The Kaiser Prototype for Health Information Technology

In 2004, Kaiser Permanente implemented KP HealthConnect, a possible prototype for an interoperable health information technology (HIT) system. A retrospective, observational study of one Kaiser Permanente region in the state of Hawaii explored the effects of HealthConnect on the performance of outpatient outcomes. Following the implementation of HealthConnect, office visits per enrollee declined from 2004 through 2007 by 26 percent, continuing a statistically significant trend noted prior to the implementation of HIT. External referrals declined 53 percent while urgent care and ER visits increased 19 and 11 percent, respectively (all statistically significant changes). The magnitude of the increase urgent care and ER visits was dwarfed by the decline in office visits.

Source: Ted Eytan (Flickr/CC)

The authors of the study also noted several Healthcare Effectiveness Data and Information Set (HEDIS) measures with mixed results on outcomes.  Screenings for breast cancer, colorectal cancer, diabetes control testing (HbA1C), and STD’s such as chlamydia all improved.  Despite these improvements, other areas of medical care show either no effect or negative effects after the implementation of the HIT. There was no change in childhood immunization status (about 86 percent in both 2004 and 2007). Diabetes control appeared to worsen even though testing was performed more often (high HbA1C: 35 percent in 2004 and 40 percent in 2007). This could be due to improvements in ordering HbA1C (a diabetes control measure) rather than poorer quality of medical care.

Commentary:

The current study adds to the body of knowledge about the generally positive impact of health information technology (HIT) which includes components such as electronic medical records, personal health records, computerized physician order entry, among other functions. However, health information technology is necessary but not sufficient for a more effective and productive health care system.  Certain clinical measures demonstrated either no effect or negative effects. Additionally, there was no investigation into the effect of KP HealthConnect on provider productivity. Better information will surely lead to better patient care, decreased duplicity of health care services, and eventually efficiencies in the delivery of care; but the seeds sown today may not reap benefits for some time.

Health Affairs. 2009. 28 (2): 323-333.

by

Cedric K. Dark, MD, MPH