By Barbara Ficarra, RN, BSN, MPA

A Go-To Health Care System for Innovation and Digital Technology

Bernard J. Tyson, Kaiser Permanente’s Incoming Chairman and Chief Executive Officer

“It’s something our members wanted, they have it and they love it,” said Kaiser Permanente’s Incoming Chairman and Chief Executive Officer, Bernard J. Tyson, in a recent telephone interview. The “it” Mr. Tyson is referring to is the digital technology that allows Kaiser Permanente members to email their physicians. To date, there are “14 million e-visits,” he said, and members gain access via a free Smartphone mobile app.

This digital technology builds relationships with physicians, Mr. Tyson said. The mobile app model allows patients to build a relationship with their physician, establish that relationship and then it’s driven by the members working with his/her physicians through online technology, he added. Members email their physicians with questions; they can make appointments and access lab results. It’s driven from members perspectives. “I did three e-visits with questions for my physician.” The e-visit allowed me to have direct interaction with my physician, he said. And, if I needed to see my physician, I’d make an appointment online.

Privacy and security
Protecting patients’ information in a digital world is paramount. Privacy is a concern and when asked if there have been any issues with privacy and security, Mr. Tyson said, “No.”

The biggest area of focus is making sure it’s encrypted, secure and password coded, he said. Patient confidentiality is a concern and we make sure records are secure, he added. We have additional security for screening. “There’s an electronic fingerprint, so we always know who accessed the record.” He added, “The whole issue of patient confidentiality is from the public perspective, making sure their records are secure, and only used by authorized personnel. At Kaiser Permanente, we take patient privacy and security very seriously, so much so, we make sure our records remain as secure as humanly possible.”

Biggest challenge of digital technology
Digital technology is transforming health care and patients are accessing their doctors digitally. The biggest challenge of digital technology (e-visits), said Mr. Tyson, is that Kaiser Permanente’s physicians are already putting in full days. “Now our physicians are working ten, twelve hour days, and then they go home and they may work another couple hours to catch up on emails.” There’s an increase in demand, but that’s a challenge, not a drawback, he said. “It’s an opportunity for technology that is readily available.” There are no incentives for physicians to email their patients, all physicians at Kaiser Permanente participate and engage with patients via e-visits. Roughly 4.2 million of the more than 9.1 million Kaiser Permanente members are registered with KP HealthConnect™, and 32 million lab results have been viewed online, according to Mr. Tyson. There have been 118 million visits to KP.org and over 12 million prescriptions have been filled via securely online using Kaiser Permanente’s electronic medical record technology.

Emailing with physicians may prevent an unnecessary visit so patients “love it,” said Tyson, “This is part of Kaiser Permanente’s connected care.

Telehealth
Since members are already emailing their physicians, the next natural progression is to move to telehealth, said Mr. Tyson.

“Here at Kaiser Permanente we have already delved into the telehealth world. Due to our unique delivery system, we can actually deliver care in home settings and outpatient medical facilities.” For example, “we may have a specialist on the east coast and a patient on the west coast who has a rare disease that we want the east coast specialist to take a look at; we can now make it happen via telehealth technology.” We have the capability of using telehealth around dermatology too, he said. “With the precision of high definition, it’s incredible what we’re able to do with telehealth.”

Physicians want to maintain visual contact with the patient, but that doesn’t necessarily mean the patient needs to come in for a doctor’s visit each and every time.

Concept to Design
Kaiser Permanente is at the cutting edge of innovation and technology. At their “innovation warehouse” known as The Sidney R. Garfield Health Care Innovation Center, they conceptualize ideas and design a plan. It’s their living laboratory. Tyson says it’s like an old James Bond movie where they have a innovative site with gadgets similar to OO7. At the Garfield Innovation Center, they brainstorm around care delivery and they build working modules inside the center, it’s a place to design the future of health care. “Kaiser Permanente has a history of being on the cutting-edge in terms of innovation and technology,” Mr. Tyson said. “This technology has been an enabler.” He playfully spoke about watching robotic surgery at the West LA Kaiser Permanente facility, saying it looked like he was watching a “gameboy.”

