KP HealthConnect

Sheryl Miller, a licensed practical nurse and a member of SEIU Local 49, is the technology coordinator for the Coalition of Kaiser Permanente Unions for the Northwest region. She’s worked for Kaiser Permanente for 30 years and has been involved in most of the major electronic changes of our time—including implementation of KP HealthConnect®—and has helped the organization with the challenge of integrating electronics into our everyday work. She was interviewed by LMP Communications Consultant Jennifer Gladwell.

Q. What did you learn working on KP HealthConnect?

A. I look at the people component of technology. If people are paralyzed with fear, they’ll never use the technology. With KP HealthConnect, we learned that peer-to-peer training, sponsor support and funding for labor flex teams—which have the people who do the job become subject matter experts—was a model for success.

In the 1980s, you did not learn typing as part of your schooling as a nurse. When we implemented KP HealthConnect, we had significant generational gaps. Some employees didn’t type. Through the labor flex teams, we ensured peers were training each other around work they understood.

Technology impacts workforce planning. We have to think ahead so we don’t become extinct. Roles will change, but through the partnership and workforce planning, we can plan for the changes and redeploy impacted staff.

Q. How is technology affecting roles today?

A. Self-check-in kiosks are rolling out in the Northwest clinics. This is what some of our patient population has been asking for. Registration representatives are a group of dedicated employees that have been doing customer service behind a desk. Now, they are being asked to be a concierge, a greeter, as well as answer complex benefit questions.

The Visual Dermatology Assist project is being piloted at two clinics in the Northwest. Medical assistants are being trained, following the provider’s order, to take a picture of a skin irregularity on an iPhone and send it to Dermatology. Sixty-eight percent of the photos were reviewed, diagnosed and had treatment plans within 24 hours. A typical appointment could take six to eight weeks to schedule. This is improving access.

Q. Have you been able to spread effective practices from the KP HealthConnect implementation?

A. ICD-10, the new coding system, goes live in October. We’ve been able to engage UBTs and labor so they are part of making the decisions and determining processes. We’re using peer-to-peer training and trying to break down barriers early on so our staff and members have the best possible outcome.

Q. All this technology is great, but what about privacy and security?

A. It keeps me up at night. I have spoken to steward councils about privacy. We are seeing an increase in social media violations that could result in people losing their jobs or being fined. We have to be very careful about what we’re posting in social media. It’s so easy to vent about a bad day, but you have to be vigilant to ensure you are not revealing patient information. I am here for the patient and to educate employees on privacy and security.

Q. You’re a chief steward, yet you seem adamantly in favor of management policy. How do you explain that?

A. I work off of fact. It’s a policy that we do not go into our own medical record or those of others unless we have a business need to do so. I am a union member, but I will never lose sight that I am here for the company, patient and union, and we all have to work together to be successful.

Q. After so many projects—what’s the secret to success?

A. I work with great people, locally and nationally. I’m not a technology expert, but if you remember the people behind the technology, it works really well. If I can help someone in care delivery enhance their ability to take care of our patients, then I’ve done my job. Technology and people are not going away—so we have to be willing to advance with it.

It’s not every day you hear of physicians offering to step in and help out staff in their assigned duties, but at the Primary Care department at Englewood Medical Office in Colorado, that’s exactly what happened.

The nursing staff, short-staffed due to medical leaves, “was overwhelmed,” says Kate Frueh, DO. Messages from patients were piling up in the electronic inbox in KP HealthConnect. Patients who might have been helped by phone or via email were coming in for appointments—making it hard for those who truly needed the in-person appointments to be seen.

“We think we’ve got some of the best nurses in the region,” says Larry Roth, MD. “We just thought, how can we help the nurses and, at the same time, help both ourselves and the patients?”

Physicians dive in

So the team brainstormed ideas, and the physicians offered to help clear the backlog.

“The nursing staff was flabbergasted,” says Linda Sawyer, RN, a member of UFCW Local 7 and the department’s labor co-lead. 

