Harvard Business School Professor Clayton Christensen has taken to the pages of Business Week magazine to argue we would better off with health care systems in which doctors and insurers are on the same side of the ledger as the patient.  That would be a system such as Kaiser Permanente.  So what is the difference between his position and that of Sidney R. Garfield, the physician co-founder of Kaiser Permanente? Well, 65 years.

Professor Christensen, an expert on the topic of disruptive innovation, says that to do otherwise means “we’re guilty of business model malpractice on a grand scale.” As the headline on Christensen’s article put it, “The way to cut costs is to put care and insurance in the same bed.”

Dr. Sidney R. Garfield in 1975

Dr. Garfield, in designing Kaiser Permanente, made that argument 65 years ago when he addressed the Multnomah County Medical Association on April 4, 1945.

Garfield, talking about what he called his “new economy of medicine,” responded to the belief expressed a day earlier by another physician who claimed the most expensive thing in a hospital was an empty bed.

“He wasn’t referring to our hospital,” Garfield told his Portland, Oregon, audience, referring to the first Kaiser Permanente hospital in the Pacific Northwest, built during World War II in Vancouver, Washington.

“The most expensive thing in our hospital is a filled hospital bed,” Garfield added. “This new economy is geared to the preventive medicine of the future. It puts the patient, the doctor, the hospital, the employer and the insurance company all on the same side of the ledger. They all benefit by the patient remaining well.”

Garfield was a disruptive innovator long before the modern term was coined by Professor Christensen in 1995.  As Garfield once said, “We are talking about changes – and changes are irritating and disturbing, but being disturbed is essential to progress.”  (See my earlier blog, “Disruptive Innovation” at the Core of Kaiser Permanente History.)

Argues Christensen today, integrated delivery systems, including Kaiser Permanente, “can provide better care at 20 to 30 percent lower cost. Clearly, systemic problems require systemic solutions.”

If Dr. Garfield was 65 years ahead of the curve on that one, consider that it was 50 years ago this spring that he first argued that the computer should become the center of medical care delivery. Last week, on March 3, he would have been smiling as Kaiser Permanente announced that every medical facility within its health system — 431 medical offices and 36 hospitals — is now equipped with Kaiser Permanente Health Connect®, the largest private sector electronic health record in the world.

We’ll have more to say about Dr. Garfield and the computer on the 50th anniversary of his first talk on that topic in May.

Tom Debley is director of Kaiser Permanente’s Heritage Resources program and author of “The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” available directly from the publisher, The Permanente Press, as well as  from Amazon.com both in paperback and on Kindle.

Above, David Otey at radio control station in 1990 around the time of the Loma Prieta Earthquake in Northern California. At right, David on the ground in Haiti.

Our latest guest blog is by David Otey from the front line of volunteers who responded to the earthquake in Haiti in January. Some people inside Kaiser Permanente remember David from his years as an emergency management specialist. He worked on many projects not the least of which included organizing and directing emergency communications with Kaiser Permanente medical centers within minutes of the 7.1 magnitude Loma Prieta earthquake in 1989; managing our Regional Emergency Operations Center during the Oakland Hills Firestorm of 1991; directing the Center to support our Southern California Region after the 6.7 Northridge earthquake in 1994. We remember David, now retired, as the project manager who helped us get our Heritage Resources program up and running starting in 2003. David represents a historic commitment among Kaiser Permanente people on the front line of disaster volunteers. He was there in New York City after 9/11 and he was there in Haiti last month. Here’s his report from Haiti:

DMAT CA-6 Deployment to Haiti – January 13–26, 2010

I had an extraordinary experience last month assisting the relief effort in Haiti.

I joined 38 of my Disaster Medical Assistance Team, DMAT CA-6 (www. ca6dmat.org) colleagues as Communications Officer for a medical response assignment in Haiti following the devastating 7.0M earthquake on January 12. We departed Oakland the next day on a red-eye flight to Atlanta, where we met other responding DMAT teams. On Friday, we flew by charter to Port-au-Prince, Haiti and began a several day stay at the U.S. Embassy (camping on the garden lawn) while equipment arrived and security arrangements were finalized.

On January 20, (after a strong aftershock woke us) our team and DMAT NJ-1were assigned to operate jointly and transported to a nearby locality, called Petionville (“Pe-Shun”ville). We were co-located with the US Army’s 1-73rd Cavalry 82nd Airborne Division (what an outstanding group they are!) on a steep hill overlooking what was a golf course in pre-earthquake times but now is home to 30-50,000 Haitians.