Designing the medical home of the future is being tackled at Kaiser Permanente’s Sidney R. Garfield Health Care Innovation Center.

Tyson talked about an interactive refrigerator. When you touch the refrigerator it tells you your calorie count, what’s in there, and what you should be eating, he said. It provides you with information to help you make smart choices in life. “It provides an incredible opportunity to provide health information.” You may take a tour of the Sidney R. Garfield Health Care Innovation Center here.

Mobile App Trends
The very first question I asked Bernard Tyson dealt with mobile apps. I asked him if physicians are prescribing health apps to their patients. “It depends on the population they’re caring for,” he said. “I believe strongly that when physicians and other caregivers continue to think about how to add value to a person who’s seeking to remain healthy; they ‘re going to be looking for tools and techniques that allow the person to self-direct their care when they are not in the direct care of their physician.” Investors are putting a lot of money into this. Things like Fitbit®, Jawbone and gadgets for walking, sleeping and exercise; this will be a trend in mobile technology, Tyson said. (More on Kaiser Permanente’s launch of an open API called Interchange in a future post. Interchange allows app developers to use Kaiser Permanente’s publicly available information for their own use.)

Future
“In the future, you’ll see how technology will support people with chronic diseases,” Tyson added. For patients with complex demands there will be medication management, appointment management and reminders for patients to take their pills.

“This is a great opportunity for the health care industry,” said Tyson. “It’s very fragmented as an industry.”

Technology will allow these health care silos to come together and make way for integration and coordination among all aspects of the health care industry, said Tyson.

I loved speaking with Bernard Tyson. His energy and enthusiasm for technology is evident. Having leaders at the helm who take the leap because they know it’s the “now” and not the “someday” approach is what creates positive change. “At Kaiser Permanente it’s “not the, we wish, we believe, it’ll be happening; we’re doing it at Kaiser Permanente,” said Tyson. “The future is here,” he added.

Kaiser Permanente’s vision: “How to help a person live a healthy life, not to just keep coming to Kaiser Permanente,” said Mr. Tyson.

Transforming health care begins with leaders ready to take a risk, jump the curve and plunge into new ideas to create a better and healthier life.

Reviewed and Revised by Kaiser Permanente 6/6/13

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By Barbara Ficarra, RN, BSN, MPA

June is Headache Awareness Month, and Sharecare experts will answer your questions during a Twitter Chat.

Sharecare Twitter Chat #headacheSC

The Headaches Twitter Chat

What: The Headaches Twitter Chat
When: June 6, 2013
Where: Twitter Chat
Time: 12 Noon to 6 p.m. EST
Who: Questions asked by you will be answered by Sharecare’s experts
Hashtag: #headacheSC
Moderator|Host: @Sharecarenow
Sharecare Experts:

• Dr. Robin Miller, Integrative Medicine, Sharecare EAB Member
• Barbara Ficarra, RN, Nursing, Sharecare EAB Member (@BarbaraFicarra)
• Joan Saige Blake, Nutrition and Dietetics, Academy of Nutrition and Dietetics
• Dr. Dawn Marcus, Neurology, Independent Physician
• Dr. Devi Nampiaparampil, Pain Medicine, U.S. Department of Veterans Affairs/NYU School of Medicine
• The Mount Sinai Medical Center, @MountSinaiNYC
• Dr. Keith Roach, Internal Medicine, Chief Medical Officer, Sharecare

Sharecare Experts Twitter Chat #headacheSC

Learn more here at Sharecare.

Please feel free to share this tweet.  Hope you can join us.

