Former Kaiser Permanente CEO George Halvorson has written on THCB on and off over the years, most notably last year with his proposal for Medicare Advantage for All post-COVID. This month he was given a lifetime achievement award by HIMSS and we are running his acceptance speech in two parts. Here’s part one — Matthew Holt
Thank you for giving me this first ever HIMSS Changemaker In Health Care Lifetime Achievement Award.
You are honoring an extremely impressive set of other current changemakers at this particular national meeting for 2021 and I am very honored and pleased to be the first person to be given the Lifetime Achievement version of this Changemaker award.
Changemaking is a good thing.
Changemaking is actually happening at a massive level for health care systems right now and that is good for health care and it is good for health care patients.
We are actually at the dawn of a golden age for health care systems, and I deeply appreciate being recognized for having done several fun, useful, and interesting things over time to help get us to where we are now.
As you pointed out, I have personally had a chance to work very directly on rolling out full electronic medical record systems in a couple of real and functional care systems to tens of millions of people.
It worked well.
We ended up with care sites in those settings that literally had no internal paper flows and that had and still have instantly available medical information for thousands of caregivers about their patients.
That tool kit worked extremely well.
Those care sites ended up with the highest ratings in the country for both quality of care and service and that high level of performance happened because the sites had both a culture of continuous improvement in their care settings and the highest levels of continuously available data for the caregivers in those sites about the patients they served.
“All-All-All.”
That was a mantra, a goal, and a strategy — and it became an actual functional capability.
Having All of the information about All the patients All the time — All-All-All is a good mantra, an extremely practical goal, an extremely functional strategy, and a very solid working practice for the delivery of care — and that data strategy worked even better than we had hoped it would work when we started down that path.
Having full electronic data on every patient improved diabetic care, chronic heart disease care, and stroke and heart damage prevention — and it created major reductions in the complications of care for chronic care patients in every category of care in all of those settings.
The data about patients was expanded at Kaiser Permanente to be the first major site and system in the world to add race and ethnicity to the care data for millions of patients.
That turned out to be extremely useful information. Having continuous use of comparative data on care-site performance by race and by ethnicity, as well as by the other measures of patient status, helped reduce cancer deaths, prevented both strokes and adverse heart effects, reduced chronic care complications, and allowed for focus of care efforts by care site and by patient in ways that continue to improve today in those care settings — because the approach is built into the culture of care in those sites as well as into the tool kits used there for the care.
The goal was to have electronic data on every patient and to use that data to significantly improve care in continuously improving ways.
That goal was met — and that success tells us that other care sites in the world should go down similar paths for both complete electronic access to care data and for using that data for the care sites to continuously improve their performance and processes.
That cost a lot of money — but it was fully worth the investment. The billions of dollars spent putting that system in place were repaid in full almost annually by the improvements in both service and care that were enabled by that data and by those systems.
So, from a lifetime achievement perspective at this conference, I am delighted to tell you that set of work was positive and it proved that system-supported care is beyond any doubt the right way for care to be delivered.
But that’s just the start.
What I want to tell you here at HIMSS today is that success is just the tip of the iceberg, and the future is actually going to be even better at multiple levels for both the tool kit and for the delivery of care.
We can do almost magical things at this point if we use the new tool kit at the most effective and optimal levels.
We have the chance to do some important additional things really well because we now know what those additional things are and we know how to put them in place.
We are on the cusp of a golden age for systems-supported care.
Every patient now has electronic data somewhere. That electronic data that now exists at some level for every patient now needs to be connected in ways that benefit both the caregivers and the patients in every setting.
The technology is there.
We are better than we ever were at building linkages in the systems world in every other industry. Care is now ready to be connected as well.
Full data sets for each patient that can now be created by FIHR and by other connectivity tools will enable and support team care along the lines created and enabled by the patient-centered medical homes model and by similar Accountable Care Organization models and processes for improving care.