I teamed up with two Communications wizards from the NJ-1 team, Mike, KC2GMM and Adam, KC2AEP, to establish field communications for our medical and support staff. Although no amateur radio equipment is utilized, the scene at the “commo” desk sure looked similar (and as cluttered) to “Field Day” setups I’ve seen (see picture). I remarked to my commo colleagues this seemed like a Field Day on steroids! While our medical staff managed treatment tents and formed “strike-teams” to hike and motor into the communities nearby, our commo team assisted in supporting radio, telephone and computer traffic between our field teams and the disaster management team at the U.S. Embassy in Port-au-Prince.

Once in the field, our joint medical teams treated more than 1000 patients over four days, including to the delight of all, the birth of two babies.

At the conclusion of field work on Sunday, January 24, our team was relieved by DMAT FL-1. The NJ-1 was scheduled to bring them up-to-speed and then rotate out three days later. We travelled back to the U.S. Embassy in Army Humvees for another night before returning to Atlanta for a debrief and team dinner. On Tuesday, January 26, we arrived safely back home.

Witnessing the devastation of Port-au-Prince and the dislocation of thousands of citizens was heart-wrenching. I am proud to have served with my DMAT colleagues and the American Haitian relief efforts. Much more recovery work remains to be done and I hope everyone able will find ways to assist.

Bess & Henry Kaiser

Thinking about sweethearts across America expressing their love this Valentine’s Day weekend, my attention was drawn to almost 200 newly acquired recordings in our Kaiser Permanente Heritage Archive.  One recording qualifies as a “singing Valentine” from Henry J. Kaiser to his wife, Bess, as World War II drew to a close 65 years ago.

First, the backdrop.

Bess Kaiser, with Henry, prepares to launch one of her husband's ships. Sons Henry Jr., left, and Edgar look on

One has to understand that the Kaisers—along with their sons Edgar and Henry Jr.—were “unabashed sentimentalists,” as Kaiser biographer Albert P. Heiner has recalled.   “They showed their affection for each other by effusive words of love they so often expressed.  And by unhesitatingly putting their arms around each on a regular basis.”

Henry Kaiser called Bess “mother” in private and public.  This struck a cord within the Kaiser organization, and she became widely known among Kaiser’s employees as “Mother Kaiser.”

In October 1945, this sentiment was reflected at a banquet honoring “Mother Kaiser” with a song from a group of Kaiser singers in a rendition of  “Let Us Call You Sweetheart.”  Based, of course, on “Let Me Call You Sweetheart,” this popular song dates from 1910—three years after the marriage of Henry and Bess.  It became a lifelong favorite of the couple.

If you take a listen to the song, you will hear the singers invite the audience to join in.  Listen especially to the end when Henry Kaiser—a little off key—joins in an unabashedly sentimental solo.

A second recording at the banquet was a humorous takeoff of the 1892 classic “Bicycle Built for Two.” Here are the changed lyrics:

Bessie, Bessie,
Give me your answer do!
I’m half crazy
All for the love of you!
It won’t be a stylish marriage,
We can’t afford a carriage,
But you’ll look sweet upon the seat
Of a bicycle built for two.

Henry, Henry, here is your answer dear.
I can’t cycle. It makes me feel so queer.
If you can’t afford a carriage,
Call off your bloomin’ marriage,
For I’ll be blown if I’ll be ‘tow’n’
On a bicycle built for two.

Henry, of course, provided much more for Bess than “a bicycle built for two.”

Bess & Henry J. Kaiser in 1946

As one of the 20^th Century’s most successful industrialists, Henry Kaiser also built several lines of automobiles. Kaiser’s love for Bess and for automobiles is illustrated in one of the photographs reproduced here. It is an image from our history archive that shows Henry and Bess playfully taking a spin in a door-less small truck in 1946 at a Kaiser industrial plant in Trentwood, Washington.

Henry and Bess Kaiser’s lasting legacy, of course, is Kaiser Permanente.  In 1942, they formed the Permanente Foundation Health Plan, a charitable trust, to serve the health care needs of 200,000 Kaiser employes on the Home Front of World War II.  It was Bess who picked the name.  The couple had a retreat along the bank of Permanente Creek south of San Francisco that she found beautiful and calming.  Read more about that in “Search for the Source of the Permanente” by our senior consulting historian, Steve Gilford.

