Kaiser Permanente CIO: Phil Fasano

Dan Farber: Phil thanks for joining me.

Phil Fasano: Thank you.

Dan Farber: You've been at Kaiser Permanente for several months now, new at the job, almost parachuted in to fix some problems there. What's the size and scope of your operation there?

Phil Fasano: Kaiser Permanente serves almost 9 million members and has almost 17 thousand physicians to do that across the country we have about 170 thousand overall employees and our IT organization is about 6500 to 7000 employees of that larger group and we spend about 3 billion dollars a year on IT. As a company, our public records would indicate we generate about 37 billion dollars a year in revenue as well, which as a non-profit we certainly utilize very effectively for the benefit of our members.

Dan Farber: Now you came from the financial industry, JP Morgan, American Financial, Capital One, what could you take from that experience over the last 20 years and bring into this health care job.

Phil Fasano: Health care is an industry that's increasingly moving to a real-time world, and as health care makes that transformation the experiences that I had in the financial services in a real-time sense, in a real-time world, effectively transfer and are immediately applicable to this industry in a number of ways. Our organization leverages electronic medical records, has moved from a paper based environment to a paper-less environment, and essentially our IT environment has to be available in a very highly reliable way, and a very consistent way for our physicians to deliver care.

Dan Farber: What are your ideas around mobile at this point?

Phil Fasano: When you say mobile, I suspect you're talking about mobile devices in our hospitals and in our medical group. We in our organization have an awful lot of currently available mobile devices that our physicians and practitioners use across all of our settings. So in our current environment we're already mobile if you will, moving into a more advanced mobile environment where we're able to extend the reach of our hospitals and our capabilities in our hospitals and our med groups outside our walls and into our member's homes. We do that through the internet we do that through connections to our physician's homes as well.

Dan Farber: What are some examples where you've gone outside of your firewalls and into the patient's home into the physician's home?

Phil Fasano: Effectively, our physicians are able to get access through our internet capabilities, kp.org, and also through some pretty specific capabilities that are very secure to their proprietary systems so that they can look at medical records for their patients if that's something that's necessary for them given their particular situation. And for our members, they're exclusively using kp.org as a vehicle to get at their medical records as well as their lab tests and email their doctors.

Dan Farber: Now as you look out into the future, there are some technologies such as RFID, is that something of interest in terms of how you might be able to gain more efficiencies?

Phil Fasano: We experiment with RFID in a center we call Garfield Center, which is our innovation center. And we look to use technologies like RFID and many other technologies to enhance the performance of our nursing practitioners, our physicians and anyone interacting with a member or patient in numerous settings that we've actually set up as mock ups in the center itself.

Dan Farber: So what is your bigger vision for the hospital setting and the patient relationship and how that's managed through technology?

Phil Fasano: Well it's clear to us that the next great thing is population care. We've largely implemented our electronic medical record, the information contained in that vast database is a tremendous resource to us and our members, and for us it's about preventive care, so population care tools translating into preventive care.

Dan Farber: How would you define a population care tool?

Phil Fasano: Very specifically, I'll talk about what's called panel management. Physicians have about 1500 to 2000 patients that they're caring for. The core analytics that asses a patient's situation, whether they're taking their pharmaceuticals or they've attended their most recently scheduled lab test, or if they've missed an appointment with their physician, will all show up in our medical record information resource. The analytics peruse that particular resource and advise the doctor or nurse that they should do something on a proactive basis to address that particular patents' situation.

Dan Farber: So how much are you investing then in this analytics side, which seems to me, would be core because you're gathering all this data, and some of the data that's very implicit in terms of someone not showing up to an appointment and using that not just for the individual patient, but collectively just as a company like Google or Yahoo mine's it's data?

Phil Fasano: Well our KP Health Connect system is the heart of that and the database that supports KP Health Connect is at the heart of this. The advanced analytics is an area that has been underway for us for many years. We're now beginning to not only pull those resources together in a way that becomes more meaningful for our corporation but substantially more meaningful for our members in a preventive care setting. The exact amount of money, I'm not sure I'm prepared to talk about at this point, but I can tell you it's substantial.

