Q&A: Kaiser Permanente Researcher on PHR Success and Loyalty

April 10, 2013
When it comes to personal health records, Kaiser Permanente is one of the biggest success stories in healthcare. Its PHR has reached four million users and a recent study revealed it has made members 2.6 more likely to stay with Kaiser Permanente. In this Q&A, the study’s co-author reveals why the PHR has been so successful, and the role Kaiser’s physicians have played in aiding the PHR’s usage.

When it comes to patient engagement, Kaiser Permanente is one of the biggest success stories in healthcare. The Oakland, Calif.-based managed care consortium has recently announced its personal health record (PHR), My Health Manager, reached four million users, and over the past year, users have accessed the portal more than 100 million times. Even more impressive:  29.7 million lab results were viewed online, 12.2 million emails were sent to providers, 10 million prescriptions refilled, and 2.7 million appointments scheduled.

Overall, 63 percent of eligible members at the provider use My Health Manager, a number which could increase with the recent introduction of its mobile platforms, with a mobile-optimized website and apps on both Android and iPhone. Furthermore, Kaiser Permanente recently released the results of a survey which found that patients with access to My Health Manager were 2.6 times more likely than nonusers to remain Kaiser Permanente members.

The study’s authors looked at 394,000 eligible members in Kaiser Permanente's Northwest region with a singular intent in mind: do PHRs make a difference as patients are making choices about their healthcare? As Terhilda Garrido, Kaiser’s vice president of health IT transformation & analytics and co-author of the study, puts it, “Is it that impactful?”

After controlling for influencing biases such as illness burden or age, the answer the researchers found was yes, it does make a difference. In a recent Q&A with HCI Associate Editor Gabriel Perna, Garrido talked about why My Health Manager has been so successful, how Kaiser’s integrated care system helps aid the PHR’s usage, and the role physicians have played in this engagement.

Below are excerpts from that interview.

What is it about My Health Manager that has led to patient satisfaction?

The thing that makes or breaks it, and differentiates it from other PHRs, is the view to a patients’ own clinical data. They don’t have to enter it, it’s not derived from claims, it’s their own clinical information. And people talk about that—the most valued feature is being able to look at your own lab results. It’s clearly important, you have to have it available. What patients talk about is being more empowered, more engaged with their own information. When they look at their labs, they look at them multiple times, and they are able to look at the health encyclopedia and get a better level of understanding. They are also seeing that feedback loop, and how they are progressing.

The other thing we hear from patients is that it’s convenient. They say, ‘I can send my physician a secure email in the middle of the night from my kitchen in my pajamas.’ It is where they want, when they want, and how they want it. That level of convenience, not only being able to access their information, but being able to take action, like refilling prescriptions, is really helpful. They really appreciate that.

How have Kaiser’s integrated capabilities–for instance, My Health Manager’s direct connection to KP HealthConnect, Kaiser’s EHR–played into the successes of the PHR?

Being an integrated system certainly helps. I also think part of it is that we have no financial impediment to the use of the portal. In other words, if I’m a patient and want to use and access it, I can do that. It’s part of their membership. Similarly on the other side, our physicians are not fee for service, essentially they don’t eat what they kill. If they don’t have a visit, and the patient prefers to send a secure email, that’s okay. This is taking care of the patient and that’s part of the way they are incentivized to be more efficient—it’s what the patient wants and they don’t lose revenue by doing that.

Another thing is that our leadership has made this a priority. They said, ‘We recognize this leads to better patient care. We’re making it a priority.’ So it’s been made available to all of our members.

Exactly, how long has this been going on for?

We had our first pilot in 2002. There was a lot of trepidation about trying this new technology. There were four physicians that were brave enough to deploy it with patients. So we have a long history with it and we’ve been on a journey for a while. We fully launched My Health Manager, as it is today, across all Kaiser Permanente regions around 2006-07.

Where do physicians play into this satisfaction and usage?

The most effective enrollment approach is when the physician talks to the patient, and says something like ‘Hey Mrs. Smith, I want you to check in with me and I want you to do it through our My Health Manager, and it’ll be easy for you, and that way I can keep up with what’s going on with you.’ That’s very effective. Part of that is trust, and knowing the physician is using it and awareness. I think physicians are absolutely critical in the roll out and enrollment process.

The other thing is its ability to enhance the patient-physician relationship through these secure emails. We’ve heard from focus groups that say, ironically enough, this brings them closer to their physician. One women was quoted as saying, ‘This reminds me of the days when physicians used to make house calls.’ You’re kind of bringing the physician into your home, your space. The other thing we hear is patients talk about being able to compose their thinking more, they might be able to say things and ask questions that they might not be able to say or even think of in a room with the physician.

For leaders at organizations trying to implement a successful patient portal, what advice would you give them?

All change is difficult. This was not easy for Kaiser, as I said, it took a while, and there was a lot of trepidation. It takes leadership to make it happen. But it can be done. It’s manageable. And the results—the fact is we’re seeing efficiencies from the PHR, and improvements in our quality of care, and it increases patient loyalty. You may not see the upside as a care provider, but know that patients appreciate it a lot, and it increases their likelihood to find health plans that subscribe to your hospital. People are choosing Kaiser, and staying with us, because of the PHR, and that’s kind of cool.

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