Let me close with special thanks to collector Ron Gorremans of Lincoln City, Oregon, from whom the Kaiser Permanente Heritage Archive acquired these World War II era recordings.  The audio clips are from master recordings of 118 ship launches during the war from Henry Kaiser’s Swan Island Shipyard in Portland, Oregon.  They are currently being digitized.  When that is complete, we will deposit the originals in a permanent preservation archive as well as make the digital copies available to the Rosie the Riveter World War II Home Front National Historical Park for use in its interpretive program.

Happy Valentine’s Day!

Kaiser Permanente people can feel a real sense of pride – present and historic – with word we are a founding partner in the Partnership for a Healthier America, the coalition that will work alongside First Lady Michelle Obama in the fight against the nationwide epidemic in childhood obesity.

On the Home Front of WWII in the Kaiser Richmond shipyards, children of the shipyard workers stepped up to the scales during their routine health checkups. Kaiser Permanente was the largest civilian medical care program in the U.S. in World War II, and is today a sponsor of the Rosie the Riveter / World War II Home Front National Historical Park in Richmond, California.

This critical movement in 2010 is reminiscent in some ways of another First Lady, Eleanor Roosevelt, when she reached out more than a half century ago in 1943 to Kaiser Permanente’s founding physician, Sidney R. Garfield, for advice on preventive medicine.  “I am interested in getting medical care, both preventive and curative, at least cost to the people,” she said in a message from the White House.

And on another leadership front, it is reminiscent of a Southern California Permanente Medical Group physician and UCLA School of Medicine professor who, 45 years ago, published the first research paper to suggest that atherosclerosis, a consequence of obesity, might in fact be a “pediatric disease.” Dr. Martin Reisman, a pediatric cardiologist, issued the seminal call for a better understanding of the dietary causes of pediatric atherosclerosis. (For more information on Dr. Reisman’s work, see the vignette, Voice of a Permanente Pioneer.)

The latest leadership initiative came as Michelle Obama announced that she’s taking a leading role as an advocate for clinical and community-based prevention approaches to fight the nationwide epidemic in childhood obesity. Her Let’s Move campaign will encourage families to commit to living healthier, active lives.

Kaiser Permanente is one of the founding partners in the Partnership for a Healthier America, is a coalition that will work alongside the First Lady to place best practices for fighting childhood obesity in every community throughout the nation. Other founding partners include The California Endowment, Nemours, the Robert Wood Johnson Foundation, the W. K. Kellogg Foundation, and the Alliance for a Healthier Generation.

Kaiser Permanente has long supported a comprehensive approach to combating childhood obesity, including healthy eating and active living, and clinical and evidence-based interventions. As Ray Baxter, senior vice president, Community Benefit, Research and Health Policy, commented on the First Lady’s announcement: “KP has been committed to clinical weight management and community health efforts for many years, and we have received national acclaim for this work…. In every community we serve, we work to fight obesity, reduce health disparities and make healthy food and physical activity a part of everyday life.”

For more information on our involvement in this effort, visit Kaiser Permanente’s News Center.

Since the late 1940s, the Kaiser Foundation Rehabilitation Center (KFRC) in Vallejo, California has treated thousands of patients with acquired neurological disorders, trauma, and neuromuscular and orthopedic conditions. This inpatient rehabilitation hospital and outpatient center also is Kaiser Permanente’s Center of Excellence for people with disabilities.

Less known is the role industrialist Henry J. Kaiser played in its inception, thereby establishing himself as a national philanthropic leader in helping establish the field of rehabilitation medicine.  Recognition for that historic accomplishment is remedied in a new book by Richard Verville titled “War, Politics, and Philanthropy: The History of Rehabilitation Medicine” (University Press of America, 2009).

Verville describes the birth of this field in part out of the need to treat soldiers who suffered combat injuries in World Wars I and II.  He traces its evolution to the present.  In his chapter “The Immediate Postwar Years,” he covers Henry Kaiser, Dr. Sidney R. Garfield and Dr. Herman Kabat in the formation of the Kabat-Kaiser Institute in 1946 – today’s KFRC.   Anyone interested can view our 11-minute video  The Power of Science and the Human Spirit  about the history of KFRC and get the full story in the context of American medical history in Verville’s book.

