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Health systems and policymakers mustn't lose sight of the big picture when discussing IT strategy and goals, believes the leader of the largest private healthcare delivery organization in the United States.

"The goal is the care," advised Kaiser Permanente president and CEO George Halvorson. "The technology is a tool."

"A lot of people put medical records in place but don't have a goal, don't have a particular strategy to use them, and if you just put the medical record in place and don't use it for anything, care doesn't get better," Halvorson told InformationWeek Healthcare in an exclusive interview. The Kaiser leader keynoted at the pan-European World of Health IT conference in Copenhagen, Denmark, this month, then spoke to InformationWeek Healthcare at the official residence of the U.S. ambassador to Denmark, Laurie Fulton.

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"What you have to be is on a pathway to make care better, and then use the medical record to reinforce that and support it because a tool always has to have a purpose," Halvorson explained. Kaiser spent more than $6 billion to install a common electronic health record (EHR) across its nine operating regions between 2004 and 2010, but the effort really never ended. "You're never done. It's continuous improvement," he added.

For this reason, Halvorson is not the biggest fan of what has been called comparative effectiveness research, the study of how healthcare providers perform relative to accepted standards of care and to each other. "Don't even think about comparative effectiveness," he advised. "What you want is continuous improvement. Start where you are, then figure out how can we make this better."

He called comparative effectiveness a "diversion" from the goal of creating a safer, more efficient healthcare system in the United States and around the world. "The real path you want to be on is continuous improvement," Halvorson said.

Healthcare systems should understand how they treat specific conditions, such as asthma, and then look for ways to improve the care, irrespective of cost, according to Halvorson. This may be easier for Kaiser than other healthcare systems--the Oakland, Calif.-based organization is both a health plan and a provider and it employs all of its physicians, so there is less pressure to churn out services and more incentive to save money--but Halvorson advised others to follow the advice of esteemed management consultant W. Edwards Deming.

"If something makes care better, then you use it and you don't look at the cost," Halvorson said. "Deming basically said you don't focus on costs, you focus on the most elegant process and nine out of 10 times, the most elegant process will cost less," he explained.

"When we're trying to figure out how to cut the number of broken bones in our seniors, we end up spending a lot less money because we've done that, but we didn't go into it and say: 'How can we save money on seniors?' We went into it and said: 'How can we actually cut the number of broken bones for seniors?' Then we put all the pieces together to do that, and it worked, and in the end, we saved money," Halvorson said. "If I would have said try to find out how to save money on broken bones for seniors, people would have tried to buy cheaper casts or something."

This focus on quality has informed Kaiser's health IT decisions for years. "Our strategy is to make the right thing easy to do but to build tools that accomplish the purpose, rather than get a tool and try to make it do something," Halvorson said.

"You figure out what are the reminders that the physicians need, not because we want to remind physicians of something but because we want to make sure that the hypertension is managed. We work backwards from hypertension to the tool, and that's been very effective."

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