By Lincoln Cushing, Heritage writer
What is the right way to reward creativity and hard work? What is an appropriate balance between corporate ownership and the public good? These issues form the root of copyright and patent law and have shifted over time and place.
Contrary to the practices of most major companies, however, Kaiser Permanente – and its earlier entity, Kaiser Industries – have long embraced the concept that sharing is not only good for the community, it’s responsible organizational practice.
On November 17, 1942, Henry J. Kaiser recommended that an independent federal agency be formed to license all new inventions and to distribute their benefits throughout industry.
His comments were published in many news outlets, including Billboard magazine’s December 1942 issue:
“Original ideas, suggestions and developments should be interchanged among allied industries, such as airplane (production) and shipbuilding and the steel industry,” Kaiser told a U.S. Senate military subcommittee studying technological mobilization.
He said he thought his position might be considered revolutionary, but added: “Industry will be more productive if patents are available to all industries able to use them. (After the war), compensation for their use should go to the individual as an incentive and not to the company that employs him (or her).”
Billboard’s article reported, “Workers in the Kaiser shipyards are encouraged to submit new ideas and techniques, and a prize is awarded each week for the best suggestion. In addition, the author of an accepted proposal works with an engineer in preparing sketches to illustrate an improved process.”
Kaiser told the committee that his industries made their data available to other builders, and likewise, he benefited from the findings of others.
Sharing tradition continues
That “revolutionary” position was not just a flash in the pan. Kaiser Permanente, Henry J. Kaiser’s most enduring legacy, has continued that tradition.
Kaiser Permanente’s fourth CEO, George Halvorson, who has led the organization since 2002, has long supported an open approach to innovation.
Some of these initiatives include:
The Care Connectivity Consortium includes Kaiser Permanente, the Mayo Clinic, Geisinger Health System of Pennsylvania, Intermountain Healthcare based in Utah, and Group Health Cooperative, based in Seattle.
The consortium is dedicated to developing systems that will allow seamless sharing of health information among provider groups.
The consortium is also committed to working toward a future where timely access to health information improves the quality of care for all patients.
The Partnership for Quality Care is a coalition of not-for-profit health care providers and health care workers dedicated to guaranteed, affordable, high-quality health care for every man, woman, and child in America. The partnership strives to improve patient care as well as prevent and treat chronic conditions by sharing best practices.
Members include Kaiser Permanente, several units of the Service Employees International Union, the Greater New York Hospital Association, Group Health Cooperative and HealthPartners in Minnesota.
In 2008, Kaiser Permanente CEO Halvorson noted: “Leading health care providers have already implemented programs that contain costs, expand access, and most importantly, improve the quality of care for chronic patients. That points the way to nationwide reform.”
Banding together to beat HIV
The HIV Interregional Initiative, a cooperative effort among all Kaiser Permanente regions and Group Health Cooperative, represents the second largest provider of integrated HIV care in the United States; the largest provider is the Veterans Administration.
Sponsors of the initiative are Kaiser Permanente Foundation Health Plan and The Permanente Federation, which represents the national interests of the Permanente Medical Groups.
The Care Management Institute, a partnership between the federation and the health plan, has developed the first clinical guidelines in the United States for HIV/AIDS treatment and the appropriate use of related drugs.
The HIV Interregional Initiative works with Kaiser Permanente’s national pharmacy purchasers to get the best prices for HIV drugs. Research using Kaiser Permanente’s electronic health records has led to exceptional success in treating patients with HIV.
In 2012, Robert Pearl, MD, executive director and CEO of The Permanente Medical Group, noted: “Our success in the treatment of patients with HIV/AIDS results from the excellence of our clinicians, our advanced [information technology] systems, our integrated delivery system and our effective coordination across specialties.”
Kaiser Permanente assists health care providers and community health clinics across the country in improving their HIV patient care by sharing its clinical best practices, provider and patient education materials, training and other expertise.
Genetic research for better chronic care
The Kaiser Permanente Research Program on Genes, Environment, and Health is one of the largest research projects in the United States to examine the genetic and environmental factors that can increase risk for chronic conditions such as heart disease, cancer, diabetes, high blood pressure, Alzheimer’s disease, and asthma.
With DNA collected from 500,000 consenting California health plan members, the project will link comprehensive electronic health records, data on relevant behavioral and environmental factors, as well as genetic information.
Working in collaboration with other scientists across the nation and around the world, researchers hope to translate project findings into improvements in preventive care and treatment.
Henry J. Kaiser started something in 1942 that continues to drive Kaiser Permanente’s quest, 71 years later, to improve health care and access to treatment for all Americans.
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.”