Dan Farber: Now as you're thinking about all these ways in which technology can be applied to the health care industry, what do you think are some of the real challenges that you have ahead?

Phil Fasano: Well like any organization that is focused on its future and the innovation in its world, for us we've coined an expression called "delivering real-time health care". And for us what real-time healthcare is essentially the culmination of our medical record, our patient experience, our internet presence, our insurance activities and claims activities, where we're pulling that information together in a way that allows us to proactively manage the patient encounter, the member encounter, and enhance the patient outcome substantially.

Dan Farber: From a technology standpoint, what's the foundation of that vision?

Phil Fasano: The foundation of that vision is an information based strategy that we're essentially in the process of rolling out across the company, which will support all the advanced analytic work that we expect to do, that will asses the vast pools of information and will also support all the other aspects of our information in real-time delivery capabilities on behalf of patients.

Dan Farber: And when you talk about "on behalf of patients", what kind of access do the patients have to their records and how is Kaiser think about this notion of what some companies like Microsoft or Google are working on in terms of them storing the patient health care records?

Phil Fasano: We think it's interesting, and we think the industry itself is making great strides to provide access to patient information, members as we call them, and that information should be widely available and we support that and we support a number of initiatives in that regard. With respect to our information we believe it's a little more advanced because our physicians actually provide the basis for it, and we provide wide access. All of our 9 million members have the potential to have access to their medical records and their claims information, their lab results, as well as have the ability to interact with their physicians currently through kp.org.

Dan Farber: Let me ask you about a few technologies. Software as a service obviously is a big trend right now, is that something you're seeing adoption of in your group?

Phil Fasano: Software as a service and service oriented architectures are absolutely in our future in a very large way. We are working through our architecture organization to design the future state architecture for Kaiser Permanente, and service oriented architectures are at the heart of that strategy.

Dan Farber: And what are some examples of how that would be different than what you have today?

Phil Fasano: Well we have an organization filled with over 5000 applications, which is quite a number, to manage and to operate. As we drive to the future with our information based strategy, it's central to that strategy to be able pull all of that information from that vast array of systems. Our service oriented architecture approach and our information bus approach will enable us to do that more seamlessly and much more on a real-time basis.

Dan Farber: You have the perfect mash-up for web 2.0 in some ways which is you have almost 9 million members, people who don't want to be patients but sometimes are, have 12 thousand physicians, dozens of hospitals and other access points. What is your thinking around this notion of web 2.0 and social networking as something to improve the health experience?

Phil Fasano: It's interesting; it's an interesting question in that it's something that we've been talking about a lot recently at Kaiser Permanente. We believe web 2.0 essentially, the capabilities represented in that particular space social networking in particular, is not only an opportunity for our members it's also an opportunity for us internally to enhance our knowledge network and really share and leverage the inherent knowledge in our organization. We do have tens of thousands of physicians all of who got A's in chemistry so their very bright people and they have great perspectives on what the next great innovation should be across the organization and where the best value is in terms of improving health of their member and their patients and sharing that and providing them vehicles to share that and collaborate is fundamentally important to who we are.

Dan Farber: So is that something you're on the road or somewhere along the path in terms of selecting a technology or building something yourself?

Phil Fasano: We have just developed an approach to our social networking and are working collaboratively across the entire organization on where our first endeavor might be.

Dan Farber: It sounds like you have a lot going on; you've been there a short time but certainly the wheels are turning really quickly so how do you measure the effectiveness of all these investments you're making, especially when you're running that fast?

Phil Fasano: You know in other organizations I would say to you return on investment, but in this organization I would say that improvements to patient outcomes is the most fundamental measure of our success as an organization and frankly for our IT activities. We really do create value for our members in that we help them essentially stay healthy and improve their health and we do that by providing information to our physicians as well as to our members about healthy living as well as managing their current situation whatever their health situation is.

Dan Farber: Well Phil, thank you very much for speaking with me.

Phil Fasano: Thank you.

Dan Farber: I've been speaking with Phil Fasano who is the CIO of Kaiser Permanente. For CIO sessions I'm Dan Farber thanks for watching.