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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Bedrock Technology: “The EHR is the Foundation of Everything We Do!”

Bedrock (bĕd’rŏk’) n.

1. The solid rock that underlies loose material, such as soil, sand, clay, or gravel.
2. The very basis; the foundation or lowest point.

Next interview for “The Business Case for Health 2.0” session is Anna-Lisa Silvestre, the VP of Online Services for Kaiser Permanente.

SS: Anna-Lisa, nice to meet you. Tell me a little about your background?

AL: I started out with Kaiser Permanente 23 years ago as a health educator. I was fortunate to be able to transition into the interactive technology unit that was created in the mid 1990’s. We had a singular focus on developing online capabilities back in the good old HTML days. However, things have dramatically changed since then and we now have over 2.5M members who have activated an online account; 60% of those users signed on two or more times last year.

SS: What do you find is the thing that draws people to your online services?

AL: We have found that it is not just one online service. For example, while we have found that most people initially come online to access “Actionable” information, such as laboratory results, they come back because they are finding value in the tools or content that is available. And it is not just one or two capabilities, it is many different things to many different people who have many different needs. We have worked very hard to identify capabilities that make the online consumer experience more effective – new services must be something that the user needs to do (access lab tests), there must be additional offerings that keep them there (appointment scheduling), and the user interface must be as seamless and simple as possible.

Remember, we are just in v1 of our online activities. While Lab online prescription refill was the initial motivator to go online, we are continuing to enhance our offerings to ensure our content is relevant and meaningful to our members. Providing members with actionable information drives everything we do.

SS: How has Kaiser supported the online services effort?

AL: We currently have a team of approximately 150 people dedicated to creating the most useful, effective, and relevant patient experience we can. In partnership with care delivery operations, we plan, develop, and implement online capabilities for Kaiser Permanente. We have recently been engaged in moving to a new Web 2.0 technology platform (Websphere that will allow us to be more nimble, more flexible, and more capable of integrating other sources of data/content moving forward. This is a big step for us, and we are excited to get there as quickly as possible.

Kaiser Permanente has been investing in engaging the patient for a long time. We have over 60 years of longitudinal experience managing our patients health. As an integrated system designed to care for patients for life, we take the really long view in terms of our investments, strategies, and how we measure our success. As a result of this alignment, we are realy focused on prevention, primary care, and patient engagement because we kno wall of these efforts get us to where we want to be – patients, families, and communities that Thrive!

SS: How do you define Health 2.0?

AL: Health 2.0 implies that the consumers are finally able to engage in their health and get connected to what they need in term of their health. We have not had many applications to help people make a behavior change in the past – where is our iHealth equivalent app? You know, behavior change is really, really hard. The more tools that are available to help people change their behavior the better. I firmly believe in the “Let a 1,000 flowers bloom” philosophy. Since it is so hard to manage diabetes, manage weight loss, or quit smoking, we need to provide as many tools as possible to help personalize the quest for each individual. Health 2.0 is a descriptive term for this new level of engagement.

SS: How did the KP mothership get engaged in Health 2.0?

AL: Well, we have been innovating online for a long time. We have been fortunate, based on our size, to do some really interesting tests with technology to improve how our we interact with our patients interact with us. At the end of the day, you only get value when the tools/technology is easy to use and allows consumers to get connected to each other. It is as people begin to network, that the network effect and synergies between information resources starts to be realized. At Kaiser Permanente, we have been exceptionally fortunate to have made a major investment in health care information technology. From the core EHR investment, we have been able to wring out several additional layers of value. Because we have demographic information, it allows us to auto enroll patients in other services; because information can be shared between our services, we can dramatically improve our responsiveness; and because we have access to all this information, we can measure, monitor, and improve our patients health experiences much more rapidly.

We are very actively engaged at looking at all the emerging Health 2.0 tools/technologies that allow us to engage patients more effectively. We are constantly looking at new businesses and new business models that we think can help us accomplish our core objectives.

SS: What has enabled KP to be successful in engaging the patient?

