, Heritage writer
Part of a series about our regional origins
Kaiser Permanente picked J. Harper Gaston, MD, a Georgia native and graduate of Emory University, to test the Atlanta metropolitan area waters and bring the Health Plan to Georgia in 1984. Dr. Gaston re-established his life in Georgia after 23 years with The Permanente Medical Group in Northern California.
His wife, Anne Hendrick Gaston, MD, a Permanente pediatrician in Northern California, also returned to Georgia in 1984. Harper Gaston reconnected with friends, colleagues and institutional representatives to build a strong base for The Southeast Permanente Medical Group, established in 1985.
Kaiser Permanente of Georgia’s physicians saw their first patients in the Northlake Medical Office in DeKalb County, opened in October 1985. Three months later, Kaiser Permanente opened the Cumberland medical office, and then established a facility near the Southwest Community Hospital to serve residents there, who were mostly African-American.
Gaston selected several prominent members of the Atlanta community to serve on Kaiser Permanente of Georgia’s Board of Directors: banker John W. McIntyre; physician Louis Wade Sullivan, who was also dean and director of the Morehouse College of Medicine and later appointed secretary of the U.S. Department of Health and Human Services); and community leader Laura Jones Hardman.
Kaiser Permanente acquired financially failing Maxicare Georgia, a health maintenance group with 35,000 members in 1988, and the Health Plan grew from 265 members at the end of 1985 to 100,000 members by 1989. Throughout the 1990s the Atlanta area continued to boom, and by 2010 the Health Plan membership had expanded to almost 250,000.
In recent expansions, Kaiser Permanente of Georgia has added new facilities in 13 locations. Today, Kaiser Permanente has 28 medical facilities in the 28-county Atlanta metropolitan area, and 400 physicians taking care of its members.
Gastons enjoyed illustrative California careers
As a Permanente pediatrician and neonatologist, Anne Gaston taught medical students and residents in the Intensive Care Nursery at University of California in San Francisco for 20 years. In 1979, she became professor of pediatrics there. She also served as director of the Intensive Care Nursery at Marin General Hospital under a special contract with The Permanente Medical Group.
Harper Gaston, an internist/cardiologist, served as physician-in-chief at Kaiser Permanente Hayward Medical Center before returning to Georgia in 1984. He served with the California Heart Association for 20 years, taking a term as president, and was an adviser to the Emory University System of Healthcare Board of Directors and a member of the Emory Board of Visitors. He retired from The Southeast Permanente Medical Group in 1992.
Emory recognizes Gastons for community service
For the Gastons, moving back to Georgia after a quarter of a century in California enabled them to renew their commitment to the Emory Medical School community that had helped launch their careers.
In 1996, both Harper and Anne Gaston were honored by the Emory University Medical Alumni Association with its Award of Honor for their career-long community activities in Georgia and California.
Since 1994, the Gastons have sponsored the Gaston Service Award Scholarships for Emory medical students who have amassed impressive records of community service.
Roots in medicine go back to early California
In 2009, Harper Gaston published A Heritage Lived up to & Beyond, a collection of stories told to Gaston by his grandmother Louise Frederick Hays, who was the Georgia State Historian from 1937 to 1951.
In 1942, Hays wrote an article about Gaston’s great-great grandfather, her grandfather, Benjamin Franklin Keene, MD, the first president of the California Medical Society in 1856. First published in 1942 by the CMA, it was reprised in 2004 in The Permanente Journal, the quarterly publication of the Permanente Medical Groups.
Dr. Keene, a Georgia physician, went to California in 1849 to seek his fortune in the Gold Rush. After a mining stint, he settled in El Dorado County to practice medicine. He represented the county in the California Senate for three terms, leaving office in 1856.
Also in 1856, he helped found the medical society that was the precursor of the California Medical Association. Dr. Keene died of paralysis, also in 1856, and was buried in Placerville, Calif. In 1912, Hays located the grave, and CMA replaced his broken headstone in 1923.
, Heritage writer
In a highly technological world, paper medical charts no longer show up in Kaiser Permanente doctors’ hands when they interact with today’s tech-savvy patients. These collections of hand-written notes of our medical complaints, drug prescriptions, lab tests and more, are going the way of fax machines and typewriters.
