Connected for Health: Using Electronic Health Records to Transform Care Delivery
by Louise L Liang, Editor
Review by Robert W Hogan, MD
Summer 2011 - Volume 15 Number 3
Connected for Health is a 12-chapter, multiauthor book that chronicles the development of Kaiser Permanente's (KP's) HealthConnect electronic health record, the largest civilian electronic medical information project in the US. The book is edited by Louise L Liang, MD, recently retired KP Senior Vice President for Quality and Clinical Systems Support, with a Foreword by Donald Berwick, MD, well-known former President and Chief Executive Officer of the Institute for Healthcare Improvement.
Studying this book, the reader will have peered at a gargantuan creation through the eyes of multiple observers. Therein rests one of the strengths of the book: it is an insider's account. I suggest beginning with the final chapter, Kaiser Foundation Health Plan's CEO George Halvorson's visionary statement. Here the reader gains a sense of the powerful vision deeply imbedded in the development of this system. Other chapters help us understand why KP undertook the rapid implementation of an enterprisewide electronic record system: How did it carry out the task? What has it produced? What are the strengths of the system and what are its weaknesses?
A clue to the intentions behind the HealthConnect development and implementation lies in the subtitle of the book: Using Electronic Health Records to Transform Care Delivery, which suggests the intention to accomplish nothing less than the transformation of health care from a cumbersome paper-based record system with sluggish information movement among all involved in the enterprise (patients, staff, managers, and professionals) to an electronic-record-based system with a new set of social expectations and norms for fast-paced electronic encounters supported by convenient computerized organization and flow of information.
So, how well does this book tell the story of the conceptualization, execution, and effect of a huge and massively expensive project? The people of KP, the administrative staff, managers, employees, nurses, and physicians, will find much that rings true in the book: concepts, language, and description of process all will be familiar. Chapter authors are clearly all very familiar with the unique culture of KP, and how that culture drove the profound changes that are involved in the HealthConnect project. But the book suffers a common flaw of multiauthor books: multiple writing styles. A successful book addressing a huge health information technology project should be authoritative, clear, and comprehensive. Some sections are clear and well written, others less so. Although chapter contributors include notables from multiple segments of KP, I found it odd that so little of the book originates from Southern California, a large Region of the program. Most notably lacking in this book is any systematic attempt to assess the response of the clinicians of KP, to the implementation of HealthConnect. By these measures Connected for Health has limited itself to a partial success even though the thematic material is of profound importance to us.
Reading this slim volume reminded me of the parable of the blind men describing an elephant, with their distinctive and different descriptions of the creature. As a full-time clinician trained to use HealthConnect, I imagine myself to be one of the blind who has been struggling to fully comprehend the behemoth since its implementation in Southern California. As a former software developer and critic, I use HealthConnect daily and I have witnessed firsthand its impact on the lives of every KP professional around me. Reviewing a book about the development of a system as huge as HealthConnect is no minor responsibility. Using it every day, I find I have a love-hate relationship with HealthConnect. I love it when it works well for locating vital facts quickly, and I hate it when the screen design allows it to be crowded with junk, or when five steps are needed to complete a task that should take one. Years after startup, HealthConnect is still a work in progress, and as impatient as I was to have an electronic record before implementation, I am still impatient to have one that is easy to work with.
There is an apocryphal story of an interview granted by Mao Tse-Tung in which a western journalist asked the Leader of Billions his opinion about the impact of the French Revolution upon the course of Western Civilization. Mao is said to have remarked simply "It is too soon to tell." So too with respect to HealthConnect; we will have to wait quite a while before anyone can attempt a comprehensive analysis of its impact on KP as an institution, on the health of its millions of members, or a dispassionate comparison with other very large electronic medical record systems. The metrics by which to carry out such a comparison have yet to be imagined.