Kaiser Web-based Tool Enhances Patient Care

We in the Northwest Region were the first in Kaiser Permanente to implement [Verona, Wis.-based Epic [Systems Corp.’s] EMR; we piloted that in 1994, and went region-wide with it here in 1996. Kaiser went down a different road nationally, but ultimately, when we got a new CEO, Mr. George Halvorson, he very quickly got on track for the rest of the company, essentially, to implement Epic. It was his expectation that, just having EMR, with the decision support that you have, in an EMR, would be sufficient to get our quality performance up to the 90^th percentile, as measured by the HEDIS [Healthcare Data and Information Set] measures, from NCQA [National Committee for Quality Assurance].

[Halvorson] in a very big national meeting, essentially announced that it was his expectation that we would all be at the 90^th percentile by the end of the decade. This was back in 2004, and 2003 when it was made. And I knew, coming from the [Northwest Kaiser experience], where we already had Epic ambulatory EMR for eight years, that it was going to take more than that.

And I happened to meet a couple of physician colleagues [from Kaiser Permanente’s Hawaii region], who had this concept that they called Total Panel Ownership. It was about how a primary care doctor should not only be responsible for the patients who are on their schedule each day, the 20 to 24 patients that they see, but instead they are responsible for the health of the entire panel [of] between 1,500 and 2,000 Kaiser members who call that doctor their primary care physician. One of the things that these docs from Hawaii said would be absolutely essential was to have basically a spreadsheet that would allow them to find the gaps in care for all of the patients in the panel, Not just the people who would be coming in to see them.

I took it upon myself to partner with [physicians from Kaiser Permanente’s Hawaii region] and with Kaiser Permanente Information Technology to get this built. We built this pretty rapidly in the second half of 2005; here in the Northwest it was completely rolled out across our region starting in the spring of 2006 through the end of 2006. We basically brought nearly identical copies of the Panel Support Tool up in both regions. We built it in Hawaii first, but it was a happy coincidence that same people who run the data warehouse for the Northwest region also run the data warehouse for the Hawaii region. One of the things I wanted to do was to demonstrate to our program leadership in Oakland that physicians from different regions could actually collaborate on this sort of thing, and agree on the rules that would drive a care engine such as this.

HCI: How important was the fact that physicians took the lead in developing this tool?

Unitan: It was very important in terms of when we rolled it out it had a lot more credibility, in part because we had developed it ourselves, and we had developed it in a way that we do business. HMOs are different than fee-for-service medicine; we’ve got some different business drivers and different incentives around the health of our population. But when I went out and trained clinicians and we went building by building to train the clinicians and staff in how to use this tool and explain why they should use this tool, the fact that it was physician-led was very important in our organization.

HCI: Does anything like the Panel Support Tool exist in the commercial market?

Unitan: Not that we know of. There are other health systems that we believe have built a similar tool, although they have not publically reported their results, and we don’t think these are in wide use. And we have not seen an electronic medical record that has this functionality.

HCI: Besides what has been derived from HEDIS, what other criteria did you use for recommendations to be monitored in the Panel Support Tool?