They’ve been replaced by Kaiser Permanente’s award-winning electronic medical record system, Kaiser Permanente HealthConnect®, which brings patients much closer to their providers.1
But preserved paper patient records going back to World War II will continue to be a valuable asset for research, even as we trade in the old cumbersome model for the new.
Gary Friedman, MD, retired director of the Kaiser Permanente Division of Research in Oakland, Calif., says Kaiser Permanente’s medical records – whether the original hard copies or digital files– are valuable assets to allow groundbreaking research.
In a 1998 article in The Permanente Journal, Friedman wrote: “Our collection of manual charts going back over 50 years is a national treasure and must be preserved despite the storage and retrieval costs entailed.”
In his 2006 oral history, Friedman said the highly touted study on the value of sigmoidoscopy in preventing colon cancer relied on paper records going back to the 1970s.2
He added: “(In) a recent study I did on the early symptoms of ovarian cancer (we found) by going into the charts (paper records) we could get much more of what the physicians recorded in text about the symptoms these women were having . . . Who knows what question might come up in the future (that could be answered) by looking at these charts that go back to the mid-1940s?”
Kaiser Permanente’s early foray into digital world
Kaiser Permanente’s journey into electronic record keeping started around 1960 and took advantage of emerging computer technology. A desire to prevent chronic disease through pre-symptom screening supplied the motivation to automate routine tests and to compile anonymous patient data for population-based research.
Barbara Breen, a medical assistant at Kaiser Permanente Oakland Medical Center in the early 1970s, had her hands on paper charts as well as on the pioneering electronic medical records of the day. She often stood by as lunch-time relief to ensure the computer ran fluidly as it processed punch cards that coded the results of patient visits for Kaiser Permanente’s complete physical (multiphasic) examination.
She was on the cutting edge of computer technology of the time and was in awe. “I got to see all these brand new machines and they assigned me to the spirometer (to test lung capacity),” Breen recalled recently. “The patients filled out a medical questionnaire (health assessment) and had 90 minutes to go around to all the cubicles where they had the tests.”
Data collected by Breen and others in the multiphasic unit were fed into early computers that took up the basement at 3779 Piedmont Ave., just off of MacArthur Boulevard near Kaiser Permanente’s flagship medical center in Oakland, Calif.
Tracking members’ health over decades
Over the years, these records, now considered invaluable and precious, have been the basis for many Kaiser Permanente longitudinal research projects. Collection of detailed patient data from 1964 to 1972 was made possible by the pioneering computer work of Morris Collen, MD, largely funded by the federal government.
Breen, who worked for Kaiser Permanente for 30 years mostly in the northern San Francisco Bay Area, recalls having the duty to retrieve charts for patients scheduled to come into the San Rafael facilities in the 1970s.
“I got a job down on Fourth Street, which was an old motel . . . General Medicine was downstairs and Internal Medicine was upstairs, and the garage next door is where all the charts were. And in those days, we didn’t have (access to) computers yet, so if you needed a chart ASAP you would order it by phone.
“The chart room didn’t always have an extra person to bring the chart over. So the medical assistant or other (staff person) went out, rain or shine, across the parking lot, into the remodeled garage and picked up your chart.”
Today, Kaiser Permanente medical centers are constructed without medical chart rooms, indicating a confidence that the electronic chart is here to stay. With KP HealthConnect® in place, patients get their routine test results much quicker, and they can discuss their care with their physicians via secure email and mobile devices.
For member convenience, patients who travel can have their medical data downloaded on to a memory stick to take wherever they go. For quality of care, physicians have access to patients’ medical information in any of Kaiser Permanente’s facilities nationwide, enabling better care and avoiding duplication of tests.
1 Kaiser Permanente has been awarded Stage 7 honors by the Health Information Management Systems Society Analytics for 36 of its hospitals. Stage 7 is the highest award in the category and recognizes environments in which paper charts are no longer used to deliver patient care. KP was also honored with the HIMSS Davis Award for excellence for 2011. The 2013 annual HIMSS conference is under way in New Orleans through Thursday, March 7.
2 Selby, JV, Friedman, GD, Quesenberry CP Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. New England Journal of Medicine 1992.
Also see: “Screening for Better Health: Enter the Computer”