Learn more during @SharecareNow’s twitter chat on Thurs 6/6 from 12-6 PM EST. Use #headacheSC to join and ask your questions @BarbaraFicarra

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By Barbara Ficarra, RN, BSN, MPA

A Candid Interview with Bernard Tyson

Bernard J. Tyson

“It’s something our members wanted, they have it and they love it,” said Kaiser Permanente’s President and CEO Bernard J. Tyson, in a recent telephone interview. The “it” Mr. Tyson is referring to is the digital technology that allows Kaiser Permanente members to email their physicians. To date, there are “14 million e-visits,” he said, and members gain access via a free Smartphone mobile app.

Digital technology

This digital technology builds relationships with physicians, Mr. Tyson said. The mobile app model allows patients to build a relationship with their physician, establish that relationship and then it’s driven by the members working with his/her physicians through online technology, he added. Members email their physicians with questions; they can make appointments and access lab results. It’s driven from members perspectives. “I did three e-visits with questions for my physician.” The e-visit allowed me to have direct interaction with my physician, he said. And, if I needed to see my physician, I’d make an appointment online.

Privacy and security

Protecting patients’ information in a digital world is paramount. Privacy is a concern and when asked if there have been any issues with privacy and security, Mr. Tyson said, “No.”

The biggest area of focus is making sure it’s encrypted, secure and password coded, he said. Patient confidentiality is a concern and we make sure records are secure, he added. We have additionally security for screening. “There’s an electronic fingerprint, so we will always know who actually went in to the record.” He added, “The whole issue of patient confidentiality is from the public perspective, making sure their records are secure, and only used by the authorized person. We take this very seriously and we make sure our records remain secure as humanly possible.”

Biggest challenge of digital technology

Digital technology is transforming health care and patients are accessing their doctors digitally. The biggest challenge of digital technology (e-visits), said Mr. Tyson, is that Kaiser’s physicians are already putting in full days. “Now our physicians are working ten, twelve hours, and then they go home and they may work another couple hours to catch up on emails.” There’s an increase in demand, but that’s a challenge, not a drawback, he said. “But it’s an opportunity for technology for being readily available.” There are no incentives for physicians to email their patients, all physicians at Kaiser participate and engage with patients e-visits. There are 4.2 million of the 9 million members registered, and 32 million lab results have been viewed online, according to Mr. Tyson, and there have been 118 million visits to KP.org. And over 12 million prescriptions have been filled via technology.

Emailing with physicians may prevent an unnecessary visit so patients “love it,” said Mr. Tyson. This is part of our connected care.

Telehealth

Since members are already emailing their physicians, the natural progression moves to telehealth.

“We’re doing telehealth now. Because of our unique model, we can actually do it in home settings and in our outpatient medical facilities.” For example, “we may have a specialist on the east coast and we have a patient who has some rare something that we want this specialist to take a look at; we can now do it via telehealth.” We have the capability to doing telehealth around dermatology, he said. “With the precision of high definition, it’s incredible what we’re able to do with telehealth.”

Physicians want to maintain visual contact with the patient, but that doesn’t necessarily mean the patient needs to come in for a doctor’s visit each and every time.

Concept to Design

Kaiser is at the cutting edge of innovation and technology. At their “innovation warehouse” known as The Garfield Innovation Center, they conceptualize ideas and design a plan. It’s their living laboratory. Mr. Tyson says it’s like an old James Bond movie where they have this innovative site with all the gadgets like OO7. At the Garfield Innovation Center they do all their innovation around care redelivery and we build modules inside this big warehouse. “We have a history of being cutting-edge with innovation and technology,” he said. “This technology has been an enabler.” He playfully spoke about watching robotic surgery at the West LA site, saying it looked like he was watching a “gameboy.”

Designing the medical home of the future is being tackled at their innovative warehouse.

Mr. Tyson talked about the interactive refrigerator. When you touch the refrigerator it tells you your calorie count, what’s in there, and what you should be eating, he said. It provides you with information to help you make smart choices in life. “It provides an incredible opportunity to provide health information.” You may take a tour here.

