Kaiser Web-based Tool Enhances Patient Care, Part II

Unitan: Then integration is really around the workflow for the clinician and the front-line staff. When we first went live, we were less tightly integrated. You essentially had to toggle back and forth between the applications. About two years ago, we were able to actually add a button in the electronic medical record that, with a single click and via single sign-on, because you already used your password, to get into the EMR. We were able to do all of that authentication on the back-end, so that, we can, within a matter of seconds, bring up the panel support tool, within a window, essentially a Web browser window, within the EMR. It’s still a standalone application, but [to] the end-user, it looks like they are right in HealthConnect doing their work. And so, tighter integration means being able to actually click on things in the actual [EMR] tool that would then actually tend the orders themselves. If you click on a care gap for an LDL, it would actually order a lipid lab. It is possible to configure what we call Web services, to be able to enable that. We have not [done that] yet here in the Northwest.

But if you have an incomplete data set, it is not necessarily going to be helpful. The tool will alert to things that the patient had [not] done, but some other system outside the EMR knows they have done. Like the claims system; we have people, for example, in some of our outlying areas, where all of the mammograms are obtained outside of Kaiser. We have to rely on our claims system to be able to essentially satisfy that care gap for that patient. If you just had it as part of the EMR, you would miss things. And that gets annoying for patients as you are reaching out to them, telling them that they need to get things done that they have already had done.

I think that being completely EMR-centric, with respect to the data source, is potentially problematic. Using the data warehouse instead is probably a better solution. And that there are definitely ways that you can use the Web browser windows, etc., in the tools, in the EMR, to make it appear as though the tool is more tightly integrated than it really is.

Zhou: It does have certain requirements for the database, for EMR. I generally expect that a full-blown EMR should have all discrete data elements, like a problem list, like a lab results, values, orders. So all those discrete data elements can be tracked and extracted into data warehouse. Meaningful use has several stages, and some of the stages and requirements are really trying to define or make sure that some of the key data elements are stored in the database at the back end, and therefore can be used for tools like the Panel Support Tool.

[Meaningful use requirements can lead to] better tools or at least tools that will have all of the key data elements needed for support the tool’s functionality.

HCI: Are there health conditions that stand out as difficult to monitor and that the Panel Support Tool is helpful?

Unitan: Certainly for diabetes and cardiovascular disease, there are a lot of both HEDIS and non-HEDIS measures that indicate good care for these patients. But, for example, there is no HEDIS measure for having the feet of a diabetic checked every year, and just having that in there to remind the clinician to do that is an important thing. When you think about all of the potential organs that can be damaged by a disease like that, there is a lot to keep track of. Other diseases that are major contributors to chronic illness include hypertension, chronic kidney disease, congestive heart failure, asthma, and COPD [chronic obstructive pulmonary disease]. As you start to add those up, each with their own individual sets of care recommendations, a tool like this can make much easier to keep track of over time.

Zhou: I think the Panel Support Tool is able to improve preventable care, screening measures, more quickly. Probably this is just the way it is for some of the control measures like diabetes LDL control or diabetes A1C control. In general, it’s much harder to improve these measures because it’s not just one test, it takes a while to [implement] medication or other care management strategies, [and to] to work with the patient to include those measures.

However, the Panel Support Tool is still pretty effective for those measures, because it has a total care gap score. Those gaps will keep referring to the pop up list and help the healthcare teams and clinicians to go out, visit them, outreach to them frequently. So, in general, it’s much quicker to improve preventive measures, screening measures. It will take a little while to improve control measures, but still more effective than other tools.