Healthcare information technology and economics.

At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit. We review the current state of healthcare costs, federal health IT stimulus programs, and experiences of several leading organizations, and offer a model for how health IT fits into our health economic future.

The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care.

We examined the impact of implementing a comprehensive electronic health record (EHR) system on ambulatory care use in an integrated health care delivery system with more than 225,000 members. Between 2004 and 2007, the annual age/sex-adjusted total office visit rate decreased 26.2 percent, the adjusted primary care office visit rate decreased 25.3 percent, and the adjusted specialty care office visit rate decreased 21.5 percent. Scheduled telephone visits increased more than eightfold, and secure e-mail messaging, which began in late 2005, increased nearly sixfold by 2007. Introducing an EHR creates operational efficiencies by offering nontraditional, patient-centered ways of providing care.

Patient access to an electronic health record with secure messaging: impact on primary care utilization.

OBJECTIVE: To determine whether patient access to secure patient-physician messaging affects annual adult primary care office visit and documented telephone contact rates. STUDY DESIGN: Retrospective cohort and matched-control studies with pre-post analysis. METHODS: The cohort study sample included 4686 adult members of Kaiser Permanente Northwest (KPNW) who had been registered KP HealthConnect Online users longer than 13 months and had used at least 1 feature. The matched-control study sample included 3201 randomly selected controls matched by age/sex, selected chronic conditions, and primary care physician to 3201 registered users. We calculated the difference in primary care office visit and documented telephone contact rates in the pre- and post-periods (defined, respectively, as 3-14 months before and 2-13 months after registration for KP HealthConnect Online). Paired t tests were used to assess significance. RESULTS: Annual office visit rates decreased by 0.23 (-9.7%) visits per member in the cohort study. Annual office visit rates for users in the matched-control study decreased by 0.25 (-10.3%); the corresponding decrease for the controls was 0.08 (-3.7%). This 0.17 (-6.7%) reduction was significant (P < .003). Annual documented telephone contact rates for users in the matched-control design increased by 0.32 (16.2%) contacts per member; the corresponding rate for the control group was 0.52 (29.9%). This 0.20 (13.7%) difference was significant (P < .01). CONCLUSION: Patient access to the secure messaging feature of KP HealthConnect Online was associated with decreased rates of primary care office visits and telephone contacts.

The gap between evidence and practice.

Despite the urgent call to action made by the Institute of Medicine's (IOM's) Crossing the Quality Chasm report in 2001, several fundamental issues in health care remain largely unaddressed. Although a number of organizations have addressed many of the system-level factors cited in the report, we have much to learn about practice and patient factors that affect clinical outcomes. Now we have new opportunities to further improve health care by learning from the data available in electronic health record databases and, perhaps more importantly, to better understand the human behavior of caregivers and patients necessary to improve health care quality.

Straight talk new approaches to healthcare. The healthcare quality equation.

Though various health organizations may define and approach quality differently, the common denominator is the patient's perspective, experience and outcome. Quality issues should be an important part of health system executives' agenda. Successful quality programs have a number of key ingredients, including decision-reporting tools and business analytics information--which depend on robust information reporting and a system-wide electronic medical record--as well as highly motivated employees and physicians. In this installment of Straight Talk, representatives from two health systems--Kaiser Permanente and Clarian Health Partners--discuss their quality initiatives.

Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study.

OBJECTIVE: To evaluate the effect of implementing comprehensive, integrated electronic health record systems on use and quality of ambulatory care DESIGN: Retrospective, serial, cross sectional study. SETTING: Colorado and Northwest regions of Kaiser Permanente, a US integrated healthcare delivery system. POPULATION: 367,795 members in the Colorado region and 449,728 members in the Northwest region. INTERVENTION: Implementation of electronic health record systems. MAIN OUTCOME MEASURES: Total number of office visits and use of primary care, specialty care, clinical laboratory, radiology services, and telephone contact. Health Plan Employer Data and Information Set to assess quality. RESULTS: Two years after electronic health records were fully implemented, age adjusted rates of office visits fell by 9% in both regions. Age adjusted primary care visits decreased by 11% in both regions and specialty care visits decreased by 5% in Colorado and 6% in the Northwest. All these decreases were significant (P < 0.0001). The percentage of members making > or = 3 visits a year decreased by 10% in Colorado and 11% in the Northwest, and the percentage of members with < or = 2 visits a year increased. In the Northwest, scheduled telephone contact increased from a baseline of 1.26 per member per year to 2.09 after two years. Use of clinical laboratory and radiology services did not change conclusively. Intermediate measures of quality of health care remained unchanged or improved slightly. CONCLUSIONS: Readily available, comprehensive, integrated clinical information reduced use of ambulatory care while maintaining quality and allowed doctors to replace some office visits with telephone contacts. Shifting patterns of use suggest reduced numbers of ambulatory care visits that are inappropriate or marginally productive.

Making the business case for hospital information systems--a Kaiser Permanente investment decision.

Further evidence in favor of the clinical IT business case is set forth in Kaiser Permanente's cost/benefit analysis for an electronic hospital information system. This article reviews the business case for an inpatient electronic medical record system, including 36 categories of quantifiable benefits that contribute to a positive cumulative net cash flow within an 8.5 year period. However, the business case hinges on several contingent success factors: leadership commitment, timely implementation, partnership with labor, coding compliance, and workflow redesign. The issues and constraints that impact the potential transferability of this business case across delivery systems raise questions that merit further attention.