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The Kaiser Permanente EMR System: A real time success
Richard D. Dell, MD, answers 4 Questions about electronic medical records in a health care system.
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As we all move in varying steps into the world of electronic medical records (EMRs), one of the leaders in this field has been the Kaiser Permanente System. I feel we all could benefit from learning more about their experience. For this month’s interview, I turned to Richard D. Dell, MD, a fellow orthopedic surgeon. He has been intimately involved in the introduction and physician acceptance of this large system.
Douglas W. Jackson, MD
Chief Medical Editor
Douglas W. Jackson, MD: The extensive EMR system used by Kaiser has taken considerable financial resources, time and effort to get it to its current status. Could you share with our readers some of the background that has accounted for your successfully integrated system?
Richard D. Dell, MD: Kaiser Permanente has a long history of using information technology (IT) to improve patient care dating back more than 40 years. Most of the early IT work performed used mainframe computers and non-user friendly interfaces. The early work involved mostly getting data out of our IT systems, such as dictated notes, test results, and pharmacy information. These IT systems also focused on scheduling appointments and billing but had little or no interfaces for clinicians getting clinical information into our IT systems except by dictating notes or having their notes scanned into our IT systems. This is similar to the hybrid digital/paper IT system that many clinicians use today in their practices. Few clinicians use a pure paper based system in their practices because this hybrid digital/paper IT system currently cost effective and easy to implement.
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More than 15 years ago Kaiser Permanente began assessing if an IT system that has an EMR interface for clinicians could be implemented that works and can be used effectively to manage our 8.6 million members. The short answer is yes, Kaiser Permanente, as of March, has HealthConnect, a system-wide, fully functional EMR.
It wasn’t cheap, it wasn’t easy, and it wasn’t quick to implement, but as we rolled out HealthConnect from clinic to clinic, medical center to medical center, and finally region to region. We found best practices that made implementation easier with each successive HealthConnect Go-live event.
By far and away the most important factor in implementing an EMR is a knowledgeable and highly motivated champion to lead the way. I can’t overemphasize the importance of this champion to oversee training before and after implementation of the EMR as well as that all hardware, software, and networking issues are addressed. The champion must understand the impact of the EMR to workflow and how the workflow can actually be improved after implementing the EMR. If you implement an EMR and think all workflow will be the same you are in for a rude awakening. The EMR is a tool and your champion will show you ways to use this new tool in making your practice more efficient, cost effective, and improves the care for your patients.
Jackson: How is the system currently used for inpatient and outpatient orthopedic care and what are some of its benefits to all the stakeholders?
Dell: The mantra at Kaiser Permanente is that HealthConnect is a tool to improve efficiency in clinical settings. We use HealthConnect in every aspect of patient care including:
- Getting data out – Everyone loves the ability to quickly get to the data needed for patient care such as notes, lab test, and digital images. The EMR gives you the ability to use filters to quickly get to data and summary reports to put the data together for ease of use.
- Getting data in – This is the part of the EMR that many clinicians dread until the EMR champion shows them tips and tricks to quickly get data into the EMR using tool like macros, smart phrases, voice recognition, and other tools to get data into the EMR. Coding has improved after our EMR for various reasons including reminders to make sure coding is done correctly.
- Order Entry – Order entry is actually very easy to do with an EMR and makes errors significantly less if implemented correctly. Order Entry is also faster now and improves medication reconciliation when patients are admitted.
Jackson: Your system has already resulted in many contributions to orthopedic surgery. Share with us the capabilities it offers to you in your areas of research interest.
Dell: We don’t let the vast amount of data collected by HealthConnect just sit on our computers. We actively use that data to improve patient care in many ways including in our Kaiser Permanente Total Joint Registry and our Healthy Bones Program. When a patient has a fragility fracture and does not quickly get a DXA and/or begin on an anti-osteoporosis medication our Healthy Bones Program uses HealthConnect to identify that patient and we have our Healthy Bones Care Managers address the care gap. This has led to a drastic increase in getting our members DXA scans and/or anti-osteoporosis treatment when indicated and a steady decrease in our hip fracture rate at Kaiser Permanente. Our members win because a fragility fracture, especially a hip fracture, has a huge negative impact on their lives. Kaiser Permanente wins because it is much less expensive for us to prevent a hip fracture than treat a hip fracture. Society also wins because Kaiser Permanente has shown examples how to use an EMR to improve patient care in a cost effective way.
Jackson: What can the rest of us learn from your successes and setbacks as you developed the Kaiser EMR system and what are some of the awards and recognition has your system been given?
Dell: Hopefully the lessons we’ve learned in implementing HealthConnect can be used by other orthopedic surgeons when they implement their EMR. The EMR can improve the efficiency of your clinic and improve patient care along the way – we know this because we’ve done it. Kaiser Permanente has now received 24 Stage 7 Awards for our HealthConnect EMR. This is the highest possible award for an EMR. Our SCAL Kaiser Permanente Healthy Bones Program is now #1 in the United States on the Health Plan Employer Data and Information Set (HEDIS) fragility fracture measure. I don’t believe SCAL Kaiser Permanente would have achieved the HEDIS award without the use of HealthConnect to identify and treat our patients at risk for osteoporosis/fractures.
Editor’s note: For more on EMRs in orthopedics, read our cover story.
- Richard M. Dell, MD, can be reached in the Department of Orthopedics, Kaiser Permanente Downey Medical Center, 9353 E. Imperial Highway, Downey, CA 90242; 562-657-4125; e-mail: Richard.M.Dell@kp.org.
