A Web-based tool that extracts information from the electronic health record helps physicians improve care and manage their entire panel of patients. Two Kaiser Permanente studies examine the effectiveness of the tool in a large, diverse patient population.
In October, the Oakland, Calif.-based Kaiser Permanente integrated health system released the first large studies of its proprietary Panel Support Tool. That tool, first rolled out in 2006, uses Web-based software that extracts information from Kaiser's HealthConnect electronic medical record (EMR) to help physicians improve and manage their patients' care. Kaiser officials say the two studies are the first to examine the effectiveness of the Panel Support Tool in a large, diverse patient population.
Kaiser Permanente leaders developed the Panel Support Tool in-house in order to help their primary care physicians manage the care of individual patients, groups of patients, or their entire panels. It works by comparing the care a patient is receiving to the care recommended by national guidelines. A physician can, for example, query the Panel Support Tool in advance of a patient visit, to find out if that patient needs a screening test or a vaccination. Physicians can also ask the Panel Support Tool to display a list of all of their patients who are overdue for a mammogram or colon cancer screening; or a list of their diabetic patients whose blood sugars are too high, or those who need a foot exam or an eye exam.
The retrospective, longitudinal study, “Effect of a Patient Panel-Support Tool on Care Delivery,” which was 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. After three years, for patients with diabetes, the percentage of care recommendations met every month increased from 67.9 percent to 72.6 percent; for heart disease patients, the percentage rose from 63.5 percent to 70.6 percent.
The second study, “Improving Population Care with an Integrated Electronic Panel Support Tool,” which was published online in Population Health Management, involved 207 primary-care teams that were using the Panel Support Tool to manage the care of 263,509 adult patients, some of whom were relatively healthy and others who had chronic diseases. The study looked at 13 different care recommendations and found that, after 20 months, the Panel Support Tool improved performance in delivering care according to recommendations, from 72.9 percent to an average of 80 percent. The researchers also found that during the first year of tool use, performance in delivering care according to recommendations improved by a statically significant degree every four months.
The Panel Support Tool monitors recommendation pertaining to medical management and screening for co-morbidities in six chronic conditions: asthma, diabetes, coronary artery disease, heart failure, hypertension, and chronic kidney disease. The tool measures preventative care measures, such as administering adult immunizations and screening for breast, cervical, and colorectal cancer, hyperlipidemia, and osteoporosis. For each care recommendation, the Panel Support Tool indicates what action needs to be taken, if any.
Recently, HCI Managing Editor John DeGaspari interviewed 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 events that led to the development of the Panel Support Tool and what it will mean for Kaiser Permanente's primary care physicians.
In Part 1 of the interview, Drs. Unitan and Zhou speak about the formation and early development of the Panel Support Tool, and the improvements in care that Kaiser Permanente's physicians have seen with its use.
Healthcare Informatics: Explain the genesis of the Panel Support Tool. How did it develop?
Robert Unitan, M.D.: I am physician leader at Kaiser Permanente, the director of operations for medical specialties. And we are always looking for ways to take better care of our membership.