Archive for June, 2010

The Tokyo Accords, Kaiser Permanente and the genesis of the American Medical Informatics Association

posted on June 28, 2010

by Bryan Culp

You may have heard the news this spring that every Kaiser Permanente medical facility is now equipped with KP HealthConnect®. KP has the largest private sector electronic health record implementation in the world.

What may come as a surprise is that KP has been for half-century a leader in medical informatics –the theory, practice and “dynamo” behind today’s health e-connectivity.

Thirty years ago leading informaticians gathered in Tokyo, Japan, for the congress “MEDINFO 80.”  Medical informatics was a young discipline, and Tokyo was the site of the third congress. The two previous congresses convened in Stockholm (1974) and Toronto (1977).  KP physicians participated in all three.  Our founding physician, Dr. Sidney Garfield, delivered a paper at the first congress in Stockholm.

What made the Tokyo congress different?  It was the first of the congresses to be organized by the new International Medical Informatics Association (IHEA), the formation of this mostly-European-in-membership society from a parent organization (the International Federation for Information Processing) was a sign that the field of medical informatics was maturing.

Morris F. Collen, MD

Second, Tokyo was the first of the world congresses to have significant U.S. involvement.  Kaiser Permanente’s pioneer in medical informatics, Morris F. Collen, MD, was the program chair and Donald A. B. Lindberg, MD, then at the University of Missouri at Columbia was the editor of the proceedings.  Participants from the United States delivered 51 papers in Tokyo on subjects ranging from computer-based medical records to computer-aided decision support.

By way of background, in 1980 there were two medical informatics associations in the United States with less than 500 members each: the Society of Computer Medicine (SCM) and the Society for Advanced Medical Systems (SAMS).  Each convened separate annual meetings and each held board members in common.  And because there was some duplication of effort within them, there grew within each the conviction that the field in the U.S. would be served if the two societies merged.

At Tokyo, Dr. Marion Ball a director of Computer Systems at Temple University and president-elect of SCM, and Dr. Ben Williams, the president of SAMS, formed an ad hoc meeting of members and boards to discuss “common interests and possible common future activities.”  Dubbed the “Tokyo Accords” by Williams, in these meetings lay the genesis of the American Medical Informatics Association.

The enthusiasm generated in Tokyo resulted in the First Congress of the American Medical Informatics Association (AMIA Congress 82) held in San Francisco in 1982.  The congress was organized by Dr. Collen and was sponsored by the Kaiser Foundation Hospitals, with SAMS, SCM, and IHEA and other co-sponsors.  Concurrently in the months preceding and following the congress, the American Medical Informatics Association grew up with the expressed purpose “to advance the field of medical informatics in the United States.”

So when the Kaiser Permanente Thrive ad “Connected” airs on your local station, remember the medical informatics congresses that convened in Tokyo and San Francisco over thirty years ago, and the foresight of the KP leadership to nurture the emerging field of medical informatics.

Click on the arrow to watch “Connected.”

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Kaiser Permanente’s LA Harbor Area Blossoms after Humble 1950 Start

posted on June 21, 2010

By Ginny McPartland 

Kaiser Permanente’s post-World War II public health plan was but an embryo in 1950 when famed labor leader Harry Bridges asked Dr. Sidney Garfield to provide medical care for West Coast longshoremen. The International Longshore and Warehouse Union (ILWU) had just adopted a health and welfare plan for its members, and Permanente’s prepaid health coverage fit Bridges’ vision. 

The health plan, then called Permanente, already had services in the San Francisco Bay area, so covering the six or seven thousand Northern California dock workers was no problem. But Permanente’s only presence in Southern California was at the Fontana Steel Plant, 70 miles inland from the Los Angeles harbor area where the roughly 3,000 longshoremen lived. 

Kennebec medical clinic in the 1950s

Garfield didn’t have to ponder Bridges’ offer for long. The struggling health plan needed members – desperately. After saying “yes!” to Bridges, Garfield flew into action. He hired a physician to run the longshoremen clinic, found a suitable building in the Port of Los Angeles town of San Pedro and opened for business in about two weeks. 

Today, Kaiser Permanente’s South Bay service area, boasts about 190,000 members, a 255-bed medical center, and medical offices in Long Beach, Torrance, Harbor City, Lomita, Carson, and Gardena. The KP South Bay community is celebrating its 60 years of history on Wednesday, June 23, in Harbor City. 

