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

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

Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently non-Hispanic whites to access their EHR information online. This differential portal could be problematic for care disparities since early links better outcomes.We sought understand specific barriers among African American and Latino at Kaiser Permanente, which has had a in place over decade, broad uptake patient population...

<h3>Abstract</h3> <b>Objective</b> To evaluate the effect of implementing comprehensive, integrated electronic health record systems on use and quality ambulatory care <b>Design</b> Retrospective, serial, cross sectional study. <b>Setting</b> Colorado Northwest regions Kaiser Permanente, a US healthcare delivery system. <b>Population</b> 367 795 members in region 449 728 region. <b>Intervention</b> Implementation systems. <b>Main outcome measures</b> Total number office visits primary care,...

Objectives To evaluate the impact of electronic health record (EHR) implementation on nursing care processes and outcomes. Design Interrupted time series analysis, 2003–2009. Setting A large US not-for-profit integrated organization. Participants 29 hospitals in Northern Southern California. Intervention An EHR including computerized physician order entry, documentation, risk assessment tools, documentation tools. Main outcome measures Percentage patients with completed assessments for...

Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from each workday. However, on average, secure with has not substantially impacted provider workloads. e-mail been associated increased member retention improved quality care. Separate studies patient portal use both decreased other health services, such as office visits, telephone encounters, emergency department hospitalizations. Directions for future...

To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across settings.To describe use of Care Directives Activity tab (CDA), a single-location feature electronic health for collecting viewing ACP documentation inpatient ambulatory settings, to assess its association with rates.Retrospective pre- postimplementation analysis 2012 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years...

Electronic health records have the potential to improve environmental footprint of care industry. We estimate that Kaiser Permanente's electronic record system, which covers 8.7 million beneficiaries, eliminated 1,000 tons paper and 68 x-ray film, it has lowered gasoline consumption among patients who otherwise would made trips doctor by at least three gallons per year. However, use personal computers resulted in higher energy generated an additional 250 waste. conclude a positive net effect...

Using electronic health records (EHR) to automate publicly reported quality measures is receiving increasing attention and one of the promises EHR implementation. Kaiser Permanente has fully or partly automated six 13 joint commission measure sets. We describe our experience with automation resulting time savings: a reduction by approximately 50% abstractor required for set alone (surgical care improvement project). However, illustrates gap between current desired states public reporting,...

To explore how nurses use an integrated Electronic Health Record (EHR) in practice.A multi-site case study across two hospitals Kaiser Permanente Northern California. Non-participant observation was used to nurses' of the EHR, while semi-structured interviews with and managers explored their perceptions EHR it affected practice. Data were analyzed thematically using codes derived deductively from literature inductively data.Key themes arising analysis suggest that changed various elements...

This study measured the impact of an electronic Panel Support Tool (PST) on primary care teams' performance preventive, monitoring, and therapeutic evidence-based recommendations. The PST, tightly integrated with a comprehensive health record, is dynamic report that identifies gaps in 32 recommendations for individual patients, groups patients selected by provider, or all provider's panel. It combines point-of-care recommendations, disease registry capabilities, continuous feedback...

Benefits of early nephrology care are well-established, but as many 40% U.S. patients with end-stage renal disease (ESRD) do not see a nephrologist before its onset. Our objective was to evaluate the effect proactive, population-based oversight (PPNO) on chronic kidney (CKD) progression.Retrospective control analysis Kaiser Permanente Hawaii members CKD using propensity score matching methods. We matched 2,938 and case pairs individuals stage 3a for pre-PPNO period (2001-2004) post-PPNO...

To assess associations between secure patient-clinician email use and clinical services utilisation over time.Retrospective cohort study July 2010 December 2013. Controlling for a surge around first use, we analysed difference of differences propensity score-matched groups users non-users 1-12 months before 7-18 after (users) or randomly assigned index date (non-users).US integrated healthcare delivery system.9345 adults with 2011 2012 continuous enrolment ≥30 9345 without matched to on...

Abstract Objective To develop an information model for automating evaluation of concordance between patient preferences and end-of-life care. Methods We modeled validated 15 care preference option domains, to which we mapped recorded in standardized advance planning documents 232 events defined by procedure medication codes. Patient were available electronic health records. Data from Kaiser Permanente Southern California modeling testing populations evaluated patients’ the they experienced....

Physician use of secure e-mail with patients is anticipated to increase under Stage 2 Meaningful Use requirements, but little known about how physicians can successfully incorporate it into daily work. We interviewed 27 "super user" at Kaiser Permanente and Group Health who were identified by leaders as being technologically, operationally, clinically adept having high levels patients. They highly valued the patients, despite concerns a lack adequate time respond, provided tips for using...

Kaiser Permanente (KP) has a long-standing commitment to conduct research and report publicly. Simultaneously, it faces different imperative: harnessing information systems leverage internal improvements in outcomes, efficiency, costs. Now that KP HealthConnect, the electronic health record, is fully implemented, challenges at are moving away from issues of data access toward mechanisms through which raw create meaningful clinical knowledge based on rigorous research. In this we describe...

Background/Aims: We describe a predictive analysis to help regional operations engage smoking members with high likelihood of enrollment into cessation services.

Background/Aims: Previous observational studies have reported conflicting results when evaluating patients' use of secure email and their in-person clinical services. Different found that between patients health care providers may substitute for, increase, or no impact on the need for In this study we used diagnosis codes order associated with emails to categorize type communication. We then evaluated whether particular categories substituted

Di Meng1 and Terhilda Garrido1 1Kaiser Permanente Program Offices