Information technology improves patient care
Systems keep track of patients and their conditions
Through the innovative use of information technology, Kaiser Permanente of Ohio is making dramatic strides in improving its management of patients with chronic conditions.
Electronic reminders are prompting Kaiser physicians to place appropriate cardiac patients on aspirin therapy, while automated phone-calling devices tell elderly patients to get flu shots and remind women when they’re overdue for a Pap smear.
Taking its cue from a government-sanctioned report called Healthy People 2000 which pointed out that the health care industry would get the most benefits from focusing on improved outcomes in the areas of heart disease, low-birth-weight infants, diabetes, injury prevention, and smoking cessation, among others Kaiser Permanente of Ohio made these clinical objectives part of its strategic goals, says Allan Khoury, MD, associate medical director of medical information.
"We have an automated medical record system that helps us to do well in all these areas and a very good electronic data base with data [compiled] since 1991," says Khoury. That data base, he adds, includes information on vital signs, allergies, immunizations, smoking status, prescribed medications, and diagnoses from every patient encounter in the Kaiser Permanente of Ohio system.
"That’s 900,000 visits a year," he points out. "It’s fairly unique, fairly complete." Results from the laboratory and radiology systems also are stored, Khoury says.
May the best system win
The process is specific to Kaiser Permanente of Ohio, Khoury explains, noting Kaiser headquarters made the decision to allow independent development of information systems by its 12 regions because there was no one model of success available. "We are making an effort to converge all those efforts," he adds. "Over five years, all 12 of the individual region systems will look similar."
Kaiser Permanente of Ohio relies heavily on its information system to produce clinical reminders at the time of a patient visit, he explains. "If a patient with heart disease comes in and is not taking aspirin, the system will first check to make sure the patient is not allergic and that there are no contraindications," Khoury says. "If not, it will remind the physician to consider aspirin use for this patient."
"We can identify a lot more without charts," says Pat Pease, RN, medicine coordinator for Willoughby (OH) Medical Center, one of Kaiser’s outpatient facilities.
"In the past, if a patient was seen at one facility one day and another the next, the second physician would start blind. Now we don’t have to re-collect that data."
Because clerks scan the information into the system as soon as a visit is completed, the record is updated virtually instantaneously, she notes.
Improved care in less time
Although no figures are available on any time-saving effects of the automated system, Pease says her sense of things is that it’s helping nurses accomplish more and keep on schedule preparing the patient to see the doctor may take two or three minutes instead of 10.
But more importantly, she adds, "We’re providing better care."
The reminders support other areas of preventive medicine as well. If a woman is in the appropriate age group and has not had a mammogram in the past two years, the system will alert the physician, he adds.
Hello, time to check your . . .
The information system also does status reports. For example, every month, every Kaiser pediatrician gets a report on patients who have reached 19 months who are not up to date on their 24-month immunizations. As a result, Khoury points out, 93% of the health system’s pediatric patients have all the appropriate immunizations by age 2. (See related story on providing incentives for physicians to use information systems, p. 60.)
"We also use the system to do direct communication with members," he says. "Someone who has high-blood pressure who has not kept an appointment gets an automated letter, saying, You really need to come in and follow up.’"
If a patient who is of Medicare age has not had a flu shot by Dec. 1, the system produces a tape identifying that person, which prompts an automated phone-calling device, Khoury says. If the person wants to arrange to have the shot, he or she is able to hang on the line and have a human being set up the appointment. "Even if the patients hang up, they’ve still gotten the reminder," he adds.
The phone-calling device also is used to contact women who haven’t had Pap tests, Khoury notes.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content