Posts Tagged ‘Kaiser Foundation International’

Kaiser Permanente and NASA – Taking Telemedicine Out of this World

posted on September 23, 2015

Lincoln Cushing, Heritage writer



Space Technology Applied to Rural Papago Advanced Health Care logo

How do you handle medical testing and care in a remote location? A really, really remote location – such as outer space?

This was one of the challenges that the National Aeronautics and Space Administration faced in the early 1970s – and it got help from one of our founding physicians and Kaiser Permanente, through what was then the Kaiser Foundation International[i] program.

KFI to Help Develop NASA-Sponsored Health System”
Kaiser Permanente newsletter, August 9, 1972

Kaiser Foundation International became a major ($1.8 million) subcontractor to the Lockheed Missiles and Space Company to help design, develop and test a ground based remote health care delivery system.

The ground-based test unit will be installed at a sparsely populated site on earth to provide medical care to local residents. Trained physicians’ assistants will employ the unit to transmit medical information on residents of the area to physicians at an established facility many miles from the remote site. If the test program is successful, it may provide system technology to improve health care and medical services to remote areas on earth. Part of a four year NASA sponsored program, this concept, as applied to a remote area on earth, will be evaluated by NASA for possible use in advanced, long-duration, manned space missions.

Interior view of the mobile health unit with medical personnel, neonatal patient and mother, from "The STARPAHC collection: part of an archive of the history of telemedicine"

“Interior view of the mobile health unit with medical personnel, neonatal patient and mother” from Arizona Health Sciences Library

The back story is that in late 1970 Morris Collen, MD, attended a Northeast Electronics Research and Engineering Meeting in Boston that included a session on medical electronics. At that conference he served on a panel with Dr. Walton Jones, Director of Biotechnology and Human Research at NASA.

Kaiser Permanente’s Dr. Collen, in addition to being a brilliant physician in the Kaiser Richmond shipyards during World War II, was also an electrical engineer and considered one of the fathers of the field of medical informatics. He pioneered the use of the “multiphasic” examination, a battery of prescriptive medical tests for incoming health plan members, which later became the Automated Multiphasic Health Test.

By late 1971 J.P. Nash, the assistant general manager of Lockheed, told Dan Scannell, Kaiser Permanente’s director of public relations, some exciting news:

“Very shortly NASA is expected to solicit proposals for the design, development and testing of a Test Bed System for an Area Health Services Field Unit. This requirement has grown out of a NASA program for which [Lockheed] has been under contract for about four years called Integrated Medical and Behavior Laboratory Measurements System. IMBLMS is a four-phase program leading to the development and operation of a space flight biomedical laboratory, for research experiment in long-duration manned space flight in post-Apollo programs . . .”

IMBLMS project patch, circa 1973

Integrated Medical and Behavior Laboratory Measurements System project patch, circa 1973

On Jan. 4, 1972, Dr. Collen wrote to Sam L. Pool, MD, at the NASA Manned Spacecraft Center in Houston:

“Of special interest to us . . . would be the development of a completely automated self-administered multiphasic health testing laboratory in which a person in space could perform everything himself, utilizing automated equipment which enters the data into the computer which is programmed to provide advice and instructions. We believe that it is now technically feasible to develop such a prototype and with our experience we estimate such could be done within two to three years at a reasonable cost.”

The project, as noted in the 1972 news story, would use a “sparsely populated site on earth” to test equipment, systems, and personnel. That location would be the Papago Indian Reservation [now known as the Tohono O’odham Indian Nation] in southwest Arizona, with the catchy space-age title “Space Technology Applied to Rural Papago Advanced Health Care,” known as STARPAHC. Lockheed issued a summary report in June 1974 that explained the “Part 1 – Design and Definition” of the project:

STARPAHC will prototype a ground-based demonstration of IMBLMS space technology with two primary program objectives: (1) to obtain data for application to future spacecraft design and (2) to improve health care delivery through application of space technology. STARPAHC is designed to improve the capability for delivering health care to the Papago Indians located on the Papago Indian Reservation in southwest Arizona.

The STARPAHC operational concept was based on utilizing the professional staff of the Sells Hospital, where the Health Services Support Control Center will be located, to provide direction and consultation to paramedical and technical personnel stationed at the remote clinics, Local Health Services Center, and the Mobile Health Unit. The interchange of information between the HSSCC, LHSC, and MHU will be accomplished by voice, data, and video communication links. Computer-based data management techniques will implement record keeping, data retrieval, and data analysis.

“Patient viewing microscope” photograph from STARPAHC report.

