Kaiser Permanente's 50-year journey to set up an electronic health record system has reached a major milestone: at the HIMSS 2010 conference in the beginning of March, the nation's largest integrated health delivery system announced it had finished implementing its KP HealthConnect program, bringing all of its 8.6 million patients and hundreds of physicians into the electronic age.

"It feels pretty good," Andrew Wiesenthal, M.D., associate executive director of The Permanente Federation, told DOTmed News when we met with him at HIMSS.

(Click on the video below to see an excerpt from our interview.)

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Kaiser, a integrated health system comprising doctors' offices, hospitals and pharmacies, claims all 431 medical offices and 36 hospitals, including recent additions in Oakland, Richmond and Vallejo, Calif., are plugged in, connecting patients to doctors, nurses and pharmacists.

The electronic health record software, licensed from Epic and first deployed in late 2003, lets patients send secure emails to their doctors and also access lab results, medication information and other health data online.

Not a Technology Project

But getting the system up wasn't, of course, easy. Dr. Wiesenthal says one of the biggest lessons they learned from implementing the EHR was that "it's not a technology project. It's a personnel management project," he says. "If you don't understand that, you will short-change yourself."

This point was borne out by the bottom line, according to Dr. Wiesenthal. He notes that less than half of the costs of setting up the electronic health system came from actually purchasing and installing hardware and software. The rest came from training and on account of lost productivity as staff took time to get adjusted to using the new programs. But this was something Dr. Wiesenthal said Kaiser expected and budgeted for.

"We planned for productivity to be lost. People would...be asked to do less when we started," he says.

And though it didn't take long for most doctors to get the hang of the system, he admits when they began they didn't like it. "[Learning the system] is not the same as being happy," he observes. What happened, he thinks, is that though it was easy for doctors to learn the basics, most didn't have a sense of "mastery" where they felt it was helping them perform faster or better.

"Regaining the sense of mastery takes longer, and it's not easily gained," he says.

"It's always something"

Another lesson is one that might not apply to other companies -- don't invent your own software.

In the 1970s and 1980s, Kaiser first began creating some electronic record-keeping systems from scratch, as there wasn't really anyone they could buy one from. "But we're not a software development organization," he says, which is why they now work with Epic - whom they regularly recommend new features to - instead of developing their own programs.

Ultimately, Dr. Wiesenthal thinks the most important lesson is that the purpose of having an electronic health record must not simply be to have an electronic health record.

"Putting it in is not the goal. Using the tool wisely to improve people's health is the goal," he says. This means, he argues, an EHR ought to be more than a "fancy typewriter" that helps make doctor's notes more legible. As an example, he mentions that an electronic health record could help more patients over 50 get screened for colon cancer. Instead of having doctors do something as time-consuming and laborious as flipping through patients' files to find those over 50 who haven't been screened yet, they could simply use the electronic record software to search for all patients in that age group who still need screening.