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Lessons Learned From The Largest Civilian EHR System

Jan 28, 2011 (07:01 PM EST)

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Phil Fasano is the executive VP and CIO at Kaiser Permanente

Implementation of electronic health records continues across the nation as healthcare providers position themselves to take advantage of the federal government's incentive payment program, which begins this year and can yield tens of thousands of dollars to those that demonstrate "meaningful use." But implementation itself, from the acquisition of equipment, software, and services to training and utilization, can cost providers hundreds of thousands of dollars, so it's nonetheless critical to make wise choices.

In choosing and deploying an EHR system, continually remind yourself of what it is you're supposed to bring to your practice: connectivity and better coordination among care teams; improved quality and patient safety; efficiency and reduced care costs. As you make system choices, ask how these goals can be advanced--or hampered--through specific EHR capabilities.

Kaiser Permanente is proud to have implemented the largest civilian EHR system in the world, KP HealthConnect, developed with Epic Systems and incorporating a number of third-party applications. It securely connects 8.6 million Kaiser Permanente patients (the company calls them "members") to their healthcare teams, their personal health information, and the latest medical knowledge.

Following are some of the valuable lessons we've learned through this ongoing journey, lessons that I hope will provide insight for your own process.

A Team Effort

We created a partnership between clinical and IT staff from the outset to make sure the EHR system would work not only on the technology side, but also in real-time application by front-line clinicians. We never treated the implementation of KP HealthConnect as an IT endeavor; we approached it as a quality initiative supported by the highest level of the organization.

Our physicians and other caregivers were instrumental in this journey from the beginning, and the system was built to facilitate and enhance doctor-patient interaction, not replace it.

We also examined our care delivery workflows and care practices to ensure that the move from paper to electronic processes would be a smooth one. This due diligence helped to expedite the rate at which our doctors embraced EHRs. Still, we needed to evolve our approach as we learned how significantly an EHR changes operational workflow.

For the first time, all eight of our regions were operating on a common technology platform. A change of this magnitude required significant IT infrastructure upgrades, as well as a level of collaboration across all of Kaiser Permanente's regions and assets that had not been required previously.

The collaboration of IT staff and clinicians is also important when selecting vendors and products. By sharing as much information as possible about requirements and workflows, you can ensure that system choices match both infrastructure and the needs of caregivers.

Putting paper records into an electronic system isn't enough. Real-time healthcare requires an always-on technology infrastructure that is highly secure and supports interoperability--with the wide range of equipment and applications used within your organization, as well as with external providers with which you must share information.




Commitment Required

As EHR systems become more sophisticated and get populated with ever-expanding patient information, data storage emerges as a major challenge, especially when you consider the data volume associated with medical images. Kaiser Permanente continues to expand its use of picture archiving and communications systems. To put it into perspective, our storage systems handle more information than can be found in the volumes of the Library of Congress. We are engaging IT professionals on how to further compress data and store it while maintaining information access.

Our electronic health record systems need to be built and accessed in a way that improves patient-centered care. Tools that support electronic records must enhance the convenience, efficiency, and transparency of our interactions; let clinicians analyze the data and help them identify needed care; and provide computer simulation models that can be customized based on individuals' health histories and other factors. Think of these as "business intelligence" tools that can enhance patient health.

It must be easy to access and use these tools, and to retrieve information from and add information to the EHR without excessive delay or administrative burden. Much of the progress Kaiser Permanente has made in recent years in population care and care registries is a direct result of fluid information exchange among providers--and between providers and patients.

Any EHR system is only as good as the ecosystem of technologies surrounding it. Integrating dozens, even hundreds, of adjacent applications and systems is paramount. When choosing an EHR system, consider ease of integration in addition to best-of-breed functionality.

EHR systems, like every other part of care, will continue to evolve, so remember that systems must be flexible and adaptable to address the future needs of both clinical and IT staff.

Phil Fasano is the executive VP and CIO at Kaiser Permanente. Write to us at iwletters@techweb.com.