Oncology medical homes and oncology care enhancement movements and alignments will definitely happen and they should thrive because the care improvement and connectivity opportunity is so huge and so desperately needed by so many cancer patients everywhere.
The difference in cancer care success levels between sites is very high and we need the public to have that information in the future to help patients make cancer care choices — and we definitely need to have the caregivers in the underperforming sites improve their care.
Artificial Intelligence (AI) will do magic all by itself in several areas of care.
AI is just beginning to have the huge impact it will have on care. AI will do almost magical things in some areas now — and that scope and that magic will expand very quickly across multiple levels of care.
We get care wrong much too often today. Misdiagnosis and very slow diagnosis and incomplete and inaccurate diagnosis happen for too many patients for too many conditions today.
The new systems tool kits that you are all building right now will help hugely in those areas.
The death rates we still have in this country from too many current misdiagnosis will be cut very quickly by more than half with the new analysis tools, and the caregivers will also all have continuously improving access to current care science and to continuously improving care protocols and care approaches that will double the effectiveness and continuously improve many patterns of care.
Patients will be able to have real time access to their own electronic care data at a functional level if we go down the right paths at this point in time as a buyer of care — and patients will value, treasure, enjoy, and personally use that data both in their current care sites and with the thousands of personal care-related apps that will be offered on the internet to help patients track, enhance, evaluate, support, and understand their own care.
Paper files are finally gone.
Care information for all patients will be on someone’s electronic medical files, and we need both the caregivers and their supportive care plans to have that information in real time to deliver and improve care and to make it available to patients in the ways that patients want that care data to be available.
That will definitely save money.
Care should cost less when we get it right.
Care should cost significantly less when we reduce the number of diabetic complications by half or more and when we have better and faster cancer diagnosis using genetic data more widely to figure out patient specific care plans that will reduce inpatient stays, complications, and death rates for patients with cancer.
Multiple new tools will allow us to detect many cancers much earlier.
And the new tools will anticipate cancer growth at the most opportune time for us to change the trajectory of each cancer case in highly beneficial ways.
We will be able to use links like Fitbit data electrocardiograms to have a much higher level of success in both preventing adverse events and responding to them at the most opportune time in ways that optimize successful outcomes.
We will have multiple sites for care — including the home — and that is relevant to you because your teams of people will need to support them all.
The home will be extremely well wired for delivering many levels of detection, monitoring, and directly delivering care. We are already beginning to see some care systems who are actually delivering the equivalent of inpatient hospital care in people’s homes and doing it with extremely high levels of quality and success. That set of patterns and that approach to in-home care will grow and it will continuously improve.
The old Kaiser Permanente systems macro strategy that we put in place when we launched the first electronic medical records for our patients and invested the first $4 billion on that trajectory said very explicitly that the future would actually be based on five sites of care — with homes as one of those five key sites of care.
The five sites of care that were built into that original Kaiser Permanente systems support plan were the doctor’s or caregiver’s physical office, the hospital, other short- and long-range inpatient settings, people’s homes, and the Internet.
The Internet links to care were almost non-existent when that five-site strategy was kicked off and put in place at KP — and that has exploded to the point where over 60 percent of the patient visits in that particular care system in this current Covid year were electronic.
That’s a very good tool kit. Patients and caregivers both like it a lot.
Patients actually prefer electronic care links for many components of care, and we can expect to see that set of electronic linkages to patients grow in vast numbers of care sites across the country and across the world.
So —
We really are at the cusp of a golden age for care today as I accept this Lifetime Achievement award. We will have better diagnosis, better and more accessible treatment, and continuously improving processes and systems at all levels, and we will spend less money on care when we get it right because we now know for a fact that better care costs much less than bad care, less than delayed care, much less than functionally uncoordinated care, and less than inadequate and dysfunctional care.
George Halvorson is Chair and CEO of the Institute for InterGroup Understanding and was CEO of Kaiser Permanente from 2002-14. The full transcript of this speech can be found here.
