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.

Kaiser Permanente's Convergent Medical Terminology.

This paper describes Kaiser Permanente's (KP) enterprise-wide medical terminology solution, referred to as our Convergent Medical Terminology (CMT). Initially developed to serve the needs of a regional electronic health record, CMT has evolved into a core KP asset, serving as the common terminology across all applications. CMT serves as the definitive source of concept definitions for the organization, provides a consistent structure and access method to all codes used by the organization, and is KP's language of interoperability, with cross-mappings to regional ancillary systems and administrative billing codes. The core of CMT is comprised of SNOMED CT, laboratory LOINC, and First DataBank drug terminology. These are integrated into a single poly-hierarchically structured knowledge base. Cross map sets provide bi-directional translations between CMT and ancillary applications and administrative billing codes. Context sets provide subsets of CMT for use in specific contexts. Our experience with CMT has lead us to conclude that a successful terminology solution requires that: (1) usability considerations are an organizational priority; (2) "interface" terminology is differentiated from "reference" terminology; (3) it be easy for clinicians to find the concepts they need; (4) the immediate value of coded data be apparent to clinician user; (5) there be a well defined approach to terminology extensions. Over the past several years, there has been substantial progress made in the domain coverage and standardization of medical terminology. KP has learned to exploit that terminology in ways that are clinician-acceptable and that provide powerful options for data analysis and reporting.