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Kaiser Web-based Tool Enhances Patient Care, Part II

November 15, 2010
by John DeGaspari
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Report authors share how the tool is being expanded and refined

Kaiser Permanente in October released the first large studies of its proprietary Panel Support Tool, first rolled out in 2006, which extracts information from Kaiser’s HealthConnect electronic Health Record (EHR) to help physicians improve and manage their patients’ care. The studies are the organization’s first that evaluate the effectiveness of the tool on the large, divergent population in the Pacific Northwest.

The first study, “Effect of a Patient Panel-Support Tool on Care Delivery,” (published in the October issue of The American Journal of Managed Care , followed 204 primary care teams who are using the Panel Support Tool to manage care of 48,344 patients with diabetes and/or heart disease. The second study, “Improving Population Care with an Integrated Electronic Panel Support Tool,” published online in Population Health Management , involved 207 primary-care teams who were using the Panel Support Tool to manage the care of 263,509 adult patients, some of whom were relatively healthy and others who have chronic diseases. Both resulted in significant, quantifiable improvements in patient care, according to the reports.

For this second part of a two-part interview, HCI Managing Editor John DeGaspari asked Robert Unitan, M.D., one of the authors of the first study, and Yvonne Zhou, Ph.D., lead author of the second study, about the Panel Support Tool’s integration with HealthConnect EHR, improvements with patient care and patient outreach, and how the tool is being expanded and refined.

Healthcare Informatics: Kaiser Permanente invested heavily on its Epic-based EMR system and customizing it. Is the Panel Support Tool a supplement to the Epic system?

Robert Unitan, M.D. : Yes. One of things that you have to realize is that not all of the data about our patients is in the electronic record. We have patients that see clinicians, say if they get injured somewhere and they are seen outside of our region while they are on vacation; or intentionally, there may be certain services that we don’t provide inside. So we have to rely on our claims system, to bring that information in. Not all of the prescriptions our patients fill are filled at Kaiser’s pharmacies. We have to have another way to input that data. So it really is all about the data. The fact that the Panel Support Tool is not running off of just the data that is available in HealthConnect, but rather it is running all of the data that is flowing into our data warehouse, makes it much more comprehensive.

And so, we wouldn’t trade what we have for an EMR-based tool that functioned in the same. We had to develop [the Panel Support Tool] outside the EMR. The data that flows into the [data] warehouse from HealthConnect is huge; [most] of that data flowing into that warehouse is probably coming from our Epic EMR. But it is that other [data]that is still very important. Because we had a data warehouse that was already very robust to begin with, the incremental cost of building this Panel Support Tool was nothing like the cost of implementing HealthConnect EMR.

A lot of [data] comes in from our claims system. Our lab, pharmacy, radiology system are integrated with HealthConnect vis-à-vis systems that exchange information, but they are not part of the electronic medical record. We also have our membership system that has demographic information about our patients that may not be in the medical record. So there are lots of sources for the data; and the data warehouse is the repository that makes the Panel Support Tool possible.

HCI: What is biggest advantage of the Panel Support Tool that you have seen?

Yvonne Zhou, Ph.D.: The Panel Support Tool has enabled us to systemize the knowledge of our medical science and provide that information in an integrated way. So it is not just the one condition; it can provide many conditions. It’s not just one care gap, it is many care gaps—mammography screening, gap diabetes A1 screening. It can be many [care gaps] and it is all integrated together. That is really the key distinction between the Panel Support Tool and some other registries or other things. In addition it has data that is very real time, very accurate, and complete. So we have all of this information, and the support of data to our healthcare teams, at the point of care, really allow physicians to provide the best, latest recommended care accurately, 100 percent of the time.