By Tom Debley
Kaiser Permanente today is arguably the most advanced non-governmental health care organization in the country, and perhaps in the world, in the use of computers in medicine. A key historic reason for that leadership is its pioneering role. So this week we recognize the moment this work all began exactly 50 years ago.
The big lesson is that innovation did not occur through magic. It took vision, openness to new ideas, and dedicated work by thousands of people over the ensuing decades.
The result is that, at a time when electronic medical record systems have barely scratched the surface of American medicine, they are pervasive throughout Kaiser Permanente. All 8.6 million members have their own electronic medical records, which are also available throughout the organization’s 36 hospitals.
What’s more, the system’s Web-based member portal enables members to view most portions of their own medical record on line, send secure messages to their doctors, order prescriptions, make appointments, view lab results, and much more.
The critical moment when the futuristic vision of computer-enabled medical care came together with an organizational willingness to embrace new ideas came in May 1960. At a four-day leadership meeting, Sidney R. Garfield, our founding physician, was giving a report about hospital designs. Then, he shifted gears and announced, “I would like to use my remaining minutes on a more important, new concept. I want to throw this idea on the table for your consideration. Please accept it in the spirit it is given. It is a controversial idea, but please keep an open mind.”
It was a whopper.
“Let us conceive a building for health—designed, streamlined and geared to serve our healthy members. This health institute could conceivably function in this fashion. Each new health plan member would automatically and periodically be called in for service. On his first visit, a history would be taken and fed in a computer.
“A duplicate of this history would be sent to his service area. On each periodic visit or service visit, further data would be taken . . . and fed into this record. This would not only develop records never before available, but might do so at a great savings in time of physicians.”
The late Dr. John G. Smillie, who was at the meeting, commented on the discussion at the time that physicians who were there felt Garfield’s proposal “had exciting merit,” adding they said “it should be studied from many angles, and designed and redesigned… (and) should be made flexible to meet new developments…”
Over the next decade, the 1960s, research and testing headed by Garfield’s colleague, Morris F. Collen, MD, propelled Kaiser Permanente into a leadership role in the emerging field of medical informatics.
Within that decade, more than one million patients had early versions of electronic medical records and became more involved in their own care because of the new levels of knowledge available to them and their doctors.
“It was the first transformational aspect of looking at how the system of caring for patients could change,” recalls Dr. Marion J. Ball, author of “Consumer Informatics: Applications and Strategies in Cyber Health Care” and adjunct professor at The Johns Hopkins University School of Nursing.
Dr. Collen recognized in the early years of his work that the computer would be an incredibly important tool in modern medicine, declaring in 1966: “The computer will probably have the greatest impact on medical science since the invention of the microscope.”
Dr. Cecil C. Cutting, the first executive director of The Permanente Medical Group, challenged all physicians in 1965 to embrace the future in a talk to the American Association for the Advancement of Science.
“. . . The great challenge,” he said, “will be the willingness of traditional medicine to accept these new concepts and reorganize to provide these services. The future . . . in medicine may well rest on the open-mindedness of the doc¬tors of the country to anticipate inevitable trends and lead the way. We earnestly hope they will.”
That Kaiser Permanente was changing from a pioneer to a continuing leader in health information technology (IT) was well established by 1968, when its annual report stated: “The computer cannot replace the physician, but it can keep essential data moving smoothly from laboratory to nurses’ station, from X-ray department to the patient’s chart, and from all areas of the medical center to the physician himself.”
This early embrace of health IT – and persistent work in the half century since – explains why, as I’ve mentioned in earlier blogs, 12 of the first 13 American hospitals to be rewarded by HIMSS, the leading health IT association, for having the highest level of e-connectivity were Kaiser Permanente hospitals. This year, 24 Kaiser Permanente hospitals have achieved that status, with more on the way. Meanwhile, less than 1 percent of America’s hospitals are at this stage.
What was said of Dr. Garfield two decades ago is just as true today: “Sidney Garfield…had a way of always operating on the cutting edge of the future.”