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Harnessing Effective EHR Use for Improved Patient Care

Kaiser Permanente is helping providers fine tune their EHR use through safety net programs, ensuring that patients receive proper care and physicians are supported.

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Source: Thinkstock

By Elizabeth Snell

- Improving EHR use can help reduce physician burnout and strengthen the patient care process. When healthcare providers understand how to best leverage new technologies and are able to adopt and implement an integrated EHR system, both patients and providers will benefit.

That has been Kaiser Permanente’s top goal with its EHR safety net programs, looking to reduce errors in the diagnostic process.

Kaiser Permanente has developed a total 54 EHR safety net programs, which are collectively called KP SureNet. The programs have helped to close major care gaps over the past few years.

Michael Kanter, MD, Medical Director, Quality and Clinical Analysis, Southern California Permanente Medical Group explained to EHRIntelligence.com that KP SureNet utilizes electronic clinical surveillance tools to systematically identify and address potential care gaps in clinical settings.

For example, the programs could pinpoint a lag in time between an abnormal test result and further investigation.

READ MORE: OCHIN Partnership to Improve EHR Use for Epic, NextGen Users

“We began in 2006 with a safety net program that identified men with an elevated prostate-specific antigen level who had not been evaluated by a urologist within 12 weeks of receiving results,” Kanter said in an email. “As a result of the safety net program, many of those men received a biopsy and subsequently were diagnosed and treated for prostate cancer.”

One Southern California KP SureNet program helped ensure that patients with an abnormal kidney function measurement received a follow-up evaluation. Approximately 12,000 patients had not received follow-up despite abnormal creatinine levels, which is a potential marker of chronic kidney disease. Of those patients, more than 3,000 were newly diagnosed and then successfully treated.

KP SureNet has also reduced the potential medication related safety risk for outpatients who have a history of falls or dementia by 70 percent.

“One of the biggest challenges for any healthcare organization is identifying and addressing potential care gaps such as with medical testing: making sure that the patient understands the results of their tests, that their doctors communicate next steps, that the patient actually gets the test or follow up done, and that there is a system in place that ensures those steps are taken. EHR safety nets can help address these challenges,” Kanter explained.

“My hope is that through our proven record of successfully implementing these kinds of programs, we can show other healthcare organizations that it is possible to implement their own EHR safety nets to improve the care of patients,” he continued. “The first step is reviewing the evidence and policies to identify the problem you want to solve and which solutions will have the greatest impact. Then subject matter experts and leadership must convene to develop and build the safety net, including tools and algorithms in the EHR, and then the outcomes should be measured on an ongoing basis.”

READ MORE: How Increasing EHR Adoption, HIE Use Fuels Healthcare Industry

The electronic clinical surveillance tool is just one example of how the Kaiser Permanente system improves care and safety for patients, while also supporting physicians, Kanter noted.

EHRs can also help facilitate collaboration among medical teams, address patient health needs outside of traditional clinical settings, intercept diagnostic and medication errors and identify social issues affecting patient health.

For Kaiser Permanente specifically, the EHR system is also the backbone to the healthcare company’s research program, Kanter said.

“EHRs can be difficult to use as they are designed more to keep track of billing and less to increase physician productivity or improve the patient encounter,” he stated. “Data entry can be time consuming and not always intuitive.”

EHRs can be modified though to better support physicians, Kanter maintained.

READ MORE: EHR System Customization Benefits Patient-Centered Medical Homes

A medical office’s culture is one of the biggest challenges to adopting and developing an EHR safety net program, he said.

“Physicians that may be resistant to change or get defensive when something may appear to have been missed,” Kanter posited. “Healthcare leaders can address these issues by encouraging a speak up culture that avoids blaming or shaming and encourages physicians to acknowledge that these programs are all about promoting patient safety.”

“For this to be successful, physicians must be comfortable with the idea that they can report near misses or actual gaps in care and that they may periodically get prompted on a suspected care gap – even if it turns out that it really wasn’t a gap,” he continued. “They need to realize that technology can help them identify care gaps and improve the care they provide to their patients.”

EHR safety nets will be critical to providing a more detailed picture of patient medical care, Kanter reiterated.

“Having these Safety Nets in place will eventually become the standard for all practices and make a significant dent in the rate of misdiagnosis in our country.”

Last year, Cincinnati Children’s Medical Center improved clinical, functional, and patient-reported outcomes for children with chronic or complex conditions by utilizing quality improvement methods. This included developing EHR registries and tools.

Over a three-year period, researchers developed the Condition Quality Outcomes Initiative to assist condition teams in applying parts of the Chronic Care Model to improve outpatient care delivery for chronically-ill children.

Having an EHR registry and system tools gave clinicians awareness and monitoring benefits, including being able to monitor which patients were being seen for care, which were missing care, and how patients were progressing. 

Optimized EHR use can help both providers and patients throughout the care process, lowering administrative burden while also ensuring that patients are properly diagnosed.

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