To sum up the historic role of Henry J. Kaiser, Verville places him in a pantheon of important leaders that includes President Franklin D. Roosevelt in setting the stage for the growth of rehabilitation medicine after World War II:  “Kaiser thus took his place along with Bernard Baruch, Jeremiah and Samuel Milbank, and FDR as philanthropists who assisted in the early development of the medical rehabilitation facility movement in the private sector. Without their initiative and willingness to back new methods in health care, the eventual growth of rehabilitation medicine might never have occurred.” (Emphasis added.)
 
To be sure, as Verville points out, the trigger for Henry Kaiser’s actions was news in 1945 that his son, Henry J. Kaiser Jr., had multiple sclerosis. When the elder Kaiser learned that Kabat, a neurophysiologist and clinical neurologist, was achieving success in treating multiple sclerosis and paralytic poliomyelitis, he asked Kaiser Permanente founding physician Sidney R. Garfield to meet with Dr. Kabat.  “He had people walking who hadn’t walked for years,” Garfield recalled.  The Kabat-Kaiser Institute was born.

Not covered in this book is the fact that Kaiser already had experience with addressing the needs of people with disabilities on the Home Front of World War II.

An early Permanente physician, Clifford Kuh, a specialist in industrial medicine, did research in the Kaiser Shipyards in Richmond, Calif., looking at workers for their capabilities despite their physical disabilities rather than viewing them as “handicapped” and incapable. It was a visionary’s viewpoint that did not become prevalent for another 30 years with the rise of the Disability Rights Movement of the 1970s and subsequent Independent Living Movement.

The importance of Dr. Kuh’s work was recognized immediately, however.  In reporting on it, the New York Times (May 21, 1944) quoted William K. Hopkins, regional director the War Manpower Commission, which collaborated on the study.  Hopkins called it “pioneering” work that would prove “invaluable in the post-war period” with service men and women who would return to the civilian workforce with disabling injuries.

As a charitable trust, Kaiser Foundation Health Plan (then “Permanente Foundation”) provided funds in 1944 to distribute the research results nationwide as a public service so that communities across the country could use it help assimilate disabled veterans into the postwar workforce.

(The Kaiser Permanente Heritage Resources program offers special thanks to its history colleague Dr. Elizabeth Sandel, chief of physical medicine and rehabilitation at KFRC today who Verville notes reviewed an early draft of his book and provided him with historical material on the history of The Permanente Medical Group and Henry J. Kaiser.)

Tom Debley’s biography of Sidney R. Garfield, released last year, sheds light on Garfield’s role as the founder and guiding force of the Kaiser Permanente Medical Care program. Debley brings Garfield out of the shadow of Henry J. Kaiser and fleshes out his fuzzy historical image with great detail.

“Everyone knows the Kaiser name, and specifically Henry J Kaiser,” writes professor and medical researcher Leon Speroff, MD, who reviewed “Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care Into Health Care” for the current issue (Winter 2009) of the Oregon Historical Quarterly.

But, Speroff wonders: How many people know Sidney R. Garfield, MD, who established and expanded the principle of prepaid, group practice with an emphasis on keeping people well?

Debley’s book is novel-like, telling Garfield’s story in a conversational and often humorous way. That’s one way to make his life’s work known. But the work of objectively analyzing Garfield’s contribution to contemporary health care is not yet finished, Speroff wrote.

“The story of Sidney Garfield in this book is compelling, but the book, although well written and a pleasure to read, is more like a Festschrift (book of tribute). One is impressed with the uniform praise (almost fawning) of Garfield and wonders whether an objective, more scholarly work would provide criticisms and character flaws that would lend an even greater dimension to this important man.

“Garfield deserves a full historical biography that would give greater credibility and understanding to the evolution of Kaiser Permanente and its contributions to American medicine,” Speroff wrote.

Author Debley, director of Heritage Resources for Kaiser Permanente, agrees with Speroff. In the book preface, Debley wrote: “This is not… a definitive biography. That awaits the work of some future scholar and medical historian.”

Debley said he appreciated Speroff’s kind words and is hoping someone will pick up where he left off with a full scholarly historical biography of Dr. Garfield. “We debated about this book and decided it was important to bring Dr. Garfield to a wide audience,” Debley said. “I’m hoping an academic or PhD candidate out there will take up the challenge.

“And given the nature of my work in a corporate history program, I feel most strongly that the definitive biography be by an independent researcher to whom our private archive would be fully open,” Debley said.

Speroff also identifies Debley’s book as a resource to inform the current health care reform debate: “Garfield died in his sleep at age 76, on December 29, 1984. He left a history that contains lessons for the present.

