1998 Davies Organizational Award Winner Kaiser Permanente Northwest Christina McClenaghan National University June, 2013

Abstract Kaiser Permanente of the Northwest (KPNW) began as a prepaid healthcare system to serve shipyard workers at the Kaiser shipyards in Vancouver, Washington and Portland, Oregon thru World War II. Over time, the scope of the organization changed and at the time of the Davies Award, KPNW served to provide care to upwards of 400,000 members at Kaiser Sunnyside Medical Center, 21 medical offices, and sic community hospitals (HIMSS, 2007). This case study will discuss how and if each of the Meaningful Use Stage 1 Priority Goals established by the Office of the National Coordinator for Health Information Technology (ONC) was addresses, as well as seek to identify if anything could have been done differently to improve the outcomes of the organization as related to the study of the Electronic Health Record (EHR) implementation.

Meaningful Use seeks to promote the use of electronic health records (EHR) systems as a way to improve health care. Benefits of meaningful use of EHR systems include providing practitioners complete and accurate information to be able to provide the best possible care available. Electronic health records facilitate better access to information that providers need to intervene earlier and improve their patients health outcomes and EHRs can also empower patients to take a more active role in their health care by ensuring that they have access to their own medical records and are able to share that information securely with family members or other providers participating in their care (HealthIt.gov, 2012). Meaningful use uses certified EHR technology to 1) improve quality, safety, efficiency and to reduce health disparities, 2) engage patients and family, 3) improve coordination of care as well as population and public health and 4) maintain the privacy and security of patient health information (PHI) (HealthIT.gov, 2012). Stage 1 of meaningful use focuses on data capture and sharing of information. Kaiser Permanente of the Northwest began their EHR implementation with the formation of an Information Services Steering Committee (HIMMS, 2007). The role of the steering committee was to develop the strategic plan, capital budget and policies that would influence the use of information within the organization (HIMMS, 2007). In 1991 the organization began work on results reporting systems (RSS) which fused electronically accessible, clinically significant data drawn from ancillary systems in a read-only format (HIMMS, 2007). This served to meet the ONC meaningful use goal of ensuring that MU results in better clinical outcomes. The RSS was able to allow providers to access a single patient-centered database which included benefit and demographics information, pharmacy data, reports, laboratory results, inpatient admission information, discharge and transfer (ADT) information, as well as tumor registry data. The successful implementation of the RSS clearly demonstrated that computer technology could serve to improve the providers ability to provide the best available care to

their patients and also made way for the clinicians acceptance of KPNWs implementation of EpicCare (HIMSS, 2007). The EpicCare pilot which began in 1993 was used in 2 outpatient medical facilities by 46 primary care providers by 1994 (HIMMS, 2007). EpicCare was more comprehensive than the RSS and automated outpatient documentation, ordering and messaging (HIMMS, 2007). The EpicCare system also provided clinicians with guidelines and medication suggestions in line with the MU goal of improving quality, safety and efficiency of health care services provided by clinicians within KPNW. While RSS required little effort from clinicians, EpicCare was more intensive and required more physician trainings to ensure acceptance and use and because it had so many more components and tools than the read-only RSS, the EpicCare system took much longer to build (HIMSS, 2007). Kaiser Permanente of the Northwest also saw the protection and security of the patient health information as key. Protection and security of PHI is also a goal of ONC MU (HealthIT.gov, 2012). Strategies employed by KPNW included keeping individual accounts and passwords and sharing such information was prohibited per organizational policy. Signed confidentiality statements were employed as well as detailed logs of all read and write activity. Routine checks on suspected breaches were done by the organizations Confidentiality Committee. Additionally, restrictions on users for application access were imposed based on the needs of the specific positions among other tools (HIMSS, 2007). With the implementation of both RSS and EpicCare, clinicians saw major changes to their workflow. KPNW remained open to feedback and promoted discussion as a mechanism for creating support and acceptance of the EHR from clinicians. Objective measurements were taken to guide future development of which surveys were very important to gauge the value to the end users (HIMMS). In 1997 clinician respondents to one such survey reported that EpicCare improved legibility and availability of chart notes, improved documentation of patient conditions and also supported disease-based

population care, tied to the ONC MU goal for improved care coordination and population health (HealthIT.gov, 2012). Cost of care was also impacted through use of the EHR as it prevented unnecessary duplication of tests, identified more cost effective modes of treatment when suitable. Because laboratory results were transmitted electronically through the EHR, clinician phone calls to the lab seeking results dropped dramatically allowing physicians to use that increase in available time to better serve their patients (HIMMS, 2007). Kaiser Permanente of the Northwest demonstrated that organizations of large size and complexity can benefit greatly through the implementation and use of EHR systems. This case study has shown how EHR systems can be used to decrease cost through ease of access to important data and reporting tools. EHR systems can also serve to support the ONC MU goal to engage patients and family (HealthIT.gov). Here is seems that KPNW has fallen a bit short. If at the initial installation of the EHR system the organization had made a push to include not just clinician and organizational end-user support and direction they may have seen even greater improvements in patient health outcomes through better patient engagement.

References Health Information and Management Systems Society (HIMSS). (2007). Improving Quality and Reducing Cost with Electronic Health Records: Case Studies from the Nicholas E. Davies Awards. Chicago, Il: HIMSS. HealthIT.gov. EHR Incentives & Certification: Meaningful Use Definition & Objectives. Retrieved from http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives