Hidden Gem at WHCC 2008

For those of you missing the World Health Care Congress 2008 in DC, you are missing a good meeting.  It has lots of networking opportunities, good speakers, lots of company booths, and good content.  I have been here and trying to run between presentations, meetings, and interviews.

I went to a presentation yesterday on PHRs (personal health records) which is a hot topic here.  I think the presentation by Jan Oldenburg (Practice Leader, Health Content, Internet Services Group, Kaiser Permanente) could be the the hidden gem of the conference.  I know a lot of people will immediately discount it for being part of an IDS (integrated delivery system) but don’t.  There is a lot to learn here.

Some of the key things include:

  • Integration of the PHR and EMR.  [Their EMR is from Epic.]
  • A focus on four key attributes – transparency, accessibility, consistency, and security.
  • Four major components: record of information (lab values, visits, notes), an interaction tool (e-mail your physician, HRA), transaction engine (refills), and links to health content.

They have an amazing 2M members on the PHR with over 60% who signed in and used the tool more than 5 times in 2007.  [They probably deserve an award just for this ability to create a sticky application.]  And, 16% signed in more than 12 times.  […which is probably all of their chronic patients with co-morbities.]

Jan talked about their promotion of the site which includes all of their materials, registration drives, and even physicians giving out cards promoting the site.  She talked about making meaningful improvements like moving from mailing out the password to the patient to instant password set-up using a similar algorythm to what banks use.  (This improved their activation to 88% over the past 2 months.  They used to lose 30% between password request and actual registration.)

And, it sounds like they have taken a very thoughtful approach to the application:

  • She spoke about the fact that they had over 3.6M e-mail exchanges between MDs and patients in 2007.  Originally, they didn’t pay MDs for e-mails since it was like returning phone calls.  But, they are looking for how to distinguish between an e-visit and an e-mail.

“E-mail helps me take better care of myself” [a quote from a patient]

  • In a published study, they showed that patients using e-mail had 7-10% less visits and 14% less use of the phone for support.  [very impressive]  But…to George Halvorson’s point on day one, this is a perfect example of misaligned incentives.  The MD uses e-mail to improve health and patient satisfaction but makes less revenue.
  • They addressed one not so obvious issue which is timing of data being released.  For sensitive lab values, they are either delayed so the physician sees it first or its only released after the physician approves it.  The key is that the physicians don’t want the patients to see the data before they get a chance to call them.
  • The patient can take an HRA (health risk assessment) and decide whether or not to share it.
  • They have some impressive statistics around changing behavior:
    • 55% lost weight
    • 58% decreased stress
    • 78% had better pain management
  • They are just beginning to analyze who the users are (e.g., chronic patients, acute patients, family).  This was a question in every PHR meeting yesterday.
  • Some of their key learnings included:
    • Information has to be timely and current
    • You have to create “in the moment” opportunities to act (i.e., e-mail your provider)
    • You have to create teachable moments
    • You have to meet members where they live
    • You have to heal the fractures of our healthcare system

“Patients who use the PHR are 65% more likely to stay with Kaiser when they have a choice of plan options.”  [WOW!  Talk about a case for adoption.]

  • They were one of the first ones that I heard talk about working with portability standards to move data from PHR to PHR and to a DTC model (i.e., Google, Microsoft).
  • The final point which was similar to what I discussed with ActiveHealth was around genomics.  Jan talked about some of the analysis they were doing thinking out years in the future about how that data could influence generations.

This is certainly worth following and looking at as a model.  Some of the things are easier because of their model (e.g., getting MDs to use e-mail and promote the web), BUT somethings are lessons that can be leveraged.


  1. WorldHealthCareBlog.org » My Vote - Hidden Gem of WHCC 2008: a hosted discussion on innovation in health care - April 23, 2008

    […] (You can see the slides on my blog Patient Centric Healthcare.) […]

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