Agent of Change

June 24, 2011
It sounds like a nice story: A boy from the Midwest grows up to become one of the country's top healthcare IT professionals. He creates an online

It sounds like a nice story: A boy from the Midwest grows up to become one of the country's top healthcare IT professionals. He creates an online scheduling system that allows patients to book their own appointments from home on the Internet, and is responsible for one of the largest EMR rollouts in the United States. He grows up to be vice president, patient care systems at HealthPartners, Minneapolis, and becomes one of the industry's best innovators, but Kevin Palattao's story is not over yet.

Palattao was born into medicine and raised in Minnesota. "I've been running around clinics and hospitals for most of my life," he says. The son of a physician father and nurse mother, Palattao understood early on what business, medicine and family meant. Palattao didn't see that much of his father growing up, he will admit. "He would round in the hospital in the morning, see patients all day, and then round in the hospital on his way home."

In the summer, Palattao would help his father in his small private practice — organizing the medical room, handling overdue billing — but even early on his eye was focused on change. "I was always struck by, God, these guys work so hard. There's got to be a better way."

For college, Palattao chose the University of California at Berkeley where he majored in political science with a slant towards international relations — an education that taught him to analyze problems on a deep level. "We have to ask the question 'Why?' over and over and over," which is, Palattao says, what drives him in his current role. While still in school, Palattao got a hands-on operations position at a start-up Bay-area video delivery company, managing inventory, delivery and management.

For his first formal work in the healthcare field, Palattao moved back to Minnesota and took a job an hour-and-a-half away at a small clinic that reminded him of his father's. "They couldn't figure out how to get their billings done, their medical records place was in a shambles, and they couldn't figure out how to schedule appointments appropriately," he says. "It was ideal for me."

A year later, Palattao really plunged in. "Somehow I got hooked up with CQI (Continuous Quality Improvement)," and met the HealthPartners group operating officer and got a supervisory job at one of their primary care clinics.

Learning the system

The more Palattao got involved in healthcare IT, the more immersed he became in research. "Talk to my wife, she'd make you laugh because I don't make any purchasing decision lightly. I'm one of those people who researches things until I'm dead with research and I understand it thoroughly enough to create an opinion on it," he says, which is exactly what he did at work.
The View from HealthPartners
  • Founded in 1957 as a cooperative

  • More than 640,000 members in Minnesota, western Wisconsin, North and South Dakota and Iowa

  • Covers nearly one in four residents in the Twin Cities Metro area

  • 10,000 employees

  • Ninth largest employer in Minnesota, second largest employer in St. Paul

  • Physicians, dentists and employees in 70 locations in the Twin Cities, St. Cloud and Duluth

  • One of the largest networks in Minnesota with more than 27,000 providers

  • Largest consumer governed non-profit healthcare organization in the nation

  • Integrated healthcare organization providing healthcare services and health plan financing and administration

Source: HealthPartners

In the early '90s, he began experimenting with a homegrown appointment patient profile scheduling system (PPS) and after that, it was on to EMRs. Using Madison, Wis.-based Epic Systems Corp. as a vendor, HealthPartners implemented the EpicCare pilot program as a registration and scheduling system. And in 2000, HealthPartners put together its first paperless clinic. The idea behind going paperless was efficiency — saving money and space — and got a major push forward when Palattao spoke up.

"The real estate was the problem, there wasn't enough office space and exam room space to make this happen," Palattao says, and the building would not allow for remodeling. "But we did have this ginormous chart room in the facility. So here is where the ideas started turning around going totally electronic. So I raised my hand and I said, 'I think we could make that a paperless clinic."

"We scanned a bunch of history from those paper medical records and then closed the chart room," he says. "We reused that space for physician office space, and we implemented an electronic record that was supported by scanning and indexing for all of the paper that we were generating internally, as well as all the paper that we would get from specialty hospitals."

Analyzing healthcare and healthcare IT is beyond complex, but being a Malcom Baldridge National Quality Award program examiner, Palattao took healthcare analysis to another level and another venue — cyberspace. However, with this endeavor there were some major bumps along the way. "In order for you to take healthcare to the Web, it demands that you have healthcare solved because," he says, "you just can't take those sorts of problems to this new environment."

Pursuing perfect care

A watershed moment at HealthPartners came when it applied for the Robert Wood Johnson Foundation Pursuing Perfection grant, which it received in 2002. The goal was to enhance the experience for both the patient and the provider, guaranteeing100 percent accuracy.

"Would you want anything less for your mom or your dad, or your brother or sister?" Palattao asks. After spending no fewer than six months on defining the word "perfection," and modeling a plan after a comprehensive diabetes care program, HealthPartners set out to implement the patient flow program.

Creating the new system required a novel way of approaching care. The HealthPartners group created a printed "pre-visit summary" that could be tucked in the door of the exam room, allowing providers a quick peek at who was inside the room before walking in. With the new system, roles and workflow needed to be redesigned and redefined.

Soon they had two clinics up on EMRs, and a paperless pilot. "We wanted to create a pull strategy, meaning, we wanted to give physicians and nurses information to have them create a psychological demand for it," Palattao says. "It was kind of like a drug dealer theory, you know? You give free samples and hopefully people will get hooked and come back," he says. A major drive behind adopting Palattao's system came from the nurses that saw its value.

Making magic

The ambitious scheduling project was not without stumbles. Asked if there was a time he ever felt like giving up, Palattao answers "countless." Part of the problem was actually figuring out where the problems were. Was the anxiety the fault of technology, workflow or culture? "Our conclusion is that technology simply increased the lumens on the problems that were already there. In the old world, people just said, 'magic happens,' and it will get done. And usually it's people running round scurrying, trying to make things happen," he says.

Words of Wisdom

"We tried to follow the Toyota mentality that first you automate and then you optimize. One of the biggest lessons is that, early in this game, we thought there was an end date to this. It's become more of a way of life. To really optimize stuff, there is probably a career's worth of opportunity." — K.P.

Palattao's next goal is complete transparency, though he understands there will be many more bumps along the way. On some days his background in international relations comes in quite handy. "The politics I see every day on this is unbelievable," he says. "There's daily diplomacy going on."

Author Information:Stacey Kramer