Kaiser redefining access with high-tech Net links

Members ‘make contact with real people’

The traditional definition of access management is taking on a new meaning thanks to the Internet. One health care organization is using the Internet to link its customers with the health system’s actual operations.

Kaiser Permanente Online, a pilot project launched recently by Kaiser Permanente of Northern California, gives members the opportunity to "make contact with real people," says Tim Kieschnick, technology development manager for Kaiser’s Interactive Technologies Initiative. During the next few months, some Kaiser members will be able to arrange medical appointments, learn what health conditions they are at risk of developing, and consult an advice nurse — all on-line.

In the future, KP Online, as it is called, will expand to offer the ability to refill prescriptions and view results of certain laboratory tests, Kieschnick says. Multimedia resources will be added that use video, animation, and sound to ask members questions and then guide them through such learning experiences as how to care for the back or how to quit smoking.

The pilot program — under way with 1,000 Kaiser members who use the Santa Clara, Mountain View, and Milpitas medical centers — was prompted by a desire to solve three key problems, Kieschnick says:

• People need access to quality health information.

• People need close relationships with their care providers, and new technologies can help them communicate better with providers.

• Health systems need to provide members with more choices and more flexibility of services.

Kieschnick says he doesn’t see these changes as reducing the role of access management, but just as another way for people to get to the services they need. "In the past, [patients] used a telephone to get to those services. Now they’ll use a computer," he says. "The first step is the appointment request, and then there might be some registration processes."

As Kaiser extends on-site services into the home, it must draw on the expertise of those — such as access managers — who do the "nitty-gritty stuff" at the medical centers, and transfer what they’re doing to the Internet, says Ann Carlson, project manager for KP Online. "The operational experience of medical care is important to this."

In fact, Kieschnick points out, Kaiser made a conscious decision to place KP Online in the operations arm of its business, rather than in marketing, as is true of many other Internet health care offerings. "We see it primarily not as a marketing device, but something to provide health care."

Empowered patients = healthy patients

The on-line service is expected to result in more informed patients, which has "all kinds of implications," he notes. "It certainly will have an effect on demand — patients staying away when they don’t need [treatment], and coming in when they do. We may start seeing the right patients at the right time."

Although use of the system may increase at first, the idea is that down the road — by empowering consumers who then become healthier and less in need of services — it will reduce demand, he says.

"The trend has been moving [care] from inpatient to outpatient," Kieschnick adds, "and this is an extension of the outpatient setting."

Kaiser is also experimenting with using "video visits" as part of the discharge planning process. That project, known as Tele-home Health, will compare the the effectiveness of standard home health — which involves in-person and telephone visits by a health care provider — against a telemedicine model that adds video visits to the mix.

"What had been happening is that patients felt they were on their own [between home health visits] and didn’t have the confidence to take care of themselves," says Kieschnick. In such cases, health concerns sometimes developed into crises and resulted in emergency department visits or hospital readmissions that could have been prevented, he adds.

In the home health project, half of the 200 patients participating are treated according to the normal case management model for home health care, and the other half receive video visits in addition to telephone calls and in-person visits.

The schedule of traditional and video visits varies, depending on the individual patient’s care plan. Patients are selected randomly and must give their consent for the project, notes Jill Deuser, RN, MBA, senior project manager with the Interactive Technologies Initiative, but participants must have chronic conditions such as obstructive pulmonary disease, cardiac disease, wounds, or diabetes.

Participants also must meet certain criteria, such as having been hospitalized at least once in the past six months, or having been seen in an urgent care clinic or emergency department twice in the past two months for the same medical problem.

The expected benefits include speedier access to medical staff — within an hour rather than waiting one to two days; sessions scheduled on a same-day basis; reduced RN travel time, meaning more time for consultations; and access to a wider range of providers.

The pilot study is addressing such issues as whether the quality of video-visit care is as good as care in person, the level of patient and staff satisfaction, how well the technology works, and whether urgent care and emergency department visits and hospital lengths of stay are reduced, she notes.

"Most of our patients are capitated," Deuser says. "Our incentive is to keep them well and manage their care thoughtfully."

One interesting outcome of the study, Deuser points out, is that even with the constraints of a small video screen and slow transmission time, the patient/nurse relationship "seems to take over."

"We’re finding that you feel that you’re in the same room with the person," Deuser adds. "Technology doesn’t seem to get in the way."