How health IT is changing health care at the point of service Featured

8:00pm EDT July 26, 2010

The use of health information technology has radically changed the medical industry, as the widespread use of electronic medical records and other tools will attest.

However, if a company wants to implement health IT, it should look for a carrier that has developed and executed a plan to unlock the benefits of that technology.

“The first step is to change patient care — the whole patient experience — so we can take better care of patients without the hassle of bringing them into the office when we don’t need to,” says Dr. Nabil Chehade, the assistant medical director of medical specialties and the director of medical informatics for Kaiser Permanente. “To be more efficient, basically. The second step is focusing on preventative care.”

Smart Business spoke with Chehade about how health IT has changed the way physicians care for patients, and why these changes matter.

What type of health IT do you use in your work?

All of our physicians do complete documentation of patient information on a common platform. Patients can send secure messages to their doctors as all doctors participate 100 percent. There is no opt-in or opt-out.

We also have a portal called Affiliate Link for our affiliated providers who aren’t part of our medical group. We make it so they can see the clinical documentation even though they are not part of our internal organization and they can respond back and forth as needed.

In addition, we have a homegrown electronic disease registry tool. It pools all the data directly from EMRs as well as other data, like claims, pharmacy, labs and radiology, and puts them together so a physician can take a look at specific patient populations. This allows the physician to look at the prevalent diseases in a population or to see lab results for a population rather than only being able to see data on an individual patient basis.

How does health IT change the way physicians do their job?

In the first couple of years, our physicians were getting acquainted with how to use these tools to replace old processes. Initially it created quite a bit of inefficiency. Suddenly, they had to use a computer; they had to do computerized order entry for labs, x-rays, and prescriptions.

Then we started leveraging the technology to change the way we care for the patient. We started using the tools in a different way.

What has been done?

First, we’ve leveraged these tools to improve the way physicians review a patient’s chart. Electronic medical records are easier to use: Physicians don’t have to carry a big chart everywhere, they don’t have to hunt through the chart to find the information they want. Sometimes the chart wouldn’t show up at their desk when the patient showed up.

Now it doesn’t matter which office they are in — they have access to the chart, even if they’re working from home. We give our physicians access to the medical records at any point of service, anywhere.

So the chart is easily accessed and user-friendly; it’s very well-organized electronically. That is a big plus for workflow and for better patient care.

Second, we’ve changed the way we care for patients. Instead of thinking about how an office visit works — how to fit everything into a 15- to 20-minute window — we can think about patient care differently, because the boundaries of paper charts and face-to-face visits don’t always have to be in play.

We are able to do a lot of things differently because, as an integrated health system, we are not bound by a lot of the criteria for generating income. In other words, physicians do not necessarily have to have a face-to-face visit with a patient in order to generate income.

So if a face-to-face visit isn’t required, we try to schedule telephone encounters. If you know ahead of time you want to follow up with a patient in six months because they need to get an X-ray, instead of scheduling them for a face-to-face visit, you schedule them for the X-ray and a telephone follow-up a few days later.

Their name will show up on your schedule with a notification that the patient is expecting your call at a certain time. You call the patient, review the X-ray with them, see if they need any other follow up, and document it in the EMR. You saved the patient the trip, you took care of the patient, and you solved their need. It’s a win-win situation for everybody.

How does health IT affect preventive care?

We have a couple big initiatives, including several tools we are using to proactively care for patients. One is called best practice alerts. When a physician sees a patient face-to-face that the system knows is potentially diabetic and has not had a recent blood test, an alert will pop up saying the patient is overdue for blood tests.

These alerts don’t just pop up for the primary care physician, but at all points of care. For example, when a woman who is overdue for a mammogram is seeing a urologist, our system will alert the urologist to order a mammogram. We make sure that not only the urologist gets the results, but also the primary care doctor, as well as the patient.

And, these alerts don’t just pop up for primary care. It’s across all points of care. Even if it’s a diabetic issue and the patient is seeing an orthopedic surgeon, the surgeon is still going to order the necessary tests.

Why is this so important?

Because we know that some patients have many more visits to specialty care than primary care. If we rely only on the primary care physician to do this work, we are going to miss a lot of opportunities for preventative care for chronic diseases. Everyone who interacts with the patient has the information to be able to help with screening and prevention.

Dr. Nabil Chehade is the assistant medical director of medical specialties and the director of medical informatics for Kaiser Permanente. Reach him at