AL: I believe it is our breadth of services, our focus on the ease of use, and our efforts to deliver relevant/actionable services that matter to the patient. Its a very simple formula actually, but much harder than what how  it sounds (knowingly laughs).

SS: You guys have had several haymaker announcements over the year with nearly every major player in health care? Do you mind running through a couple of them?

AL: Yeah, here are a few notables:

Kaiser Permanente HealthConnect

  • KP HealthConnect, the electronic health record built on Epic Software code and customized clinical content from Kaiser Permanente, serves as the foundation of nearly everything that we do on The fact that we have this level of clinical information is an exceptional foundation from which to build our online capabilities. We could have never gotten where we are without having Epic and MyChart as foundation elements.
  • We have accomplished a great deal in terms of implementing KP HealthConnect, but we believe that this is just the beginning. The real work lays ahead of us, optimizing the health information technology to transform the way we deliver care. There is so much we can do now that we are fully digital and getting more and more adoption by physicians, patients, and our health plan all the time.

My Health Manager on

  • The Kaiser Permanente personal health record on which allows members and their care teams to share the same medical information via KP HealthConnect.
  • In terms of online services, we have seen immediate value from our investment: nearly 100,000 people a day are coming online to make appointments, refill prescriptions and email their doctors. This is an incredible time saver for everyone, improves satisfaction,and improving convenience, and saving money for everyone involved.
  • It has also allowed us to begin to look at how primary care is delivered.

Microsoft Health Vault

  • We have announced a data exchange project with Microsoft Health Vault. We are currently planning for the exchange of information. We have completed the prototypes that are required to test the concept, and begun the validation work.
  • This is not to mention all the security, legal, and regulatory work between HIPAA and non-HIPAA covered entities (that is pretty interesting in and of itself). It is highly complex to figure out all the things required to move data around.

Google Health

  • In full disclosure, I have served on the advisory council for Google since 2007
  • We have had a number of conversations with Google. We look forward to continuing the dialog around bi-directional information flow between our two organizations.
  • A lot of our conversations have been focused on standards – including our desire to use CCD and Googles experience with the CCR at the Cleveland Clinic.

Veterans Administration

  • We have been approached by several government organizations to help make their intakes much easier. We have all this information that is useful for them and they are asking us to work with them.
  • This particular project has to do with eligibility/demographic exchange between one Provider (KP) and another Provider (VA).

SS: What is it about KP that has allowed you to be so far out on the edge?

AL: It’s a good question; and actually Kasiser Permanente is quite a unique place. We are a non-profit, fully integrated (insurance, provider, and members all a part of a single organization) delivery system with an extensive array of offerings and a 60 year history of caring for our members. As a result, we are fully aware of the need for preventive services to be applied across the lifetime of the member. It is in our best interest, to have the patients best interest top of mind. Innovation, an important part of what Health 2.0 offers, helps us stay in front of this curve and more importantly deliver these advances in the most efficient, relevant, and engaging way possible.

SS: That’s about all the time either of us have. I will look forward to continuing the conversation in San Francisco.

AL: Thank you so much – I will look forward to being with everyone next week.

7 comments on “Bedrock Technology: “The EHR is the Foundation of Everything We Do!”

  1. That is a very interesting topic. Actually, Gartner analysts predict that, by 2009, healthcare investments in IT will increase by more than 50 percent, which could enable clinicians to reduce the level of preventable deaths by 50 percent by 2013. Of course, nowadays most healthcare organizations have already invested in IT outsourcing, for anything from Telco and Wireless, to Application Data Development (i.e. LIMS, SOA), or even Business Process Management.
    We’ve put together a detailed white paper on these subjects: . What is your experience with IT outsourcing in healthcare? Are these figures close to your personal experience or do you think there are certain issues we’ve missed covering? I strongly appreciate your professional opinions.

  2. Chris Frostt says:

    This is a great article and correct that companies should engage and implement and effective Laboratory management systems with domestic and international regulations and industry standards, and provides comprehensive reporting, monitoring and analysis capabilities

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