January 26, 2011

Identified success factors for health care IT implementation

New data shows a comprehensive technology infrastructure improves efficiency and patient engagement and satisfaction.

OAKLAND, Calif. – Two Kaiser Permanente studies published today in Health Affairs show that a comprehensive electronic health record can increase consumer convenience and satisfaction and provider efficiency while maintaining clinical quality, and that connecting patients directly with their care providers and giving online access to important medical information was critical in adoption of online tools.

The papers were published just two weeks after President Barack Obama signed into law a $789 billion stimulus package that includes $19 billion earmarked for health care IT. The two studies could help answer questions about how best to maximize that investment to improve the U.S. health care system.

The first paper, The Kaiser Permanente Electronic Health Record, Transforming and Streamlining Modalities of Care, examined the impact of KP HealthConnect™, Kaiser Permanente's comprehensive health information system, on ambulatory care patient contacts, including outpatient, urgent care, emergency department visits, scheduled telephone visits and secure patient-physician e-mail messaging.

The study was based on Kaiser Permanente’s 225,000 members in Hawaii, and found that between the implementation of KP HealthConnect™ in 2004 and 2007, office visits per member decreased 26.2 percent, total scheduled telephone visits per member increased nearly 900 percent. Secure e-mail, which began in late 2005, increased nearly six-fold by 2007.

In addition to the convenience of fewer office visits and the benefits of faster resolution of health issues, e-mail messaging and scheduled telephone visits saved consumers the often overlooked out-of-pocket expenses for travel and parking, and time lost that would otherwise be spent at work or other pursuits.

"Technology is transforming the way we deliver health care at Kaiser Permanente," said study co-author Louise Liang, MD, recently retired senior vice president, quality and clinical systems support, Kaiser Permanente. "We must become more efficient and sensitive to the needs of the individual patient to improve our health care system. Our experience can inform other efforts to harness the power of health care IT."

A second paper, If You Build It Will They Come? The Kaiser Permanente Model of Online Health Care, examined the rate at which consumers are adopting online health services, which services they are using, and the key factors that contribute to consumer acceptance of online health tools. With the world's most widely used personal health record, Kaiser Permanente's experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team, allows them to view key components of their medical records, conduct clinical transactions online, and provides them with information so that they can make knowledgeable decisions about their health.

Other key findings in "If You Build It Will They Come?" include:

  • In 2007, there were nearly 33 million total visits to My Health Manager at kp.org, and an average of 90,315 visits per day – a three-fold increase from 2004.
  • Consistently ranked among the site's top six visited features between 2004 and 2007 were prescription refill, online appointment transactions, facility directory and health encyclopedia visits.
  • The most visited feature on the Web site in 2007 was viewing lab test results, which became widely available to members in 2006.
  • In 2007, 300,000 secure e-mail messages on average were sent to providers each month, an increase of 152 percent from 2006. Since the completion of the study, the popularity of e-mail soared, with an average of 500,000 e-mails sent from members to providers each month.
  • By 2007, 62 percent of members registered on kp.org accessed the site two or more times in a six-month period – up from 27.7 percent two years earlier.
  • Member registration data showed that consumers of all ages are using online health tools. Recent data shows that approximately 31.5 percent of Kaiser Permanente's 8.6 million members are accessing the secure features on My Health Manager.
  • The study also examines challenges in the nationwide adoption of EHRs, including financing issues, as well as the opportunities available to the federal government, regional health information organizations and health care organizations and providers, both small and large.

    "This shift to online health services requires a paradigm shift within the health care industry, and large, integrated systems like Kaiser Permanente have a responsibility to share learning and best practices," said study co-author Anna-Lisa Silvestre, vice president of online services at Kaiser Permanente. "Knowing which online features are most popular, what sort of adoption rate to expect, and what factors will encourage acceptance of online health services may prove useful, regardless of practice size – and may move the issue of patient-centered health IT forward nationally."