“Patient viewing microscope,” STARPAHC report.

STARPAHC ended in 1977, and resulted in several advances in the nascent field of telemedicine. A 1979 article in Medical Care interviewed 47 individual care providers in the program, and concluded that the major problems were the unreliability of equipment and the time required for television consultations. The major benefit cited was improved access to health care for a population not previously receiving such care near their homes. Another positive outcome noted by non-physician providers was the linkage to physicians via television and voice communications from remote areas.

In 2001 the Arizona Health Sciences Library acquired important archival materials documenting the STARPAHC project and established the Arizona Archive of Telemedicine.

Telemedicine – terrestrial and beyond – has evolved considerably since the early 1970s. In 1980 Dr. Collen would serve as a member of the NASA Workshop on Space Shuttle Studies. And Kaiser Permanente is as deeply committed to exploring its applications now as it was when the field was brand new.


[i] In 1964 Kaiser Industries established the not-for-profit Kaiser Foundation International to administer foreign medical care programs. With Kaiser Permanente’s reputation on the rise, requests for consulting help started to come from places where Kaiser Industries didn’t already have a presence. Between 1964 and 1969, the international group was engaged for medical care projects in 15 African countries. When it closed down in 1975, KFI had been hired and paid for projects in 30 countries around the globe, including rural locations in California, Utah, and West Virginia. KFI was replaced by Kaiser Permanente International in 1996. Today KPI is a self-supporting subsidiary that offers educational programs about the Kaiser Permanente model and provides speakers at international conferences.


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Global enterprises gave rise to export of Kaiser Permanente health care

posted on February 27, 2012

by Ginny McPartland, Heritage writer

KFI nurse visits with NIgerian patients at Port Harcourt.

Second in a series

Established initially as an industrial health plan, Kaiser Permanente had grown and morphed into a community health plan with over one million members in six states by the mid-1960s. Meanwhile, Henry Kaiser’s ventures had spread across the globe and the basic concepts of industrial and preventive health care traveled with him.

This meant the idea of prepaid health care provided by doctors in group practice was getting a lot of exposure in places where it might be needed most.

The World Health Organization was busy helping African and other developing countries set down their “national health plans,” and industrial nations were taking a serious look at investments in these countries. Already with health care programs in Jamaica, Ghana, Argentina and Brazil, Kaiser Permanente seemed in a prime position to take the lead in other emerging nations.

“At first, we held the belief that since we managed a large, comprehensive and widely-accepted health care system in the United States, that we were in a favored position to cope with the health problems associated with industrial enterprises all over the world,” KP Health Plan President Clifford Keene told a group at Harvard University in 1969.

“This theory turned out to be true in a limited sense,” he continued. “We learned quickly that the medical care circumstances in rural India and in Jamaica are essentially different from those in California.”

A package disaster hospital (PDH) as it arrived in Lagos, Nigeria, to be transported by river steamer to Port Harcourt where KFI restored a war damaged hospital. Public Health Reports photo, 1970.


Keene explained that developing nations, especially those with a national health plan, urgently needed primary health care workers, clean water, sanitation and disease control before they could even think about clinics and hospitals. Adjusting to local circumstances, Kaiser industrial health care leaders filled in the gaps where needs were most urgent – and bided their time.

KP establishes independent international agency

By 1964, Kaiser Permanente was getting requests from the U.S. and foreign governments to help plan and launch health care services in needy countries. Feeling the strain and drain on the Permanente Medical Care Program whose staff was responding to the calls, Keene and the board of directors established Kaiser Foundation International (KFI).

This not-for-profit entity, with an $55,000 initial grant from the Kaiser Foundation, was a separate self-sustaining agency established to fulfill government contracts to provide help setting up health care in foreign or domestic rural areas.

In its life between 1964 and 1975, KFI was involved in projects in more than 30 countries, including the U.S. where the agency helped set up programs in rural areas of California, West Virginia and Utah. Its workers took on projects in 13 countries on the African continent, as well as in India, Pakistan, Bahrain, Italy, Indonesia, Venezuela, Argentina, Brazil, Peru, Jamaica, the Bahamas, Canada, Okinawa, Taiwan and the Island of Curacao.

Wood and canvas cots from a package disaster hospital (behind these Nigerian children) were put to good use. Public Health Reports photo, 1970.


