Kaiser Permanente HealthConnect - EHR and SNOMED


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Andrew M. Wiesenthal, MD, SM
Associate Executive Director, The Permanente Federation

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  • Kaiser Permanente HealthConnect - EHR and SNOMED

    1. 1. Kaiser Permanente HealthConnect <ul><li>Andrew M. Wiesenthal, MD, SM </li></ul><ul><li>Associate Executive Director, The Permanente Federation </li></ul>
    2. 2. About Kaiser Permanente <ul><li>Integrated health care delivery system </li></ul><ul><li>32 hospitals and medical centers </li></ul><ul><li>430+ medical offices </li></ul><ul><li>*$35 billion annual revenues </li></ul><ul><li>8.5 million members </li></ul><ul><li>150,000+ employees </li></ul><ul><li>8 regions serving 9 states and D.C. </li></ul><ul><li>13,000+ physicians </li></ul><ul><li>Largest nonprofit health plan in US </li></ul>* 2006 revenues
    3. 3. About Kaiser Permanente HealthConnect™ <ul><li>We are deploying virtually all major applications in the Epic product suites: </li></ul><ul><ul><li>Clinicals—inpatient and ambulatory, and inpatient pharmacy </li></ul></ul><ul><ul><li>Access—scheduling, registration and ADT </li></ul></ul><ul><ul><li>Revenue Cycle—billing and claims </li></ul></ul><ul><ul><li>eHealth </li></ul></ul><ul><ul><li>Enterprise Foundation—synchronization software </li></ul></ul><ul><ul><li>Managed Care—utilization management and referral management </li></ul></ul><ul><li>The largest civilian deployment of an electronic health record in the world. </li></ul>
    4. 4. Scope of KP HealthConnect Care Delivery Core Outpatient Inpatient Scope of KP HealthConnect Suite Scheduling Registration Clinicals Billing Scheduling Admission, Discharge and Transfer Clinicals Billing Pharmacy Emergency Department Operating Room Health Plan Web Access Portal Ancillaries Referral & Utilization Management Finance Lab Radiology/ Imaging Others (immunizations, EKG, dictation) Outpatient Pharmacy Claims Processing Membership/ Benefits Benefits Accumulation Pricing System Data Warehouse / EDR Enterprise Data Repository Capital Planning General Ledger Financial Reporting
    5. 5. KP HealthConnect Delivers the KP Promise Quality Our Patients Can Trust <ul><li>High Quality </li></ul><ul><li>We have clinical information available 24/7. </li></ul><ul><li>Our clinical outcomes are unsurpassed. </li></ul><ul><li>Our clinicians know in real-time the recommended best practices. </li></ul><ul><li>We are the national leaders in patient safety. </li></ul><ul><li>We enhance our research to support evidence-based care. </li></ul>Personal & Convenient Service <ul><li>Personal </li></ul><ul><li>We have and use up-to-date clinical, social and patient preference information. </li></ul><ul><li>We provide patients information for shared decision making. </li></ul><ul><li>We enhance personalized care. </li></ul><ul><li>Convenient </li></ul><ul><li>Our patients access information via telephone, Web and email. </li></ul><ul><li>We actively support our patients’ participation in their own care. </li></ul><ul><li>We minimize wait times and out-of-pocket costs with efficient access to care. </li></ul><ul><li>We achieve superior integration and continuity of care. </li></ul>Affordable Health Care <ul><li>Affordable </li></ul><ul><li>We reduce the cost of care and improve visit experiences. </li></ul><ul><li>We eliminate waste associated with paper medical records and missing medical records. </li></ul><ul><li>We eliminate costly in-person services unless medically necessary or desired by the patient. </li></ul><ul><li>We streamline IT and administrative processes and costs </li></ul>
    6. 6. Progress to Date <ul><li>More than 8 million members have a partial or complete EpicCare® Ambulatory record </li></ul><ul><ul><li>All members will have one by mid-2008 </li></ul></ul><ul><li>On-line functionality for members (MyChart®) is live in all of our 8 regions </li></ul><ul><ul><li>2.5 million members are currently registered to access KP HealthConnect through kp.org </li></ul></ul><ul><li>Seven KP hospitals are now live with EpicCare® Inpatient </li></ul><ul><ul><li>27 more hospitals will go live by 2009 (including hospitals currently under construction) </li></ul></ul><ul><li>Practice Management (Access & Revenue Cycle) deployments are complete </li></ul>