Mobile App Trends

The very first question I asked Bernard Tyson dealt with mobile apps. I asked him if physicians are prescribing health apps to their patients. “It depends on the population they’re caring for,” he said. “I believe strongly that as physicians and other caregivers continue to think about how to add value to a person who’s seeking to remain healthy; they’re going to be looking for tools and techniques that allow the person to self-directed care when they are not in the direct care of the physician.” Investors are putting a lot of money into this. Things like Fitbit, Jawbone and gadgets for walking, sleeping and exercise; this will be trending in mobile technology, he said. (More on Kaiser’s launch of an open API called Interchange in a future post. Interchange allows app developers to use Kaiser’s publicly available information for their own use.)

Future

“In the future, you’ll see how technology will support a person who has chronic diseases,” he added. For patients with complex demands there will be medication management, appointment management and reminders for patients to take their pills.

“This is a great opportunity for the health care industry,” said Mr. Tyson. “It’s very fragmented as an industry.”  It allows for silos to come together and for integration and coordination.

“At Kaiser Permanente it’s “not the ‘we wish,’ ‘we believe,’ ‘it’ll be happening,’ we’re doing it at Kaiser,” said Mr. Tyson. “The future is here,” he added, it’s about “how to help a person live a healthy life, not to just keep coming to Kaiser Permanente.”

I enjoyed speaking with Mr. Bernard Tyson. His energy and enthusiasm for technology is evident.  Having leaders at the helm willing to take the leap because they know it’s the “now” not “someday” approach helps create positive change.  Kaiser is one of the leaders in health care and other health systems can learn from them.

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Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving more than 9.1 million members, with headquarters in Oakland, Calif. It comprises:  Kaiser Foundation Hospitals and their subsidiaries, Kaiser Foundation Health Plan, Inc., The Permanente Medical Groups.  The operating revenue in 2012- $50.6 billion and 12, 286,684 secure emails have been sent to physicians and clinicians.

Your turn

Does your organization implement secure online physician emailing?  If you are a patient, do you email your physician?  Please share your experience in the comment section below.  As always, thank you for sharing your insightful thoughts and for your very valuable time.

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By Barbara Ficarra, RN, BSN, MPA

Do the ethical rules of law apply to medicine?

Ethical issues in social media are a concern for attorneys, and health care professionals can learn from attorneys on how to avoid ethical blowups.

In a recent article in the New York State Bar Association State Bar News, it states that attorneys face a minefield of potential ethical problems when it comes to using social media to boost business or interact with clients. The article, “Using social media, cell phones can bring difficult ethical pitfalls cases to intellectual property landscape,” offers good advice for attorneys which can be applied to the health care arena.

Best advice for avoiding ethical blowups

1. Be aware that everything you post online is a reflection of you. Don’t criticize a judge for a verdict that didn’t go your way and don’t give out legal advice. “These things have a way of getting back to you and biting you in the rear,” said Jeremy Feinberg, special counsel for ethics at the state Office of Court Administration.”
2. “Despite security features, privacy settings and other protections, no one is truly anonymous on the Internet, at least for very long, Feinberg said.” (He noted the incident with Manti Te’o, University of Notre Dame football star and the Internet hoax against him. Subsequently, the perpetrator of the prank was identified.)
3. Privacy settings on a Facebook page should be considered only a little insurance warned Feinberg and David A. Lewis (Hinshaw & Culbertson LLP). “Feinberg said in order to make the best use of privacy settings, it is important that attorneys keep abreast of the latest technological changes relating to particular social media outlets.”
4. Feinberg and Lewis states there are problems using cell phones to communicate with clients via voice mail or text messaging. “Because phone numbers can be transferred, it is possible for an attorney or a client to share privileged information with a stranger, should one or the other change his or her cell phone number. Cell phones and other electronic messaging tools, Feinberg advised, are best reserved for scheduling and mundane messages.”
5. Attorneys need to be careful of the ethical issues relating to blogging. Blogging is a popular way for attorneys to discuss legal matters online. (Feinberg and Lewis)
6. “Attorneys offering opinions in response to a question posted on a blog inadvertently could be establishing a lawyer-client relationship. Blogging also could violate other rules, such as those governing attorney advertising.” (Lewis)
7. “Friending” someone on Facebook or connecting with someone on Linkedin can pose problems for attorneys. Lawyers checking out a juror’s profile could be considered inappropriate conduct. (Feinberg and Lewis)
8. “When having online contact with unrepresented parties, Rule 4.3 of the Rules of Professional Conduct comes into play.” Lewis and Feinberg’s advice: “Do not dispense legal advice, other than advising the individual to get a lawyer, and keep any communication as free of legal language as possible.

