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Overview
Kaiser Permanente, America's largest not-for-profit health maintenance organization, is a huge company with an intensely personal mission. At facilities across the United States, Kaiser provides nearly eight and a half million members with prenatal care, heart transplants, and everything in between. Giving the best possible medical attention to each individual patient - whether it's emergency surgery they need or just a routine physical - is a formidable challenge, one that Kaiser's medical staff responds to around the clock, seven days a week.

When the HMO developed a clinical-knowledge portal for its 50,000 doctors, nurses, and other caregivers, search was a key part of the plan. The Permanente Knowledge Connection, available from anywhere in the Kaiser wide-area network, gives medical staff access to diagnostic information, best practices, publications, educational material, and other clinical resources. Besides drawing on a central data repository containing HTML pages, PDF files, and Microsoft Office documents, the portal's resources include documents on servers distributed across the whole breadth of the United States, from Hawaii to Maryland.

Putting the right information quickly and easily into caregivers' hands is essential to the clinical portal's success.

The Challenge
Brad Hochhalter, director of Kaiser's clinical portal, initially turned to a system using manual tagging to power the clinical portal's search. But even after spending nearly two years trying to optimize the costly and complicated system, it still wasn't delivering the expected results.

Part of the problem had to do with a basic incompatibility between the manual-tagging system's stringent indexing requirements and the ambiguities inherent in medical terminology. Manually weighting and indexing the portal's content to produce relevant search results became a laborious undertaking, and even then Hochhalter found the results iffy at best. "One problem is that so many clinical concepts are ambiguous," Hochhalter explains. "There are also a lot of synonyms. So it's a really big chore to try to predetermine all the possibilities for a search path - which, unfortunately, is what we were forced to do."

And this difficulty wasn't about to go away, says Hochhalter. "The amount of available medical knowledge doubles about every seven years. All this made the manual-tagging system problematic. "Because of the enormous challenges of trying to organize medical content in a systematic way, we weren't getting the results we needed quickly enough. And we weren't getting the right return on our investment."

"For some limited content areas, it probably works pretty well," Hochhalter adds. "But for us, the return wasn't there. Every time they indexed, they spent several hours double-checking the index manually, and that came out of my budget. Those things add up after a while."

Besides drinking up time and money, the system wasn't delivering what Kaiser's caregivers needed - and the deluge of irrelevant and unreliable results made them hesitant to use the portal's search at all. "I was getting soaked on search, and I wasn't getting results," Hochhalter notes. "I wasn't getting anything better for the time and money I was putting in. It just wasn't worth it." With both Hochhalter's IT budget and the quality of patient care at stake, something clearly had to change.

The Solution
"Right out of the box, without any tweaking at all, the Google Search Appliance was more effective than the system we'd been working on for a year and a half," says Hochhalter. "It was a perfect marriage of Google's product and Kaiser's needs." The Google Search Appliance GB-1001 he put in place enabled him to index 150,000 documents distributed across the Kaiser network. Clinicians now search the site in situations that run the gamut from leisurely research to urgent care, from the exam room to the emergency room. Doctors and nurses use the Google Search Appliance to help them reach diagnoses and specify treatments, check the side effects of new medications, and consult clinical research studies and other medical publications. Physicians can also search the Kaiser intranet from home when they're on call to give immediate guidance more easily.

"Google's spell checking is an especially useful feature in the medical profession," Hochhalter adds. "Doctors' spelling can be as bad as their handwriting, and pharmaceutical product names don't make things any easier. Besides, when you're working in the ER, there are plenty of opportunities for typos. So it's great to have the search engine suggesting corrections when users slip up."

Because the price was so low, he didn't need budget approval, which enabled Hochhalter to get the system up and running immediately. And the Google Search Appliance takes almost no IT staff time for maintenance - about an hour a week. "I have to look at this as a business, too," Hochhalter points out. "And I've got other things I can spend IT dollars on that are equally pressing for me. So if I can get search working easily and cost-effectively, so much the better."

Hochhalter credits the Kaiser staff's quick acceptance of the new search partly to its speed and accuracy, and partly to their familiarity with Google. "We didn't make any tweaks at all to the results page - we left it exactly like the pages on Google.com. Frankly, there's a certain cachet with Google that helped me get people interested - because Google is the industry standard in search." In the months since Google search went live at Kaiser, the frequency of searches is rising rapidly as caregivers see how much more useful the search results are. "It's clearly better than it ever was before," says Hochhalter, "and the number of searches is going up significantly each month. Between January and February of this year, there was a 30 percent increase."

Now Hochhalter is hoping to make Google the standard search technology for the whole Kaiser Permanente organization. "The Google Search Appliance was the highlight of my last year," he declares. "It was the best thing on my evaluation. I overcame so many obstacles just by plugging that thing in and turning it on."

About the Google Search Appliance
The Google Search Appliance is an integrated corporate search solution that extends Google's award-winning search technology to intranets and websites. The Google Search Appliance is available in three models: the GB-1001 for departments and mid-sized companies; the GB-5005 for dedicated, high-priority search services such as customer-facing websites and company-wide intranet applications; and the GB-8008 for centralized deployments supporting global business units.

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