Big Data Helps Kaiser Close Healthcare Gaps

One benefit of Kaiser Permanente spending an estimated $6 billion for an integrated electronic health records (EHR) system to serve 9 million people across eight regions from coast to coast is it that has amassed a vast repository of clinical data. That storehouse also contains information from a patient portal, ancillary systems, smart medical devices and even home-based patient monitoring systems.

All those terabytes of electronic data now are helping to fuel a massive analytics operation, part of an overall organizational goal of improving care and reining in costs. "It's all about the data and information, not the electronic health record," Carol Cain, senior director of clinical information services for the Kaiser Permanente Care Management Institute, said this week at the Healthcare Information and Management Systems Society (HIMSS) annual conference in New Orleans.

Kaiser has embraced a concept of "complete care," which one Southern California Permanente Medical Group described as "giving my patients everything they need, whether they know it or not," according to Cain's presentation.

"We need to incorporate so much more data that is available," Cain said. Data needs to be "synthesized in a meaningful way" and delivered to primary care physicians at the point of care to help suggest appropriate interventions.

Cain said Kaiser views big data as being characterized by "volume, variety and velocity." The term "refers to datasets whose size is beyond the ability of typical database software tools to capture, store, manage and analyze," she said.

"Our ability to monitor our members' health is greater than our members' ability to know what needs to be monitored," Cain explained.

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Kaiser Permanente has developed several modules of population management, all designed to identify and close gaps in care. If a patient shows up with knee pain, for example, management tools suggest doctors ask about a cancer screening, in an effort to make office visits "proactive" and organize care around the concept of the patient-centered medical home, Cain said.

The analytics also has to be done in a way that won't make patients feel like Big Brother is watching over them, Cain said. Instead, Kaiser wants people to think that the integrated delivery system is helping to prevent illness and find health problems early. If patients allow Kaiser to access information linked to their supermarket loyalty cards, the organization will not send warnings every time they purchase a candy bar, Cain said.

What Kaiser can do is rely on its platform to combine patient-specific knowledge, such as whether an individual has filled a prescription. This can help with medication adherence, according to Cain. Analytics are helpful for developing care plans before patients are discharged from hospitals, too.

Kaiser also can advise patients to telephone or schedule e-visits if a primary care physician determines a problem is not worth an in-person appointment. "That is something that is often appreciated by our members," Cain noted.

Cain said that patient needs are not always clinical, either. During a 12-hour hackathon in the analytics department, Kaiser IT professionals were able to correlate access to parks with rates of obesity in Oakland, Calif. "In some of our communities, we are investing in building parks," Cain said. Kaiser also has partnerships with YMCA and schools in some areas to address lifestyle issues that can affect health.