The future of modern medicine

Kaiser Permanente has a lot on its plate at the moment. As the country’s largest non-profit health provider, it takes care of 8.6 million people across nine states. Robert Pearl, MD, reveals to Business Management how technology is helping to revolutionize 21st century healthcare.

Taking time out from the demands of daily life for simple activities is not a luxury many people can afford.  Fortunately a few years ago the Internet came along and made it possible for us to buy clothes or groceries, compare insurance packages or get a credit card without ever having to leave the office.  But while we can click our way to a new suit or next year's holiday from the comfort of our desks there are some appointments that continue to require face-to-face communication.  Despite living in an era of video conferencing, smart phones and Skype, the demands of medical care, whether an emergency procedure or routine examination, still necessitate accurate and personal interaction between an individual and a physician. So how can today's technological advancements that have streamlined so many industries be used to improve our healthcare system?

Dr. Robert Pearl, CEO of The Permanente Medical Group, one part of healthcare giant Kaiser Permanente, recognizes the importance of a high level of communication technology in healthcare.  "I just don't think," he says, "that people are going to be willing to accept that healthcare will be a century behind the rest of their lives." Pearl, who firmly believes that "medicine demands convenience and productivity," has been a key force behind developing and implementing innovative communication technology into Permanente's operations. He understands that this technology not only improves efficiency at Permanente from a business perspective, but it has also directly improves patient care. "I do not believe that quality medical care can be provided without the advanced information technology systems in the 21^st century," says Pearl. "Without having all the information, one cannot make the proper diagnoses, one cannot provide the proper treatment. Without the online tools, people can't get the convenience that they expect in so much of their life."

Paperless productivity

Kaiser Permanente is at the cutting edge of technology innovation in the healthcare sector, having implemented three advanced IT systems into the business that have helped to revolutionize patient care. Pearl highlights that these innovations were developed from the belief that "technology in healthcare should allow us to eliminate distance."  The first, he explains, is the foundation of Kaiser Permanente's electronic healthcare technologies, the electronic medical record, KP HealthConnect.  This system has all patients' records on one fully integrated database and allows any physician that consults a particular patient to gain complete and thorough access to that patient's history so as to make a comprehensive assessment in a more timely manner. Updates to a patient's records, such a new x-ray scan, will instantly appear on the HealthConnect system, so as a patient consults a variety of physicians, each one will be able to access the most current records for that patient.

Pearl claims that we should expect to see more of this kind of technology in the healthcare world in the coming years, predicting that in the future electronic management systems will be required as standard by both the federal government and the patients themselves. "I believe that [this system] will require the patient to demand the same level of convenience in healthcare that they demand in the rest of their lives," explains Pearl, and likens the system to an ATM, highlighting how when a person travels to another country and withdraws money, the ATM can inform that person exactly how much money is in their bank account, in whatever country they come from.

Beyond the database, Kaiser Permanente has implemented video communication systems that create swift communication links between physicians and their patients, the research center and other physicians.  This allows specialists to decide on a course of treatment for a patient without even being in the same hospital, a potentially life-saving device. Pearl's assertion that these advanced technology systems are integral to patient care is certainly accurate; a study published in the New England Journal of Medicine in June found that heart attacks in Kaiser Permanente Northern California dropped 24 percent in the last 10 years, and serious heart attacks that do permanent damage declined by 62 percent. The chance of Kaiser Permanente's patients dying from heart attacks and strokes is 30 percent less than patients at other hospitals in the surrounding communities. He explains how KP's telecommunications have had an influence over such figures, using a stroke patient by way of an example. For an emergency patient who presents with the symptoms of a stroke, an immediate consultation with the neurologist is paramount; faster administration of powerful stroke medication directly determines recovery and long-term brain function, however can have dangerous side effects if used inappropriately. KP's technology can now link the patient and the emergency room physician with the neurologist, who may be some way away, in order to make a fast and accurate diagnosis.

Convenient care

The third element of Kaiser Permanente's technology scheme is the national website, kp.org, which contains a homepage for each physician, as well as tools for patients to manage their own healthcare. By utilizing the technology on the website patients can make appointments, check laboratory data or order repeat prescriptions, and in addition can start to manage illness ranging from head aches or back pain, right through to complex diseases such as heart failure. Pearl is keen to emphasize the convenience aspect that this technology brings to the lives of KP's patients, for example people who need to visit their doctor regularly for a particular medication. "That's the kind of convenience people want. They want to be able to get their care wherever they are, whenever it may be, and they'd like to have more control."

