.

All told, these weaknesses suggest that over more than ten years after its Epic rollout, KP leaders still haven’t put their entire consumer health IT strategy in place. Here are a couple of my concerns.

Specialist appointments aren’t integrated

The biggest gripe I have with Kaiser’s interactive tools is that while I can schedule PCP appointments myself, I haven’t been able to set specialist appointments without speaking to a real live person. (My primary care doctor seems to be able to access specialist schedules and set appointments with them on my behalf.)

This may work for someone with no significant health problems, but creates a significant burden for me. After all, as someone with multiple chronic illnesses, I schedule a lot of specialist consults. You don’t realize how much time it takes to set each appointment with a clerical person until you’ve done it for five times in a week.  Try it sometime.

You might assume that this is a rationing measure, as organizations like KP are pretty strict about limiting access to specialist care. The truth is, that doesn’t seem to be the case. At least when it comes to my primary care physician (a big shout out to my PCP, Dr. Jason Singh) it doesn’t seem to be unduly hard to get access to specialists when needed.

No, I have concluded that the reason I can’t schedule specialist appointments online is that KP still hasn’t gotten their act together on this front. My guess is that the specialist systems live in some kind of silo, one that KP hasn’t managed to break down yet.

Mobile and web tools clash

As noted above, I’m largely satisfied with both KP’s consumer portal and its mobile app. True, the website sprawls a bit when it comes to presenting static content — such as physician bios — but the portal itself works fine. The mobile app, meanwhile, is great to use, as it presents my choices clearly and uses screen real estate effectively.

That being said, it annoys the heck out of me that there are minor but seemingly pointless, differences between how the portal and the mobile app function. It would be one thing the app was a shrunken down version of the website, offering a parallel but more limited version of available functions, but that isn’t how it works.

Instead, the services accessible through the portal and via the mobile app vary in small but irritating ways. For example, when emailing providers, you must choose a prewritten subject line from a drop-down menu. And I don’t know why, but the list of subjects available on the web portal version varies significantly from the list of subjects you can access via the mobile app.

There may be a rational reason for this. And mine may sound like a petty objection. But when you’re trying to address something as important as your healthcare, you want to know what’s going on with every detail.

I’d identify other ways in which the app and website portal vary, but I don’t have any other examples I can recall. And that’s the whole point. You don’t remember how the site and/or portal function until you stumble into another incompatibility. You roll your eyes and move on, but you see them again and waste one more spark of energy being annoyed.

It’s all about tradeoffs

So, you might ask if there’s any broad lesson to be taken from this. Honestly, probably not. I don’t like that KP’s tools pose these problems, but they don’t strike me as unusual.

And do my criticisms have any meaning for other healthcare organizations? Nothing more than a reminder that patients will take note of even small problems in your health IT execution, particularly when it comes to tools they rely upon to get things done.

In the end, of course, it’s all about trade-offs, as with any other industry. I don’t know whether KP chose to prioritize a potentially dangerous problem in provider-facing technologies over consumer quibbles, or just don’t know what’s going on. Perhaps they know and have added the fix to a long list of pending projects, or perhaps they don’t have their act together.

Still, lest it is lost in the discussion, remember I’m the customer, and I really don’t care about your IT problems. I just want to have tools that work every time and simplify my life.

So this is my official challenges to Kaiser leadership. For Pete’s sake, KP, would you please help me cut down on the specialist phone calls? Perhaps you could create a centralized specialist appointment call center, or use carrier pigeons, or let me suss out their schedules using my vast psychic powers — hey, they’re all options. Or maybe, just maybe, you can let me schedule the appointments online. Your call.

E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT

Posted on May 19, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Usually, particularly when I have complaints, I don’t name the providers or vendors who serve my healthcare needs, largely because I don’t want to let my personal gripes overshadow my analysis of a particular health IT issue.

That being said, I thought I’d veer from that rule today, as I wanted to share some details on how Kaiser Permanente, my new provider and health plan, supports consumers with health IT functions. Despite having started with Kaiser – in this case the DC metro division – less than a week ago, being an e-patient I’ve had my hands all over its Web – and mobile-based options for patients.

I’m not going to say the system is perfect by any means. There are some blind alleys on the web site, and some problems in integrating clinical information into consumer records, but so far their set-up largely seems thoughtful and well-managed.

Having allegedly spent $4 billion plus on its Epic rollout, it’s hard to imagine how Kaiser could have realized that big a return even several years later, but it seems that the healthcare giant is at least doing many of the right things.

Getting enrolled

My first contact with Kaiser, after signing up with Healthcare.gov, was a piece of snail-mail which provided us with our insurance cards and a summary of our particular coverage. The insurance cards included my health plan ID/medical record number.

To enroll on the core Kaiser site, kp.org, I had to supply the record number, my birth date and a few other basic pieces of information. I also downloaded the KP app, which offers a far-more-elegant interface to the same functions.

Medical appointments

Once logged in, it was easy to choose a primary care doctor and OB/GYN by searching the site and clicking a selection button. If you wished you could review physician profiles and educational history as well as testimonial quotes from patients about that doctor before you chose them.

Having chosen a doctor, booking an appointment with them online was easy.  As with Zocdoc.com, you entered a range of dates for a possible consult, then chose the slot that worked for you. And if you need to cancel one of those appointments, it’s easy to do so online.

Digital communication

I was glad to see that the Kaiser portal allows you to email your doctor directly, something which is less common than you might think. (My last primary care group wouldn’t even put their doctors on the phone.)

Not only that, everyone I’ve talked to at KP so far– three medical appointments, as I was playing catch-up — has stressed that the email function isn’t just for show. My new providers insisted that they do answer email messages, and that I shouldn’t hesitate to write if I have questions or concerns.

Another way KP leverages digital communications is the simple, but effective, device of texting me when my prescriptions are due for a refill. This may not sound like much, but convenience matters! (I can also check med reminders by logging in to a custom KP meds app.)

Data sharing

Given that everyone at Kaiser uses the same Epic EMR, clinicians are of course more aware of what their colleagues are doing than my past gaggle of disconnected specialists. They seem quite serious about reading this history before seeing me, something which past physicians haven’t always done, even if I was previously seen by someone else in their practice.

KP also uses Epic’s Care Everywhere function, which allows them to pull in a limited summary of care from other Epic-based providers. While Care Everywhere has limits, the providers are making use of what they can.

One small wrinkle was that prior to two of my visits, I filled out a questionnaire online and when asked to submit it to my electronic patient record, did so. Nonetheless, I was asked to fill out the same questionnaire again, on paper, when I saw a specialist.

Test results

KP seems to be set up appropriately to share standard test results. However, I’ve already had one test, a mammogram, and in doing so found out that their data sharing infrastructure isn’t quite complete.

After being scanned, I was told that I’d receive my results via snail-mail, in about two weeks. I’m glad that this was a routine screening, rather than a test to investigate something scary, as I would have been pretty upset with this news if I was worried.

My conclusions

I don’t want to romanticize Kaiser’s consumer HIT services. After all, looked at one way, KP is only doing what integrated health systems are supposed to do, and not without at least a few hitches.

Still, at least on first view, on the whole I’m pretty happy with how Kaiser’s interactive functions are deployed, as well the general attitude staff members seem to have about consumer use of HIT tools. Generally speaking, they seem to encourage it, and for someone like me that’s quite welcome.

As I see it, if providers outside of the Kaiser bubble were as married to a shared infrastructure as KP providers are, my care would be much improved. Let’s see if I still if I still feel that way after the new health plan smell has worn off!