Electronic Health Records Connect a Fragmented System

Kaiser Permanente believes electronic medical records are vital to manage chronic diseases
The Lund Report

August 31, 2011 -- When Cindy Starnes was diagnosed with type 2 diabetes, she was scared and nervous about the future.

But she also knew she had a choice about where to take her health, and Cindy chose to act. Using the tools of Kaiser Permanente’s Electronic Medical Record, KP HealthConnect, Cindy established regular contact with her care team. She emailed her blood glucose results two to three times per week, and her doctor signed her up for diabetes management classes.

Cindy lost 33 pounds, and her blood sugar dropped from 142 to the high 90s. She says she couldn’t have done it without her support system, including the ability to stay in touch online. “I have talked with others who have been diagnosed with diabetes, and they were not given a fifth of the information that I was,” said Cindy.” I really appreciate that the care teams at Kaiser Permanente are doing their best to help me control what I can at the onset of this disease, instead of letting the symptoms get worse.”

Electronic health records (EHR) are a key part of Cindy’s success story. Kaiser Permanente believes EHR are essential if America is going to move successfully to a proactive, prevention, health based model that manages chronic diseases well, and away from the reactive, wait-until-they’re-sick model that most of America has now.

In an editorial on reforming the healthcare system that ran last month in Scientific American, the opening paragraph ends with this sentence: “The U.S. needs to get smarter about restraining soaring medical bills while improving the quality of care.” While not offering specific solutions, the editors do point out what they see as the major cost drivers, and a fragmented delivery system is at the top of the list.

At Kaiser Permanente, we feel strongly that one of the ways our healthcare system can “get smarter” and reduce fragmentation is through Information Technology. We’ve led the way with our multi billion dollar investment in KP HealthConnect, the world’s largest civilian electronic health record. 

Through the kp.org portal, patients can use a wide array of options and tools including emailing their doctors, viewing lab results, renewing prescriptions, and making  appointments online.  By the end of the year, thanks to mobile apps, all of these functions will be available from KP members’ smart phones. The system (used by about half of Kaiser Permanente’s 8.8 million members) has not just made our members’ lives more convenient, it helps them stay healthier.  

 KP HealthConnect helps the care team do their jobs better as well. The Panel Support Tool is a prime example: it takes securely key information from individual health records and helps clinicians identify care gaps among each patient the provider is treating. Physicians can quickly view  all of their patients’ records and find out how they’re doing on key health indicators such as mammography, colon cancer and other screening/prevention work.  When physicians log onto the system, they’re reminded of the evidence that 2% of future cancers will be secondarily caused by radiation exposure from medical exams; it’s a caution to use the evidence based approach to ordering all radiologic procedures.  There are many more examples.

How advanced is KP HealthConnect? In the hospital setting, the industry standard for judging IT systems is HIMSS (Healthcare Information and Management Society) Analytics. HIMSS provides a globally trusted benchmark to measure the effectiveness of healthcare organizations’ use of technology and Electronic Medical Records. Kaiser Sunnyside Medical Center earned HIMSS Stage 7, the only hospital in the Northwest to achieve it. It means that there are no paper health records at the hospital. Of the 59 Stage 7 hospitals in the country, 35 are Kaiser Permanente facilities. And, when the Kaiser Permanente Westside Medical Center opens in Hillsboro in 2013, we expect the hospital to be awarded Stage 7 as well. 

HealthConnect and other Electronic Health Records help the care team work together with the patient to achieve Total Health. It’s the answer to the fragmentation that plagues much of American health care. And when everyone in the system has an incentive to prevent sickness, instead of an incentive to wait and treat the sickness after it happens, then the patient wins.  As CMS administrator Dr. Don Berwick said, “The greatest untapped resource in health care is the patient and their family.” When we really tap that resource, we will finally see statistics for health outcomes going up, and costs going down.

Dr. Unitan is director of operations for medical specialties, the co-inventor of Kaiser Permanente Northwest's Panel Support Tool, and the physician lead for PST development and implementation.


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I agree electronic health records (EHR) are critical to better patient care and increased efficiencies. The missing component is EHRs need to communicate. Even with Kaiser, the EHR used by Kaiser is the same one used nationally for all Kaiser regions but each region can't necessarily "talk" to each other and communicate between EHRs because of how the EHRs were implemented in each region. This is not a new issue. Health Information Exchanges (HIE) have been touted as one of the key solutions in creating a hub health care professionals can use to communicate electronically to allow faster access to patient information when needed. The missing component with HIEs is the connection between EHRs and HIEs. This is also a challenge that has not been fully addressed and in many areas addressed at all. Oregon has published proposed rules that allow patients to "opt out" of HIEs. If the patient does not take action (with some exceptions related to specially protected health information), the patient's health information may be transmitted through HIEs. The problem is Oregon has broadly interpreted "HIE" to mean any electronic communication. Currently a number of hospitals and clinics already allow access to each of their EHRs and even imaging systems to assist with better patient care. Under the proposed rule, if a patient elects to exercise his or her right to not participate in an HIE, all electronic communication between health care professionals will cease. This means those clinics accessing hospital EHRs or imaging systems will need to cease and everything moves back to paper. The rule does not just address transmission of patient information through an HIE hub network. This represents a significant step backwards in providing patients with the care they need and requires these organizations to cease doing the business of health care as they have been for a number of years. This represents what could be a potential cost to health care organizations and significant risk to patients. I understand allowing patients to "opt out" of transmission of their health information through an HIE (the entity versus the process). I'm lost on why Oregon would endanger patients and increase health care costs by defining "HIE" as not transmitting patient information through HIE hubs but any electronic communication between health care professionals. I believe Kaiser and others are on the right track. There is a significant amount of work to do to create a robust exchange of patient information that better serves the patient and increases efficiency. I'm still at a loss why Oregon intends to thwart existing efforts to quickly exchange patient information "point-to-point" or directly between health care professionals. This is a longstanding practice and now the state proposes to take a large step backwards in providing patients with quality care and increasing efficiency in the provision of health care. Chris Apgar, CISSP Apgar & Associates, LLC

Having to change health care plans - and sometimes providers - with every new employer has led to a very fragmented system. Kaiser can integrate its network, surely, since "they are one." I wonder how hard it will be to bring all of the private clinics into the fold

Things may be just ducky within Kaiser, but until there's "interoperability," Kaiser isn't integrated because it has such a paltry urgent care/ER system. If I need either -- especially ER -- I am out of luck in terms of any ER accessing my records, even if said center also uses Epic. This is a huge patient safety issue. No one in his/her right mind is going to drive from most of Portland, particularly the westside, to Kaiser Sunnyside for emergency care, especially since it can't handle trauma. One solution: Patients must have access to their records. All their records, not just visit summaries and scattered lab tests. They, or their designee, could then give an ER permission to access same via Kaiser's (or anyone else's) portal. And of course the patient could access the full record, too.