EHRs improve chronic illness care
Specialty care physicians can improve the health of high-risk patients by reviewing EHRs and proactively providing e-consultations and treatment plan recommendations with primary care physicians, according to the results of a Kaiser Permanente pilot project published online July 9 in the British Medical Journal.
The quality improvement project at Kaiser demonstrated that specialists can take a more active role in managing the health of populations with chronic illness--in this case, kidney disease--by using EHRs to coordinate care among primary and specialty care providers. In the project, nephrologists consulted remotely with primary care doctors to help manage patients at risk for end-stage renal disease.
Using a system developed by the article's lead author and nephrologist Brian J. Lee, MD, and his colleagues at Kaiser, nephrologists in Hawaii used electronic lab results to rank more than 10,000 kidney patients not yet referred to a specialist by their risk for kidney failure. Then, they monitored the patients most at risk to make sure they were getting care in line with evidence-based treatment recommendations.
After identifying the at-risk patient population, the nephrologists relied on Kaiser's HealthConnect EHR system to evaluate the next steps. The nephrologists used the EHR to review the patient's EMR and to provide an e-consult to the patients' primary care physicians, according to the authors. In many cases, nephrologists recommended referral for more intensive specialty care. In others, the primary care physician was given the treatment plan necessary to prevent the need for referral.
Lee and colleagues wrote that the five-year project showed EHR usage increased early intervention for high-risk patients and reduced by two-thirds the number of late specialist referrals--those occurring within four months of the onset of end-stage renal disease.
"The goal with kidney disease is to detect it early enough to make changes that will slow the disease down," said Lee. "Patients who have a chance to consult with a nephrologist well before the onset of kidney failure are less likely to be hospitalized and more likely to survive longer. Our patients are more successful in starting dialysis when they are able to choose the type of dialysis or transplant with their physician, have a dialysis access implanted, start treatment outside of the hospital before becoming very ill, and be educated and psychologically prepared for it."
While the vast majority of chronic kidney disease patients can be successfully managed by primary care doctors, the authors noted that some patients are better off cared for by a nephrologist, particularly those at highest risk of worsening kidney disease.
"Our integrated system of primary and specialty care physicians working together provides complete care--from the prevention of disease to the management of acute and chronic illness," said Geoffrey Sewell, MD, president and executive medical director of the Hawaii Permanente Medical Group, whose 410 physicians exclusively provide care for 222,594 Kaiser members in Hawaii.
"This pilot illustrates the benefits of leveraging technology and the expertise within a multi-specialty group practice," Lee said. "In the past, specialists have been limited to helping only those patients who were referred to them. Now that we can use databases to identify disease trends and populations, and electronic health information to provide data on individual patients, our specialists can proactively find and recommend treatments for patients who could really use their help."
The quality improvement project at Kaiser demonstrated that specialists can take a more active role in managing the health of populations with chronic illness--in this case, kidney disease--by using EHRs to coordinate care among primary and specialty care providers. In the project, nephrologists consulted remotely with primary care doctors to help manage patients at risk for end-stage renal disease.
Using a system developed by the article's lead author and nephrologist Brian J. Lee, MD, and his colleagues at Kaiser, nephrologists in Hawaii used electronic lab results to rank more than 10,000 kidney patients not yet referred to a specialist by their risk for kidney failure. Then, they monitored the patients most at risk to make sure they were getting care in line with evidence-based treatment recommendations.
After identifying the at-risk patient population, the nephrologists relied on Kaiser's HealthConnect EHR system to evaluate the next steps. The nephrologists used the EHR to review the patient's EMR and to provide an e-consult to the patients' primary care physicians, according to the authors. In many cases, nephrologists recommended referral for more intensive specialty care. In others, the primary care physician was given the treatment plan necessary to prevent the need for referral.
Lee and colleagues wrote that the five-year project showed EHR usage increased early intervention for high-risk patients and reduced by two-thirds the number of late specialist referrals--those occurring within four months of the onset of end-stage renal disease.
"The goal with kidney disease is to detect it early enough to make changes that will slow the disease down," said Lee. "Patients who have a chance to consult with a nephrologist well before the onset of kidney failure are less likely to be hospitalized and more likely to survive longer. Our patients are more successful in starting dialysis when they are able to choose the type of dialysis or transplant with their physician, have a dialysis access implanted, start treatment outside of the hospital before becoming very ill, and be educated and psychologically prepared for it."
While the vast majority of chronic kidney disease patients can be successfully managed by primary care doctors, the authors noted that some patients are better off cared for by a nephrologist, particularly those at highest risk of worsening kidney disease.
"Our integrated system of primary and specialty care physicians working together provides complete care--from the prevention of disease to the management of acute and chronic illness," said Geoffrey Sewell, MD, president and executive medical director of the Hawaii Permanente Medical Group, whose 410 physicians exclusively provide care for 222,594 Kaiser members in Hawaii.
"This pilot illustrates the benefits of leveraging technology and the expertise within a multi-specialty group practice," Lee said. "In the past, specialists have been limited to helping only those patients who were referred to them. Now that we can use databases to identify disease trends and populations, and electronic health information to provide data on individual patients, our specialists can proactively find and recommend treatments for patients who could really use their help."