It’s been a rough ride 

The Harbor area health plan’s six decades of existence can be characterized as a roller coaster ride with its ups, downs, and unexpected turns. The years have brought growth, at times unmanageable, stopgap solutions to facility needs, the San Pedro murder of a popular doctor, and a fire that disrupted operations for a year – not all roses and sunshine. 

The early medical group, led by Ira “Buck” Wallin, MD, worked out of a small clinic in San Pedro and had to fight for legitimacy and for staff privileges at any of the area hospitals. They were blackballed by the local medical community for practicing what was called “socialized medicine” when the “Red Scare” was the order of the day. This contention was typical of the anti-group-practice atmosphere anywhere Permanente Medicine established itself. 

In the beginning, and for many years, the doctors made house calls and took turns sleeping overnight in a blood draw room in the clinic. They were at the beck and call of the longshoremen and their families. Over the first five years, the ILWU became steadily more impatient with the health plan for delaying construction of a sorely needed Harbor area medical center.

Early Parkview clinic in Harbor City

 Meanwhile, the group had expanded to Long Beach – first to an old house and then to the old posh Kennebec Hotel across from the Pike, a popular amusement park in Long Beach. The health plan also opened a Los Angeles clinic and then a hospital on Sunset Boulevard. From 1953 when the Sunset Hospital opened until the Harbor City hospital was built in 1957, patients were shuttled to Los Angeles for hospital care.

After a tussle with the ILWU that threatened the loss of the group, Sidney Garfield and Buck Wallin got the funding to build the Harbor City medical center. The first medical office building, called Parkview, was opened adjacent to the hospital in 1958.

South Bay no stranger to innovation

The South Bay/Harbor City movers and shakers contributed more than their share of innovative ideas over the years. Some examples:

  • In 1964, Harry Shragg, who later became area medical director, was the first in Southern California Kaiser Permanente to perform outpatient surgery, a practice that would become prevalent for its economy and medical soundness.
  • In 1964-65, Buck Wallin and Chief of Medicine William Fawell pursued the idea of discharging patients sooner and providing follow-up medical care in their homes. When Medicare came along in 1965, suddenly (home health care) became one of the ‘in’ things to do.
  • In the early 1970s, Harry Shragg, Internist Jay Belsky, and Medical Group Administrator Ed Bunting worked together to develop a new exam room layout that would leave more room for the patient and the examination table. “It was such a big success that it was adopted and became standard for all of Southern California, Bunting said.

The good, the bad and the ugly

  • In 1967, Dr. Shragg saw the opportunity to help disadvantaged Harbor City people through a local program funded by the federal Office of Economic Opportunity. Kaiser Permanente used its community service funds to provide medical care for 100 participant families.
  • In 1960, Leon Quattlebaum, a well-liked and respected 36-year-old Harbor City OB-GYN, was killed in San Pedro by a local tough who, unprovoked, punched “Q” in the jaw, knocking him to the cement floor and fracturing his skull. The prosecutor at the murder trial said the only reason for the killing was the murderer’s “malignancy of heart.”
  • In November of 1973, a night fire of unknown origin collapsed the three-story Parkview engineering tower and threatened to destroy Harbor City’s medical records and appointments data. The medical offices and appointment center were up and running again in about a week, said MGA Ed Bunting. But it took about a year to rebuild the burned out section at the center and make the complex whole again.

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Henry Kaiser’s Respect for People of All Races Dates from African-American Worker Who Was One of First Employees Ever Hired

posted on June 15, 2010

By Tom Debley
Director of Heritage Resources

“Tote! Tote!”

Little Edgar Kaiser, 5, would call out to a gregarious black laborer named James A. Shaw with those words.

Jimmy Shaw would hoist the lad up onto his shoulders and carry the boy, all the while raking asphalt on a road-building project for Edgar’s father, Henry J. Kaiser.

The year was 1913. The site was a work camp where the toddler would often live, sleeping in a car or a tent, with his parents, Henry and Bess Kaiser. Little Edgar’s affection for riding on Shaw’s shoulders, calling out “Tote, Tote!” when he’d see Shaw, earned Jimmy the nickname “Tote,” or sometimes “Totem,” for the rest of his life.

