By Natalie Kish, Special to the Kaiser Permanente Institute for Health Policy
Implementing Kaiser Permanente’s electronic health record was no easy task — it required about $4 billion and a great deal of effort to roll out across the organization. But Kaiser Permanente HealthConnect®, as it is known, is a notable success story: all 618 medical offices and 38 hospitals now use it; it offers more than 10 million members continuous access to their medical information, and patients report feeling more empowered to participate in their care.
Patient engagement has been a primary focus for Mary Reed, DrPH, a research scientist in Kaiser Permanente’s Northern California Division of Research. Reed has spent much of the last 11 years analyzing how that engagement has changed as Kaiser Permanente has implemented its EHR. She recently discussed three of her studies, which focused on how KP HealthConnect has improved chronic disease management for providers and patients.
To conduct the studies, Reed and her team examined Kaiser Permanente’s clinical diabetes registry, an electronic database containing health information for diabetic patients. According to Reed, diabetes is a valuable case study for understanding the impact of health IT.
“Patients with diabetes have a regular need for health care, and diabetes has a large population and various quality of care metrics,” Reed said. Although her studies focused on a single chronic disease, she believes the results can be used to explore how providers and patients can use EHRs to manage other long-term illnesses.
Reed’s team conducted its first study between 2004 and 2009 during the staggered roll out of KP HealthConnect. Their research compared diabetes treatment between patients in centers that had implemented the EHR and patients in centers that had not yet adopted the technology. They found that physicians in practices who used EHRs were more likely to monitor patients’ cholesterol levels and intensify diabetes treatment if needed. These two changes in clinical practice led to a reduction in patients’ levels of low-density lipoprotein cholesterol (or LDL-C) — also known as “bad” cholesterol.
The second study, published in 2013, further analyzed the 2004-2009 data. Researchers measured the impact of physicians’ use of the EHR on emergency department visits and hospitalizations among patients with diabetes. Reed wanted to test the theory that improvements in initial care, such as greater availability of patient information, reduce unfavorable clinical events. For patients in practices that had adopted KP HealthConnect, the team found reductions in emergency department visits and hospitalizations by 5.54 percent and 5.21 percent respectively.
Reed’s third study, which is still under way, examines the impact of diabetes patients’ use of Kaiser Permanente’s My Health Manager. This online portal leverages KP HealthConnect data to allow patients to view their health records, manage prescriptions, schedule appointments and contact their physicians. To date, the research has shown that nearly 50 percent of diabetes patients view their cholesterol levels within one week of the test results being posted, and viewing results on the portal is associated with following up with a provider.
While these tools have been shown to be effective as part of health care delivery, Reed also emphasized the importance of understanding the patient perspective on EHR-based communication.
“More and more care is going to happen outside of the traditional setting. As virtual care becomes more popular and technology becomes more patient-facing, having patient reported outcomes is essential,” she said.
To hear from members who use My Health Manager, Reed and her team convened a patient advisory panel. They found patients are satisfied with the communication tools of the EHR patient portal. Patients report feeling enabled to contact physicians more often than before and better able to build rapport with their providers. According to Reed, patients see the portal as another method of communicating, just as people use different modes — phone, email, letters, and face-to-face interactions — to maintain personal connections.
Reed hopes that her research findings will encourage stakeholders outside of Kaiser Permanente to keep an open mind about the integration of virtual care into health care. While she acknowledges that some health professionals may find these technologies unfamiliar at first, she believes that health IT may be an integral component of providing patient-centered care.