After testing a couple of time blocks and working together, the physicians began setting aside 30 minutes every morning to help triage messages and call patients back directly without getting the nurses involved—and they do it again in the afternoon.

As a result, the team consistently closes encounters within an hour more than 40 percent of the time. With more problems being resolved by phone, appointment slots have opened up and access for patients needing in-person appointments has improved. Morale in the department has improved, too—and the team recently won the Colorado region’s quarterly “Value Compass” award.

Meantime, team members have been working with Linda Focht, their UBT consultant, to boost their Path to Performance ranking—which was only at Level 2 late in 2012, despite functioning at a high level in most dimensions of the Path to Performance.

Common challenges

Focht says some of the challenges that held the team back are common across the program—a department reorganization (including a reduction in staff), new work procedures and gaps in team training. And there were new co-leads who were unfamiliar with the process for assessing team performance.

With some of those issues addressed in the first months of 2013, the team moved up to a Level 3 in the most recent ranking.

“The team members kept their focus on the goal of more streamlined work processes,” says manager Mary Watkins, RN, “and all of the staff of the Primary Care Department are helping each other to become more successful.”

 Watch a video about this team on the KP intranet.

When Webster Parker brought his prescription glasses back to the clinic in Redlands (Southern California), he thought he just needed to replace a lens that had fallen out. But when Parker reported his eye was watering excessively, optician Alicia Rendon spotted a red flag in Parker’s Kaiser Permanente HealthConnect™ record and, within the hour, set up an eye-saving appointment with an ophthalmologist.

“The prescription was fine,” says Rendon, a Teamsters Local 166 member whose unit-based team recently embraced a new workflow, including use of KP’s electronic health record system, to troubleshoot their redos—instances where patients return eyewear purchases. “Once I looked into HealthConnect, there was this big stop sign.”

Her review of the record suggested that Parker, 85, might need a common surgical procedure to lower the intraocular pressure in his right eye, a condition often associated with glaucoma. An old eye injury exacerbated the problem, and Parker’s ophthalmologist had set up a flag in the system to watch for changes to the eye.

“I had surgery that week,” says Parker, a retired pharmacist who once ran a drugstore with his pharmacist wife. “The eye feels better. It feels normal. They did a wonderful job.”

Looking at the whole system

Focusing on redos not only saves KP in terms of the cost of materials and labor but also helps improve service scores. By bringing in ophthalmologists and optometrists, who examine eyes to treat disease as well as prescribe the lenses that opticians dispense, the team could better identify redos linked to eye-health problems rather than product defects—as in Parker’s case.

But opticians, used to handling paper charts and focusing on frame styles, were reluctant to try one of the team’s first tests of change: using KP HealthConnect to rule out medical reasons for unsatisfactory eyeglasses.

“We got buy-in” to overcome the initial resistance, says management co-lead Darren Smith, site supervisor for optical dispensing and a former optician. “It takes just two or three to really commit and spread the practice. Now, it’s not just a retail store where you come and buy something. Here, we are talking about your health.”

Educating patients and staff

To protect patient privacy, opticians' access in HealthConnect was mostly limited to conditions related to eyeglasses' prescriptions rather than a broader range of eye issues. Now the optometrists and ophthalmologists help the optical UBT members spot problems and counsel patients on practices that will protect their eyesight and enhance their eye care.

“Not everyone is going to be able to see 20/20,” says Trissy Bastin, business line manager for Vision Essentials. She directs the service area’s five optical clinics and serves as sponsor for the UBT. “The patients have to be reminded of that. You have to be able to see what kind of eye conditions they have.”

Parker has been a KP member for just seven years. But three decades in the health care industry fostered his appreciation for the electronic patient record—and cooperation and coordination among caregivers.

“What makes Kaiser special is that any doctor can have your complete record at his fingertips,” Parker says. “They can track problems and make recommendations.”