Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients

Information TechnologyTransformation and Analytics, Kaiser Permanente, Portland, Oregon, USA.
Health Affairs (Impact Factor: 4.64). 07/2010; 29(7):1370-5. DOI: 10.1377/hlthaff.2010.0048
Source: PubMed

ABSTRACT The American Recovery and Reinvestment Act identified secure patient-physician e-mail messaging as an objective of the meaningful use of electronic health records. In our study of 35,423 people with diabetes, hypertension, or both, the use of secure patient-physician e-mail within a two-month period was associated with a statistically significant improvement in effectiveness of care as measured by the Healthcare Effectiveness Data and Information Set (HEDIS). In addition, the use of e-mail was associated with an improvement of 2.0-6.5 percentage points in performance on other HEDIS measures such as glycemic (HbA1c), cholesterol, and blood pressure screening and control.

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    ABSTRACT: Secure messaging (SM) allows patients to communicate with their providers for non-urgent health issues. Like other health information technologies, the design and implementation of SM should account for workflow to avoid suboptimal outcomes. SM may present unique workflow challenges because patients add a layer of complexity, as they are also direct users of the system. This study explores SM implementation at two Veterans Health Administration facilities. We interviewed twenty-nine members of eight primary care teams using semi-structured interviews. Questions addressed staff opinions about the integration of SM with daily practice, and team members' attitudes and experiences with SM. We describe the clinical workflow for SM, examining complexity and variability. We identified eight workflow issues directly related to efficiency and patient satisfaction, based on an exploration of the technology fit with multilevel factors. These findings inform organizational interventions that will accommodate SM implementation and lead to more patient-centered care.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2014; 2014:954-62.
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    ABSTRACT: Background: Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed to recall-based) rates of cancer screening. In this article, we seek to better understand cancer screening patterns in a population of insured Asian Americans. Methods: We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population and compared them with non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider-and patient-level) of screening completion among Asian patients. Results: Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient–physician language discordance for mammography [OR, 0.81; 95% confidence interval (CI), 0.71–0.92] and colorectal cancer screening (OR, 0.79; CI, 0.72–0.87) and positively associated with patient–provider gender concordance for mammography (OR, 1.16; CI, 1.00–1.34) and cervical cancer screening (OR, 1.66; CI, 1.51–1.82). In addition, patient enrollment in online health services increased mammography (OR, 1.32; CI, 1.20–1.46) and cervical cancer screening (OR, 1.31; CI, 1.24–1.37). Conclusions: Language-and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations. Impact: This study demonstrates how the use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting. See all the articles in this CEBP Focus section, "Cancer in Asian and Pacific Islander Populations." Cancer Epidemiol Biomarkers Prev; 23(11); 2208–17. Ó2014 AACR.
    Cancer Epidemiology Biomarkers & Prevention 01/2014; 23(11):2208-2217. DOI:10.1158/1055-9965.EPI-14-0487 · 4.32 Impact Factor
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    ABSTRACT: Patients are increasingly using the Internet to communicate with health care providers and access general and personal health information. Missed test results have been identified as a critical safety issue with studies showing up to 75% of tests for emergency department (ED) patients not being followed-up. One strategy that could reduce the likelihood of important results being missed is for ED patients to have direct access to their test results. This could be achieved electronically using a patient portal tied to the hospital's electronic medical record or accessed from the relevant laboratory information system. Patients have expressed interest in accessing test results directly, but there have been no reported studies on emergency physicians' opinions. The aim was to explore emergency physicians' current practices of test result notification and attitudes to direct patient notification of clinically significant abnormal and normal test results. A cross-sectional survey was self-administered by senior emergency physicians (site A: n=50; site B: n=39) at 2 large public metropolitan teaching hospitals in Australia. Outcome measures included current practices for notification of results (timing, methods, and responsibilities) and concerns with direct notification. The response rate was 69% (61/89). More than half of the emergency physicians (54%, 33/61) were uncomfortable with patients receiving direct notification of abnormal test results. A similar proportion (57%, 35/61) was comfortable with direct notification of normal test results. Physicians were more likely to agree with direct notification of normal test results if they believed it would reduce their workload (OR 5.72, 95% CI 1.14-39.76). Main concerns were that patients could be anxious (85%, 52/61), confused (92%, 56/61), and lacking in the necessary expertise to interpret their results (90%, 55/61). Although patients' direct access to test results could serve as a safety net reducing the likelihood of abnormal results being missed, emergency physicians' concerns need further exploration: which results are suitable and the timing and method of direct release to patients. Methods of access, including secure Web-based patient portals with drill-down facilities providing test descriptions and result interpretations, or laboratories sending results directly to patients, need evaluation to ensure patient safety is not compromised and the processes fit with ED clinician and laboratory work practices and patient needs.
    Journal of Medical Internet Research 01/2015; 17(3):e60. DOI:10.2196/jmir.3721 · 4.67 Impact Factor

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