“As America struggles to provide effective and efficient health care in the 21st century, many of the concepts and plans being articulated can be found in Garfield’s story,” Speroff wrote.

The reviewer also refers to the history of Kaiser Permanente presented in Rickey Hendricks’ 1993 book “A Model for National Health Care: The History of the Kaiser Permanente” “It would be useful for present-day legislators to read,” Speroff wrote. Debley also recommends Hendricks as a source of more information about Sidney Garfield’s life and work.

Speroff, an OB-GYN, is founder and former director of the Women’s Health Research Unit at OHSU. He is the author of many books on women’s health as well as several historical books. His works include: “A Good Man: Gregory Goodwin Pincus, the Man, His Story, and the Birth Control Pill,” as well as the biography of Carlos Montezuma, MD, an American-Indian physician who was a prominent activist for Indian rights in the early 1900s.

“Dr Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” may be purchased on the Permanente Press Web site. The book is also available as a Kindle book on Amazon.com.

In November 2008, Southern California Permanente Medical Group sponsored the 50th Annual Pediatric Symposium at which nine distinguished guest faculty lectured on new developments in pediatric medicine.  Professor Zvi Laron delivered the keynote address.  Laron, author of over 1400 scientific papers and 30 books and the Editor-in-Chief of Pediatric Endocrinology Reviews, is Director of the Endocrinology and Diabetes Research Unit at Schneider Children’s Medical Center of Israel and Professor Emeritus at Tel Aviv University.

Dr. Benjamin Fass, chairman of the symposium since 1993, celebrated the 50th year achievement in his opening remarks, “The Meaning of a Number.”  Dr. Fass practices pediatric endocrinology and general pediatrics at Kaiser Foundation Hospital West Los Angeles and is Associate Clinical Professor of Pediatrics, David Geffen School of Medicine, UCLA.

The Meaning of a Number

On a winter day in 1955, a man stepped off a train at Union Station in downtown Los Angeles. He was wearing a gray Fedora and a brown winter coat, and was easily recognizable to the two men who came to pick him up. They were from Kaiser Permanente. They knew that he took the three day train trip from New York because he had a fear of flying. His name was Hodes, Dr. Horace Hodes, and the men were Dr. Erwin Goldenberg and Dr. Sam Sapin. Dr. Hodes was Chair of the Department of Pediatrics at Mt. Sinai Hospital, New York, and renowned in the world of infectious disease. He had been invited to this new medical organization, Kaiser Permanente, by one of its early members – Sam Sapin – of a budding pediatric department, to discuss the recent polio epidemic and the Cutter vaccine catastrophe. Little did these two men know that this episode would initiate a long tradition of pediatric symposia of which we celebrate the 50th event this weekend.

In 1953, Dr. Raymond Kay and 16 physician associates organized the Southern California Permanente Medical Group (SCPMG). At that time, there were only three Kaiser Medical Areas, Fontana (the first) and Sunset, both with their own Hospitals, and Harbor City. These new and outstanding pediatricians, spearheaded by Dr. Erwin Goldenberg, determined to build an organization based on an ethos of life-long learning… The man in the gray Fedora and brown winter coat could not have imagined that he not only helped birth these symposia, but also helped set a very high bar as to the extraordinary quality of all future conferences.

The first 10 years of the symposia were “chaired” by different pediatricians, but in truth, organized and managed by Shirley Gach, who was then what is today the Department of Physician Education. By 1965, the symposia, which previously were held at Sunset and generally consisted of one nationally prominent speaker, grew in scope and became more formal. The Chiefs of the Pediatric Departments at that time wisely chose Dr. Billie Moore to officially Chair the symposia, aided by a committee composed of pediatricians from each medical area. I was fortunate enough to be one of those members in later years and learn at the master’s knee. Billie chaired the symposia from 1965 to 1992 with unparalleled success. She was kind enough to ask me to chair subsequently, and I began in 1993.

Those early “founding fathers” conceived of these symposia as not only superior educational opportunities, but also as a way to bring together the pediatricians of all areas and to network and socialize in order to help knit the pediatricians into a solid and interconnected group. Today, there are over 300 pediatricians in the Southern California area and to a great extent we have been wildly successful in achieving both goals.

