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David Leonhardt, in a recent Economic Scene column in the New York Times on health care reform, observed, “Our health care system is engineered, deliberately or not, to resist change.” Or as President Obama told the NewsHour’s Jim Lehrer recently, “…What the American people understand is that the status quo is unsustainable.”

Kaiser Permanente, whatever resistance to change does occur within it, was actually engineered to be the opposite by founding physician Sidney R. Garfield.

He believed strongly in change – deliberate, evidence-based change that was disruptive.

This brings up another article in the Times back in January. Under the headline “Disruptive Innovation, Applied to Health Care,” Janet Rae-Dupree wrote about the Sidney R. Garfield Health Care Innovation Center.

She quoted the eminent Stanford economist Alain C. Enthoven, noting he has studied the nation’s health care system for decades. Integrated systems like Kaiser Permanente, he told her, “are the disruptive innovation we need to turn loose on the rest of America.”

Now consider the words of Dr. Garfield from 40 years ago when he was talking to a management group about how computer automation in health care could propel Kaiser Permanente 20 years into the future: “We are talking about changes – and changes are irritating and disturbing, but being disturbed is essential to progress.”

Today, Kaiser Permanente is a recognized world-class leader in the field of the electronic health record and other IT innovations.

Proposing change triggers opposition, and Garfield was accustomed to that. As he said back in 1957:

“Opposition is good. Resistance to change is a law of nature and a law of physics. If it were not for opposition or resistance to change, every crackpot idea that anybody had would go into effect and there would be chaos.”

“To overcome that resistance, you must be good; you must be right; you must be strong. In that respect, opposition puts you on your mettle and forces you to perform your task well.”

Or as a health care writer once said of him, “Dr. Garfield’s innovations have been raising the eyebrows, and sometimes the hair, of traditionalists since the 1930s.”

That’s disruptive innovation.

(If you are interested in knowing more about Dr. Garfield, my new biography is called The Story of Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care (The Permanente Press, 2009). It can be ordered directly at https://xnet.kp.org/tpj/garfieldbook.html as well as from sources such as Amazon.com.

And welcome to our new history blog! We’d like our blog to become a dialogue, so feel free to send us comments and questions.)

– Tom Debley

I never cease to marvel at how fear of computers is debated in American medicine after 50 years.

Indeed, sometimes contemporary news and commentaries remind me of why I decided to write a new biography of Dr. Sidney R. Garfield, who was a revolutionary figure on a number of fronts in 20th century medical history. His legacy, of course, is Kaiser Permanente, where 8 million people now have electronic medical records because of the work he started in 1960. As one medical historian has observed, Garfield created “a medical program that changed the face of U.S. health care.”

What brought all this to mind as a way to launch our new history blog was an exchange of opinions a few months back in the New York Times. Said a medical school professor: “The computer depersonalizes medicine,” adding that “before we embrace the inevitable, there should be more discussion and study of electronic records.” Commented another professor, from another medical school, “I must agree wholeheartedly…the presence of a computer in the exam room is more of a detriment than an advantage.”

Wow! I almost spilled my morning coffee! Dr. Garfield rejected such ideas starting in 1960 – a half century ago. An electronic medical record, he said, can “give the physician a much sounder base for better doctor-patient relations than he has today.”

The view was cemented as a Kaiser Permanente philosophy by 1968, when its Annual Report focused on its work to take full advantage of new technologies and stated, “The computer cannot replace the physician, but it can keep essential data moving smoothly from laboratory to nurse’s station, from X-ray department to the patient’s chart, and from all areas of the medical center to the physician himself.”

Thus, Kaiser Permanente joined a handful of others in launching the first medical computing experiments in history, which is why today it can maintain the largest system of civilian electronic health records, Kaiser Permanente HealthConnect®, serving doctors and their patients in the world. And why, in the 1990s, we did the earliest research establishing that the computer in the exam room does not interfere with the doctor-patient relationship.

Dr. Garfield truly was a visionary. If you are interested in knowing more about him, my new biography is called “The Story of Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care” (The Permanente Press, 2009). It can be ordered directly at https://xnet.kp.org/tpj/garfieldbook.html or at Amazon.com.

We’d like our blog to become a dialogue, so feel free to send us comments and questions.
–Tom Debley