Worried that medication prescribed by a Kaiser Permanente emergency-room doctor in Baldwin Park wasn't helping her chronic asthma, Andrea Edwards went to see her regular physician.
Dr. Kevin Rossi, whose office is 15 miles away in Kaiser's Downey clinic, ordinarily might have ordered X-rays or stronger medication. But because Kaiser has begun to put many patient records into a systemwide database, he was able to discover that Edwards had been prescribed cough syrup and an antibiotic, not the prednisone she thought she was taking.
"I was able to get out of there in 30 minutes -- with the right medicines," said Edwards, 20. "I could see my records. Having them be available electronically makes it easier for all the doctors I have to coordinate my care."
Eventually all of Kaiser's 8.3 million members nationwide will find their records available electronically. Nowhere is the conversion moving more aggressively than in Southern California, where a new leader has made the project a priority.
Three months ago, Dr. Benjamin Chu, 52, became president of Kaiser's Southern California region, which serves 3.1 million members with a budget of more than $11 billion and runs 11 medical centers from Bakersfield to San Diego. Kaiser also is in the midst of a $7-billion campaign to replace or expand many of those hospitals, and intends to build two more by 2008.
Among Chu's qualifications: he headed New York City's Health & Hospitals Corp., a public system serving 1.3 million patients that made the switch to computerized records on his watch.
Chu said that Kaiser's unique integrated model attracted him to his new job.
"We're not just an HMO plan, we're a provider as well," he said. "That's a powerful model."
As a result, he said, "All the pieces are here," not only for computerizing records, but for using that system to cut costs and improve care.
"Once you know who in your population has what illnesses and how severe they are, you can think creatively about getting the healthcare system not to be just reactive but proactive," he said. "Our mission is to keep people as healthy as possible, even before they get sick."
Oakland-based Kaiser Permanente is America's largest nonprofit health insurer. Formed in 1942 for Kaiser shipyard and steelworkers, it opened to the general public in 1945. Now controlled in part by the 11,000 doctors who work for it, Kaiser believes its integrated system lets it break down barriers that can add cost or create confusion.
Like hospital administrators around the nation, Kaiser envisions a system that gives doctors access to up-to-the minute lab results and diagnostic images, allows instant referrals, transmits prescriptions immediately and lets healthcare workers treating a patient from different locations easily share information. By 2007, when the system is due to be complete, Kaiser members also will be able to access their own medical records through the Internet.
Kaiser's effort, dubbed KP HealthConnect, is part of a nationwide information technology initiative endorsed by President Bush that includes "E-prescribing," a program that would fill prescriptions electronically by linking doctors, patients and pharmacists. Hospitals around the country are embarking on ventures similar to Kaiser's -- but none on such a scale.
The movement has stirred opposition from some privacy advocates, who say electronic records may be harder to keep confidential than paper ones.
"I understand the reasoning behind this," said Beth Givens, director of the Privacy Rights Clearinghouse, a San Diego nonprofit advocacy group. But "how do you make sure people have legitimate access to just the information they are entitled to?"
Among the challenges for Kaiser, Givens said, is building a system that separates physical and mental health records and does not give insurers access to the medical histories of their customers or let employers see the records of their workers.
"When you put 8 million records into one system -- wow, that is a tremendous target for those hackers and for insiders who might get paid to access someone's records," she said.
Underscoring this risk, a disgruntled former Kaiser employee in March publicized a security breach that allowed public access to confidential patient information from the Internet, exposing names, medical record numbers and in some cases lab results of 140 patients. Kaiser is suing the ex-employee in Alameda County Superior Court, a spokesman said.
Kaiser's new system is designed to resist hackers, will be password protected and will meet or exceed federal requirements for patient safety, Kaiser officials say.
Besides electronic records, Chu said he also was focused on controlling healthcare costs.
"The healthcare industry as a whole, we have to really take a hard look at keeping these costs down," said Chu. "Frankly, I don't see how you can keep sustaining double-digit increases for much longer."