While these tips are specific to attorneys, health care professionals can learn from them. Health care professionals can avoid a minefield of ethical problems if they engage in social media judiciously.

Advice 1 through 3 applies to anyone who is online. Don’t criticize anyone, understand no one is truly anonymous and privacy settings have little insurance, but 4 through 8 needs to be addressed for health care professionals. Social Media has transformed the way health care professionals communicate in health care today. Physicians are texting and emailing patients, they are blogging and they are on Facebook and Linkedin and they are interacting with patients. Do the rules of giving out medical advice apply to physicians who engage with patients via telemedicine? Do the ethical rules of law apply to medicine?

In my upcoming interview with attorney David A. Lewis, I will address these issues and more, and I will bring them to you in Part II. Stay tuned.

Source

Mahoney, Mark, (March/April 2013). Using social media, cell phones can bring difficult ethical pitfalls cases to intellectual property landscape, Vol. 55. No. 2, New York State Bar Association, State Bar News, p. 16.

Your turn

Does your organization have ethical guidelines? What are they? How do you avoid ethical pitfalls?  Please share your insights in the comment section below.

As always, thank you for your very valuable time.

More on the legal aspects of social media for health care professionals can be found here.

More on Legal Aspects of Social Media Here

• Doctors and Social Media: Personal vs. Professional Online Content
• Doctors and Social Media: Legal Aspects and Bottom Line
• Doctors and Social Media – Two Photos Which Could Prompt State Boards to Investigate
• State Medical Boards Addresses Inappropriate Online Physician Behaviors
• Social Media Health: 3 Key Elements to Use When Engaging in Social Media
• Social Media Legal Concerns: Questions and Answers with David Harlow, Esq.
• List of 20 Excellent Social Media Networking Resources
• 3 Reasons Why Social Networking Is Not a Waste of Time for Health Professionals
• Healthin30-Social Media/Networking

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Image courtesy of adamr/ FreeDigitalPhotos.net

By Barbara Ficarra, RN, BSN, MPA

I’m truly honored to be invited to attend and participate in TEDMED 2013 at The Kennedy Center in Washington, DC, April 16-19, 2013. TEDMED, a multi-disciplinary community of innovators and thought leaders will gather together to share ideas about the future in health and medicine.

I will be participating in a special event, the Great Challenges Day, which rounds off TEDMED 2013.  Great Challenges Day is dedicated to the 20 Great Challenges of Health and Medicine and takes place on Friday, April 19th at the Marvin Center, on the George Washington University Campus.

Recently, I participated in The TEDMED Great Challenges and I was part of the Medical Communication team.  We gathered together on Google Plus Live Hangout to talk about how to improve medical communication in the health care today.

(Medical Communication team members include, Joseph Kvedar, MD, Robert Arnold, MD, Selma, Caal, MD, John Cox and Barbara Ficarra, RN, BSN, MPA.)

More on TEDMED Great Challenges

TEDMED Great Challenges: Improving Medical Communication-Sound Bites for Twitter

Part 2 – TEDMED Great Challenges: Improving Medical Communication-Sound Bites for Twitter

Part 3 – TEDMED Great Challenges: Improving Medical Communication-Sound Bites for Twitter

TEDMED Great Challenges of Health and Medicine – Medical Communication

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