Kaiser Permanente Health Information System Implementation – Health System Example

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"Kaiser Permanente Health Information System Implementation" is an impressive example of a paper on the health system.   Kaiser Permanente, as an integrated health care delivery system, has displayed a consistent and reliable track record of developing complex information technology (IT) systems.   Kaiser Permanente, with some exceptions, has followed a conventional data valuation model. The premise of this model focused on data optimization that required inter-organizational information sharing and coordination in a vertical manner.   Previous Kaiser Permanente systems were effectively integrated and preformed their modular capacity well for their existing system parameters.   In operation from the late 1980s through the 1990’ s Kaiser Permanente Health Information System (HIS) effectively served the needs of over two million Kaiser Permanente insured clients in eight states and in over 75 unified Kaiser Health facilities nationwide. Introduction:                       By definition, the process of creating a single unit by joining different parts is integration.

(White, 2008) The process of integration creates a new whole by joining different parts; therefore, integration is also the process of the organization.   Integration has two aspects - one is the process of integration and the other is the resultant unified conditions.

(White, 2008)  As a process, integration always follows one of two formats.   Vertical where the components of a system, are developed by a single acquisition program and are integrated into a step by step fashion to produce the desired capability, and Horizontal where integration creates two side by side systems that are merged to create new capabilities across the new unified system.                                 ( Hybertson, 2009) Kaiser Permanente prior to the KP Health Connect system utilized a legacy HL7 messaging product. (Cochran, 2009)  Systemically, the HL7 system established a very controlled and predictable mutual relationship between the whole and the units within the Kaiser Permanente information system that could be expanded and enhanced in a uniform vertical integration plan.

(Montalbano, 2008)  Based on other management variables and sound advice the Kaiser Permanente Board of Directors chose to peruse a vertical integration model of the existing HL7 with modest upgrades. that would be very low-risk and cohesive with the existing system. (Cochran, 2009) The resultant implementation would harness what worked and was established and introduce sound “ principals of uniformity” (Ash et. al. 2004)  as a process to be undertaken. The Kaiser Permanente Board of Directors established a concrete system objective that stated “ The sum purpose of new system integration was to initialize and bring about a singular organizing principle that can link money,   people, technology and ideas into a comprehensive information system that delivers more cost-effective care. ” .(Cochran, 2009)             Problem Analysis:                       In 1985, Kaiser Permanente Board of Directors prepared to launch a very aggressive acquisition plan across the Sunbelt states of the Western US.

. (Cochran, 2009)  The plan called for the acquisition of over twenty mid-market health providers and systems in the states of Texas, Arizona, and Georgia.

The resultant expansion would add two regions to the Kaiser Permanente structure and require a substantial and robust evolution of the current Information system. (Montalbano, 2008)                       As plans for the acquisition were launched, corresponding corporate plans to enlarge the legacy HL7 system were being studied and prepared.   The nature of the problem analysis was based on the current size and scope of the HL7 system within the 6 Kaiser Permanente service regions.   To orchestrate and manage the integration program and expansion of the HL7 into the evolutionary HIS system Kaiser Permanente contracted with IBM systems to manage the project from planning and inception through implementation and installation.

. (Cochran, 2009)    III-System Integration Planning:                       As the sole contractor responsible for the entire project IBM systems created a detailed four-point, 30-month program to substantially integrate the new HIS system across all existing and planned Kaiser Permanente health centers and facilities.   The plan centered on a “ homogenous” integration (Ash et. al. 2004) one work station at a time, one facility at a time.     The Four Components of the IBM system followed specific parameters reflected by the needs of Kaiser Permanente.   The components established were focused on meeting the Kaiser insured client’ s health needs.

They included matching services and capacity to meet the Kaiser client’ s projected needs, coordinating and integrating care across all 8 Kaiser Regions, and providing an information system to link patients, providers, and payers across the entire system in a uniform format. (Montalbano, 2008) IV-System Inetgration:                       IBM established a robust and formulaic approach to upgrading and expanding the HL7 system into the HIS system throughout the Kaiser Permanente family.

IBM developed as Strategic Information Systems Alignment (SISA) to assist and guide the project seamlessly. (Casalino et al. 2003)  The components of the plan featured dedicated contract IT/IS workers from IBM co-locating at each Kaiser Permanente facility.   At each facility, the IBM contractors would train the in-house Kaiser Permanente IT employees on the installation and upgrades necessary throughout their facility.   Once the training was completed the IBM contractors would serve as team leaders who supervised the Kaiser Permanente IT staff as they installed and tested each work station and booted the stations into the facility IT system This very detailed approach created a seamless vertical integration based on a “ controlled” pattern as prescribed in a trickle-down plan.

(Ash et. al. 2004) V-Systemic Flaws:                       The very stringent nature of the IBM integration plan restricted system growth in a very dynamic fashion.   IBM created the HIS system as an “ Internal” system only. .(Cochran, 2009) The resultant lack of expandability was planned directly by IBM as an “ evolutionary” process that would over generations of upgrades ad an “ external” IT system that functioned independently from the HIS system.

(Cochran, 2009) Unfortunately, Kaiser Permanente did not in the subsequent decade follow-up with the pre-planned upgrades to the HIS system.   Instead, new executives determined it was better to abandon the HIS system entirely and create an “ IT leap” forward with a custom high dollar IBM system. (Montalbano, 2008) VI-Conclusion: While the HIS system integration was carried out as a “ whole” within the “ principals” (Casalino et al. 2003) of the integration plan, the core understanding of the “ limitations of the system, were ignored by executives and managers alike. ” .(Cochran, 2009) In the end, the IBM integration functioned perfectly, it was however protracted and completely vertical which as with most health information systems resulted in a dated obsolete information system that was mischaracterized as state of the art upon its completion.   The Kaiser Permanente HIS system worked after implementation exactly as envisioned, the weakness in the system that ultimately shortened its application was the hardware that was “ upgraded” and “ utilized” .

(Montalbano, 2008)


E. Montalbano, 2008 Microsoft, Kaiser Pilot Integration of E-health Systems, ABC News/IDG News Service, June 9, 2008, http://abcnews.go.com/Technology/PCWorld/story?id=5030248.

J. H. Cochran, 2009, Statement on Behalf of the Kaiser Permanente Medical Care Program Before the Committee on Health, Education, Labor, and Pensions (Washington, D.C.: United States Senate, Jan. 15, 2009).

White, B. E., May 12-15, 2008, Complex Adaptive Systems Engineering (CASE), 8th Understanding Complex Systems Symposium, University of Illinois at Champaign-Urbana, IL.

Hybertson, D. W., 2009, Model-Oriented Systems Engineering Science, New York: Taylor & Francis.

Ash, J. S., M. Berg, E. 2004. Some Unintended Consequences of Information Technology in Health care: The Nature of patient Care Information System-related Errors. J. Am Med Inform Assoc 11(2) 104-112.

Casalino et al. (2003). "External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients with Chronic Diseases." Journal of the American Medical Association 289(4): 434-441.

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