Over the course of these symposia, things changed due to the nature of our expanding group, the growth of subspecialties, the question of pharmaceutical support, and the emergence of the internet as an important educational tool, to name but a few. The unspoken understanding by our early founders that these symposia would be part of the Kaiser Permanente experience and offered at no charge, also changed. In 1999, the first registration fee of $50 was imposed to a great outcry from the group. But let us speak of happier things. Despite these changes, the symposia have continued to attract speakers of the highest caliber to present topics that are current, useful, and are on the cutting edge of medical research and medical practice.

Dr. Benjamin Fass and Dr. Zvi Laron

So, the meaning of a number, of our number, 50, is simply an opportunity to not only celebrate the success of these symposia, but also to reflect on our beginnings and to thank our “founding fathers” who conceived of these symposia; to thank those who, as a labor of love, have been involved with the creation of each of these conferences: our chairs, chiefs, committee members, presiders, moderators, and educational coordinators, and mostly you, the attendees, who have been faithful to our historical educational mission. Our sincere hope is that our organization unwaveringly continues to support these symposia for another 50 years.

As the man from New York in the gray Fedora might have said at this point, “fuhgidehbowdid,” and go find your dear friends, have a cup of tea … learn from this outstanding guest faculty, and enjoy this superb conference.

– Benjamin Fass, MD, SCPMG pediatric endocrinologist and Associate Clinical Professor of Pediatrics, Department of Pediatrics, David Geffen School of Medicine, UCLA

In the 1950s, it was the custom of Henry Kaiser Jr. and family to record a holiday album for the friends and employees of the Kaiser Industries.  In this recording from December 1955, the year that Disneyland opened, Henry Jr. exhibited his fine singing voice with a Disney classic from “Pinocchio.”  This audio clip features family friend, Eddie Truman on the organ, with xylophone accompaniment, and Henry Jr. singing “When You Wish Upon A Star.”

when.you.wish_1955

The road that led to KP HealthConnect goes back more than forty years when a secure, electronic health record in an integrated system was an aspiration of the team at KP’s Medical Methods Research (MMR). In 1968 Morris F. Collen, MD and his team built a medical information system that peers described in the era as the most advanced of its kind. It was an aspiration of medical informaticians throughout the country, and KP was uniquely qualified to deliver on the promise.

First some background. In 1963 the MMR team used an IBM 1440 computer to store patient clinical data collected in a discrete unit involved in the early detection of disease. The fledgling information system designed for the multiphasic screening exam stored patient identification data, physician examination and patient history data, lab results, and EKG and X-ray interpretations. Programmed rules and algorithms alerted physicians to diagnostic results that fell outside of normal limits. Patient histories were accessible to physicians for comparison study throughout the life of the patient. The system also advanced epidemiological research and evidence-based protocols.

Morris Collen conferring with informatician James Sweeney of Tulane University, 1969

With this as a starting point, MMR aspired to design a comprehensive information system with the patient record at its core and with ancillary subsystems for the storage of pharmacy and lab pathology data; administrative information (patient identification / account services); and hospital information (admissions, bed utilization, inventories). With computing ability to store and retrieve pertinent data amassed over years, the design called for real-time reporting and 24/7 communication of essential medical data at all points of service, with robust security protocols to protect member confidentiality.

By 1969 system design had matured and the National Center for Health Services Research and Development Agency funded a five-year pilot implementation at the San Francisco Kaiser Foundation hospital and medical offices.

Within four years the San Francisco Kaiser Foundation hospital and physician offices were recording and storing patient registration data and physician diagnoses from 13 outpatient clinics for 2000 visits daily in its medical, surgical, pediatric and obstetrical clinics. Pharmacists in the outpatient pharmacies entered 1,200 prescriptions daily into the appropriate electronic patient records. A clinical laboratory subsystem handled data for 3,000 daily lab tests. Electrocardiogram, pathology and radiology reports were recorded via IBM magnetic tape-selectric typewriters. All systems data was fed via phone data line from a Honeywell mini-computer on-site in San Francisco to the central IBM computer in Oakland.

Central Computer Center in Oakland, ca. 1969

Though the project terminated in 1973 when the granting agency went out of existence informaticians viewed the KP San Francisco integrated system as a milestone achievement in medical information systems. A. F. Westin, Professor of Public Law & Government at Columbia University drew note to its distinction when he said that “few other medical institutions have moved as far in the development of a computerized medical record system.” Donald Lindberg, MD, the current Director of the National Library of Medicine, remarked: “…by far the most advanced of all American general MISs was that at Kaiser Permanente.”

– Bryan Culp

See Kaiser Permanente: 50 Years of Health IT Leadership