Nigerian civil war leaves damaged hospital in its wake

KFI was called upon in 1969 to bring back to life a Nigerian hospital that had been debilitated in the civil war that started in 1967. James Hughes, MD, Kaiser Industries vice president of Health Services at the time, explained:

“This project was completely unrelated to any commercial activities by Kaiser Companies in Nigeria. It was undertaken strictly in response to an urgent request by the government (U.S. Agency for International Development) for technical assistance in a matter of general medical care. Presumably, the request was based upon our prior experience in the organization and delivery of health care on other West African (Ghana, Ivory Coast, Togo, and Senegal) projects.”

The 250-bed hospital at Port Harcourt in the area of Biafra previously had been the referral center for the entire Rivers State of Nigeria with a population of one million. “The Port Harcourt situation looked particularly grim,” reported Keene.

“The war was still in progress 50 miles north of the city and the Biafran troops were making periodic sorties toward the airfield on the outskirts of Port Harcourt. KFI existed to handle tough overseas assignments, but we have never acted in a war zone,” Keene continued.

KFI physician Carl Friedricks, right, explains his work in Nigeria to KP Hospital Administrator Peter Rout and Violet Rout, MD.

“When the physician (Carl Friedericks MD) arrived, he told us his first impulse was to turn around and come home. Medical care was critically needed by the remaining civilian population and by refugees streaming out of the jungle zone,” Keene reported.

KP team resuscitates Port Harcourt hospital

The initial team of five acquired a package disaster hospital (PDH)* from the U.S. Public Health Service. Electrical generators, emergency water equipment, and medical supplies and equipment were “scrounged from unbelievable sources,” Keene said. “A Nigerian staff was recruited and trained, on a counterpart system (that matched) native physicians, technologists and nurse volunteers to (our 20) personnel from the United States.”

In the first months at Port Harcourt, the hospital had a daily census of 80 to 100. Dr. Friedricks saw patients with familiar diseases such as diabetes, hypertension and pneumonia. But he also noted many patients with tuberculosis, parasitism, malnutrition and severe anemias.

“Tropical ulcers are common and yield to prolonged medical treatment and skin grafting. Malaria is the most common cause of fever . . . One young lad suffering from a heavy hookworm infestation came in with a hemoglobin of 2.0 grams, or about 13% of normal levels; blood transfusion and medication brought him up to 42% of normal hemoglobin to permit his discharge for home medication.”

Intravenous kits from the disaster hospital were used to save starving children, left. A technician, at right, displayed an X-ray developed by using a Polaroid process that didn’t require water, which was in very short supply at Port Harcourt. Public Health Reports photo, 1970.


They also dealt with issues such as having no dishes to feed the inpatients, getting fuel for the repaired coal stove and outfitting the makeshift operating room and exam rooms with light fixtures. Transportation was not a problem: the U.S. government supplied them with four Land Rovers and a Rambler station wagon. Nigerian Airways had regular flights between Port Harcourt and Lagos, the largest urban area in Nigeria.

San Francisco KP nurse goes to Nigeria

Frances Fuller, formerly assistant director of KP’s San Francisco Medical Center, arrived in Nigeria in September of 1969 as the KFI chief nurse. She went to work setting up nursing classes for 40 Nigerian students as well as developing a hospital procedure manual and a central supply and distribution system.

Fuller reported remodeling of a lecture theater for use as a temporary surgery. “When the room is ready, we will take the instruments and other supplies from the PDH (package disaster hospital) and start doing more surgery.” In the midst of her reporting on the status of the medical facilities, she interjected: “Grounds are being well kept. We even have flowers in the courtyard.”

In 1971, the KFI team departed Port Harcourt leaving a locally staffed, well-functioning and well-equipped community hospital.

Kaiser Foundation International report, circa 1972.

Financial troubles doom international agency

Unfortunately, all of KFI’s ventures didn’t end happily. In Peru, a project to set up a hospital system for blue-collar workers was ended abruptly when the government was overthrown and all funds for health care projects withdrawn.

In 1968, politics killed another KFI project, this time in Libya. At the request of the U.S. state department, KFI sent a physician to discuss improved medical staffing of hospitals and clinics in Libya. When Libyan government officials learned that Kaiser assembled its Jeeps in Israel, they dropped the project, due to the Arab League boycott of companies doing business with Israel.

An ill-fated project to bring prepaid group practice to Saudia Arabia in 1974 ultimately brought down KFI, Permanente medicine’s first but not last international arm. Scott Fleming, KP senior vice president, said the project presented major cultural and legal problems that were costly to solve. In general, the KFI financial picture didn’t look promising at that time so the directors decided to discontinue its operation altogether in 1975.

Next time: Great press about Kaiser Permanente abroad fuels renewed initiative to teach eager foreign health officials about the KP care delivery model.

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