The Kaiser Permanente Electronic Health Record: Transforming And Streamlining Modalities Of Care

KP headquarters in Oakland, California, USA.
Health Affairs (Impact Factor: 4.97). 03/2009; 28(2):323-33. DOI: 10.1377/hlthaff.28.2.323
Source: PubMed


We examined the impact of implementing a comprehensive electronic health record (EHR) system on ambulatory care use in an integrated health care delivery system with more than 225,000 members. Between 2004 and 2007, the annual age/sex-adjusted total office visit rate decreased 26.2 percent, the adjusted primary care office visit rate decreased 25.3 percent, and the adjusted specialty care office visit rate decreased 21.5 percent. Scheduled telephone visits increased more than eightfold, and secure e-mail messaging, which began in late 2005, increased nearly sixfold by 2007. Introducing an EHR creates operational efficiencies by offering nontraditional, patient-centered ways of providing care.

Download full-text


Available from: Terhilda Garrido,
257 Reads
  • Source
    • "A comprehensive integrated EHR, KP Health Connect, contains all patient information.19 20 "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine if IndiGO individualized clinical guidelines could be implemented in routine practice and assess their effects on care and care experience. Matched comparison observational design. IndiGO individualized guidelines, based on a biomathematical simulation model, were used in shared decision-making. Physicians and patients viewed risk estimates and tailored recommendations in a dynamic user interface and discussed them for 5-10 min. Outcome measures were prescribing and dispensing of IndiGO-recommended medications, changes in physiological markers and predicted 5-year risk of heart attack and stroke, and physician and patient perceptions. 489 patients using IndiGO were 4.9 times more likely to receive a statin prescription than were matched usual care controls (p=0.015). No effect was observed on prescribing of antihypertensive medications, but IndiGO-using patients were more likely to pick up at least one dispensing (p<0.05). No significant changes were observed in blood pressure or serum lipid levels. Predicted risk of heart attack or stroke decreased 1.6% among patients using IndiGO versus 1.0% among matched controls (p<0.01). Physician and patient experiences were positive to neutral. We could not assess the separate effects of individualized guidelines, user interface, and physician-patient discussions. Patient selection could have influenced results. The measure of risk reduction was not independent of the individualized guidelines. IndiGO individualized clinical guidelines were successfully implemented in primary care and were associated with increases in the use of cardioprotective medications and reduction in the predicted risk of adverse events, suggesting that a larger trial could be warranted.
    Journal of the American Medical Informatics Association 09/2013; 21(3). DOI:10.1136/amiajnl-2012-001595 · 3.50 Impact Factor
  • Source
    • "This case study offers weight to the evidence that large-scale change in the National Health Service is complex and takes time [30]. Indeed, many of the models that are providing inspiration to the National Health Service currently (e.g. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study). The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes. Although the pilot has demonstrated the beginnings of large-scale change, it remains in the early stages and faces significant challenges as it seeks to become sustainable for the longer term. It is critical that National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.
    International journal of integrated care 07/2013; 13:e027. · 1.50 Impact Factor
  • Source
    • "This study aimed to examine how practices had integrated record access during the course of a one year pilot, and to identity human, organizational or technical barriers warranting attention prior to wider rollout. It also sought to explore whether some of the benefits demonstrated in US studies of PHR, such as improved provider-patient relationships, patient self-care and reduced consulting time,15 were also being felt in British health centres adopting record access. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Primary care centres within NHS England that had offered online record access for the preceding year. Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients' health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.
    05/2012; 3(5):34. DOI:10.1258/shorts.2012.012009
Show more