He once again draws on an experience from within the company to highlight the potential benefits that these advances in technology can have on individuals. Accutane, he explains, is a very powerful treatment for people with acne, particularly teenagers and people in their early twenties. It is necessary to evaluate patients using Accutane once a month, to make sure the treatment is working and the patient is not suffering from side effects, such as depression. "It can be quite disrupting to have to come to the doctor every single month in order to be checked," explains Pearl. "We're now using video to do that. And the advantage also is that quite a number of people on the medication can go off to college, now we can do it even though it's a large distance away."

The knock-on effects of these new efficiencies in patient care on a patient's business or employer are equally invaluable. In the same way that the internet made it possible for us to go about the mundane tasks of every day life without leaving our desks, so these new systems in healthcare have made it possible to consult with your physician without necessarily having a face-to-face consultation. "In Northern California," Pearl explains, "we take care of about 3 million people. We offer secure messaging - what most people think of as email, but it's done through the same secure servers that a financial institution would use, so its fully protected in terms of patient confidentiality." Pearl goes on to explain that in the North California region around 5 million emails were sent between patients and doctors last year. He reveals that if just 20 percent of that figure had been an actual visit to the doctor, that would represent 2,000 years of patient time. With the average KP customer earning $70,000 a year, that represents an $80 million productivity saving. "I think that's what people want," Pearl says. "We should be able to give care wherever you are. It'll also allow us to get rid of time, whenever you want it, and it should offer you a series of choices about how you want to obtain it."

Research and development

Behind Permanente's technology innovation is the Sidney Garfield Center, the head quarters of the company's technology research and development program. To demonstrate the center's capacity for technological innovation, Pearl explains the time it takes for a development to be integrated into the Permanente system. "If you read the literature on innovation in healthcare, it's about a 17 year time cycle between a new idea coming in place and it actually being broadly implemented. I think as a consequence of both the Garfield Center and other innovative parts of out program and the integrated care we have, we've taken that 17 year cycle and squashed it down to two or three years." What the center does, Pearl explains, is to create some foundational technology, such as the video technology, and integrate that across all of Permanente's operations. "That same technology could be used in 30, 40, 50 other ways, and we're trying that right now," he says, once again pulling from his abundant experience of technology improving healthcare. In dermatology, he reveals, the US suffers from a national shortage of specialists and consequently patients often have to wait weeks of months to see a dermatologist but at Kaiser Permanente, 93 percent of dermatology cases can be resolved the same day through the tele-dermatology scheme. "What we do is, while you're in the primary care physician's office, we take an image, sometimes digitally, sometimes with video technology, and the dermatologist looks at it. Very often we can make a definitive diagnosis and save you time and get you the treatment to begin very quickly."

All of the technology developments are integral to Pearl's aim to drive the healthcare sector, which he describes as 19^th Century cottage industry, into the 21^st Century. "We should be able to truly understand healthcare at an exponentially greater level in the future than we have in the past," he says, reiterating the cost benefits, the greater levels of efficiency and the preventative power of technology advancements. "If every American got the same care that we provide today, next year there would be 200,00 fewer heart attacks and strokes." He could continue providing anecdotes from his experience as CEO at one of the country's leading health providers, but there is no need. Pearl's examples all point to one simple fact: technology has infinitely improved patient care.

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Fast Facts

• A study published in the New England Journal of Medicine in June found that heart attacks in Kaiser Permanente Northern California dropped 24 percent in the last 10 years, and serious heart attacks that do permanent damage declined by 62 percent.
• At the Kaiser Permanente division of research, KP has one of the largest human genomic databases in the country, with more than 100,000 DNA saliva samples being genotyped now.
• 93 percent of dermatology cases can be diagnosed at the first visit to the primary care physician.
• If every American got the same care that KP provide, there would be 200,000 fewer heart attacks and strokes.

Consultation time line

1. Patient X visits her doctor complaining of lung problems.
2. Doctor sends Patient X for an x-ray.
3. By the time Patient X returns to her doctor, the x-ray has been assessed by the radiologist and the report has been sent back to her doctor using voice recognition software.
4. Patient X's doctor is concerned, so he contacts the pulmonologist at another hospital via video communication and they examine the digital x-ray that is now on the database.
5. Together, the doctors reach a diagnosis and decide on a course of treatment.
6. By the time Patient X reaches the pharmacy, her medication is ready to be collected.
7. The time from first consulting her primary care physician to receiving her medication is two hours.