Kaiser Permanente puts mobile health first

Consumers are now accessing personal information through mobile devices in such numbers that US health insurer Kaiser Permanente is now adding functionality to its My Health Manager mobile app before its website.

Kaiser Permanente's vice president of online services, Anna-Lisa Silvestre, told the National Medicines Symposium in Sydney last week that while the My Health Manager web service has been hugely popular, with over 63 per cent of its eligible members using online services, the company was now developing functionality for mobile devices before adding them to other digital services.

“By 2015 in the US, we have learned through a number of studies that mobile will be the dominant way,” Ms Silvestre said. “People won't be going to their PC first, they will be going to their mobile.

“Today, 15 per cent of our traffic comes from mobile and that keeps going up, and it has surprised us how fast that has taken off. People were using their mobile to get to our services before we even optimised it so they had a pretty bad experience. Now we are really making sure that everything works on a mobile device.”

The Kaiser Permenante experience points the way to how private health insurers in Australia will develop their online services for members, and may be an indicator of how consumers will one day demand to interact with their PCEHR.

Kaiser's member-services product My Health Manager allows users to view their medical record, see their latest test results – often before their doctor – book an appointment online, view their prescription history and order repeats, and also to interact with their doctor via email.

The idea of patients emailing doctors and seeing test results first made for some discomfort in the audience, with Ms Silvestre's co-presenter, NSW GP and NEHTA clinical lead Chris Mitchell, looking somewhat aghast at the idea. However, Ms Silvestre pointed out that Kaiser's doctors were salaried staff and that it was only routine test results that were released online.

“When we first had test results the doctors were very nervous about having patients see a test result before they'd had a chance to see it themselves,” she said. “So we started with a delay of about 72 hours and the doctor could see the result first, write an electronic note on it or call the patient, and then it was released online.

“Now we are in a situation where the vast majority of test results are released automatically, so that means you can get your blood drawn in the morning in the lab and you can actually see the result that afternoon for most tests, and also before the doctor does.

“What do you think happens then in the model of medicine, where the patient has primary, first access to information about themselves? They might have questions and that's a good thing. Sometimes they get alarmed and they can send an email in and they can then be reassured, but a lot of times when they go back for the next visit they are prepared because they know.

“This is a good thing as our clinicians start to understand how their role changes in that dynamic. They are no longer the power authority with all of the information facing them. The information is turned the other way and engaged patients make better patients. They do better when they have the information.”

She said clinicians were also initially wary of being inundated with emails from patients, but Kaiser's experience has shown that most emails were appropriate.

“Emails are generally very appropriate and they often centre on medication and people wanting to know, 'here is my experience with that medication, what should I do differently, I'm having these side effects', and that direct communication I think has and will have a huge impact on the quality of care.

“They also don't have to go through a nurse or a person on the phone to take that message so in their own words, because it is free text, they can put in their own words what is going on, and how important it is for patients to have their own voice and not be represented by someone else in terms of their concern.”

Kaiser also allows patients with a repeat prescription to order a refill online and to have it posted to their homes for free.

“We have an online pharmacy centre with very cool distribution centres which are robotic,” she said. “The drugs are loaded in those fulfilment centres and they are lowered onto a conveyer belt and they go pick the meds and put them in bottles, and when it gets to the end the pharmacist looks at the order to make sure the drug matches what has been prescribed – that cuts the error rate down considerably, because it is all automated.

“If they have a refill in the script, [members can] go online and choose the refill and the drug can be mailed to their home free of charge. The benefits of that are many. We have about 30 per cent of our volume moving through that channel today.”

Ms Silvestre said all of these functions were now being converted to allow access through smartphones and other mobile devices.

“Mobile is now so front and centre about how we are moving forward that we are using the expression 'mobile first'," she said. "The reason we are doing that is that if you develop for mobile, it will be a much better experience for your website too because it forces you to design in a very simple way, and that's a good thing. With the web, I think we got a little carried away with the amount of content we could put on.

“In the US, almost half of the people have a smartphone and Australia is not far behind. Your rate is growing too and that is really something to pay attention to because again, when you are walking around with your smartphone, that's where you are. Think of it as 'care where you are' – you can access services, get reminders and do much of healthcare through a phone.”

She said concerns over privacy and security, and that older people will not readily use digital services, were stereotypes.

“Our numbers don't bear that out. People expect it to be secure and private but it does not get in the way of people signing on and using our services. And the other one is that older people won't use it. In the 60-69 years of age group, over 60 per cent are using our online services, which we have always been very surprised by, but again it is back to relevant, easy to use services that allow people to connect.”

Posted in Australian eHealth

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