"Totem" Shaw is seen in an undated photograph after his retirement in Fontana, Calif. (Photo courtesy of John Charles Anicic Jr., author of "Images of America: Kaiser Steel Fontana," Acadia Publishing, 2006.)

This was in the early years of Henry Kaiser’s fledgling road-building business—long before he became the great 20th century industrialist who gained fame building highways, dams, and World War II ships.

And Totem Shaw’s story, as recorded in historic archives, helps shed light on both Henry and Edgar Kaiser’s later reputations as businessmen who understood the value of workforce diversity and, in their personal lives, moved beyond racial divides decades before the rest of the country.

Born in 1879, Shaw was not quite two years older than Henry J. and represents the earliest documented friendship between the Kaisers and a person of African heritage. Shaw’s is a powerful story that helps explain why Henry Kaiser was open to hiring minority workers.

Shaw was Kaiser’s first black employee, hired several years before Kaiser even formed his own company. He actually was hired by A. B. Ordway, Kaiser’s very first employee, when they were working for another company paving part of Post Street in Spokane, Wash., about 1909. Kaiser was general superintendent and Ordway was foreman.

One day Shaw walked up to the Post Street paving gang and asked Ordway for a job. According to Gordon Barteau, a Portland Oregonian newspaper reporter who wrote a profile of Shaw in 1943, “Ordway sized Tote up and said he thought Tote looked kind of runty for a job like that.”

In a style reminiscent of Kaiser himself, Shaw offered to work for free for a week on trial.

“Well … the first day he wore out two men and the next day Ordway told him he was on the payroll,” the Oregonian reported.

“Tote” worked in a variety of jobs on just about every big Kaiser project – from road building in Cuba to the Grand Coulee Dam, the Vancouver Shipyards in World War II, and the Kaiser steel mill in Fontana, Calif., before he retired. It was during the war years in Vancouver, according to Barteau’s article, that whenever Henry Kaiser “comes to town he always looks up Tote and they hash over the old days.”

Clearly, it was Shaw’s relationship with Edgar and his ability as a skilled laborer with problem-solving skills that made him a lifelong, unforgettable friend of Henry Kaiser.

During construction of the original Highway 99 between Redding and Red Bluff in Northern California, in 1921, Kaiser was having trouble keeping a muddy detour open. He’d sent in a work crew of six men, and they had failed.

Kaiser summoned Shaw. “Tote,” he said, “every truck on the job is stuck in the mud. …You go down there and see what you can do.”

Shaw grabbed an axe, a pick, and a shovel. In short order, he had all of the trucks out of the mud and running.

“How did you do it?” Kaiser asked him.

“Mr. Kaiser,” he replied, “when you do things, you mixes brains and money. Well, sir, I mixes mud and brains.”

“Kaiser loved the phrase,” wrote one of his biographers, Mark Foster. “It became a company slogan.”

Shaw lived his final years in Fontana. They had a big party for him when turned 85 in 1964. In addition to cards, gifts, and a huge birthday cake, a teletype arrived from the giant Kaiser Industries headquarters in Oakland—birthday greetings from A. B. Ordway, who had known “Tote” since the day he had walked up to Ordway on Post Street in Spokane and asked for a job.

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Tom Debley Earns National Park Service Award

posted on June 4, 2010

By Ginny McPartland 

RICHMOND – The National Park Service presented its Home Front Award to Kaiser Permanente’s Heritage Resources Director Tom Debley Monday (May 24) as part of the city’s 2010 Historic Preservation Awards.

Debley is being cited for leading “initiatives to create and support” the home front park, which is on the site of the World War II Kaiser Richmond shipyards. 

The National Park Service Home Front Award is to recognize people, projects, programs or publications that preserve a home front site or structure, or that promote recognition and understanding of the WWII era in Richmond’s and the nation’s history. 

The purpose of the city’s historic awards program is to increase public awareness of Richmond’s heritage by recognizing individuals, organizations, businesses and agencies whose contributions demonstrate outstanding commitment to excellence in historic preservation, local history or promotion of the city’s heritage. 

Click this link to hear Tom’s remarks on receiving the award 

 streaming video courtesy of the KCRT Information Network

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