    7. 7. Conformance to Standards <ul><li>KP HealthConnect is based on an array of existing and emerging national (US) and international standard vocabularies </li></ul><ul><li>Chief among these standards is SNOMED-CT </li></ul><ul><li>Others include: </li></ul><ul><ul><li>LOINC—laboratory </li></ul></ul><ul><ul><li>DICOM—images </li></ul></ul><ul><ul><li>RxNORM—pharmaceuticals </li></ul></ul><ul><ul><li>NIC, NOC, NANDA—nursing assessment vocabularies </li></ul></ul><ul><li>We have assembled all of these into a logical hierarchy we call CMT, or convergent medical terminology </li></ul><ul><li>All intersystem messaging is HL-7 compliant </li></ul>
    8. 8. Standardized Vocabularies vs. ICD and CPT <ul><li>Richer, more granular expression </li></ul><ul><li>More familiar to clinicians </li></ul><ul><li>Hierarchical, group-able, and susceptible to concatenation </li></ul><ul><ul><li>Ideal qualities for decision support, analysis, and population-based clinical and public health intervention </li></ul></ul><ul><li>Greater clarity across interfaces </li></ul>
    9. 9. How Does it Work? <ul><li>Epic software is organized around a set of Master Files </li></ul><ul><li>Visualize spreadsheets of terms </li></ul><ul><ul><li>Name </li></ul></ul><ul><ul><li>Unique identifier </li></ul></ul><ul><ul><li>Aliases/synonyms </li></ul></ul><ul><ul><li>Maps to other data/classification schemes (ICD, CPT) </li></ul></ul><ul><li>The key Master Files are: </li></ul><ul><ul><li>Diagnosis (around 40,000 SNOMED-CT terms) </li></ul></ul><ul><ul><li>Procedures (around 100,000 terms—includes supplies) </li></ul></ul><ul><ul><li>Anatomy </li></ul></ul>
    10. 10. How Does it Work? <ul><li>When a clinician documents care, the software constrains entry technique and choice in certain categories </li></ul><ul><ul><li>Chief complaint </li></ul></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><li>Physical findings </li></ul></ul><ul><ul><li>Assessment/Diagnosis </li></ul></ul><ul><ul><li>Plan </li></ul></ul><ul><ul><ul><li>Orders </li></ul></ul></ul><ul><ul><ul><li>Patient instructions </li></ul></ul></ul>
    11. 11. How Does it Work? <ul><li>When a clinician uses the chart for longitudinal purposes, entry technique and choices are also constrained </li></ul><ul><ul><li>Problem list </li></ul></ul><ul><ul><li>History </li></ul></ul><ul><ul><ul><li>Medical, Surgical, Family, Social </li></ul></ul></ul><ul><ul><li>Allergies </li></ul></ul><ul><ul><li>Immunizations </li></ul></ul><ul><ul><li>Medication management </li></ul></ul>
    12. 12. Why do it This Way? <ul><li>We are implementing an EHR, not a vocabulary </li></ul><ul><li>We need to enable clinicians to document in a language that sounds right </li></ul><ul><li>Extraction of data for financial, performance management, and research purposes is a crucial derivative function of the EHR </li></ul><ul><li>SNOMED-CT and the group of vocabularies in our CMT offer the most robust solution to this problem set </li></ul>
    13. 13. What are the Problems? <ul><li>We are among the first to do this </li></ul><ul><li>Publicly available SNOMED-CT has had some gaps </li></ul><ul><ul><li>Certain diagnostic categories </li></ul></ul><ul><ul><li>Procedures and supplies </li></ul></ul><ul><ul><li>Mappings to classification schemes of financial importance in the US </li></ul></ul><ul><ul><ul><li>ICD, CPT </li></ul></ul></ul><ul><li>SNOMED did not (and the IHTSDO does not) have the internal resources to fill those gaps rapidly </li></ul><ul><ul><li>Work is ongoing to refine the process of requesting or uploading new terms </li></ul></ul>
    14. 14. What Does it Look Like?
    15. 15. Key Chart Elements are Encoded Chief Complaint Vital Signs Allergies Health Risks
    16. 16. Medications are Encoded Prescribed at our pharmacy Patient reported
    17. 17. Patient “Snap Shot”
    18. 18. Documenting Review of Systems with Encoded Elements
    19. 19. Documenting Review of Systems…
    20. 20. Documenting Review of Systems…
    21. 21. Documenting Physical Examination with Encoded Elements
    22. 22. Free Text is also Possible
    23. 23. Encoding Allows for Alerts
    24. 24. Granular Encoding in Medication Ordering
    25. 25. …Also Allows for Alerts by Drug Name…
    26. 26. …Or Drug Class
    27. 27. Orders Can be Associated with Diagnoses
    28. 28. Documentation can be Structured into Historical Flows
    29. 29. In the End… <ul><li>The Holy Grail </li></ul><ul><li>Physicians Document </li></ul><ul><li>Nurses Document </li></ul><ul><li>Data is created </li></ul><ul><li>Systematic Feedback Occurs </li></ul><ul><li>Improved Health Outcomes and Operational Efficiencies are Possible </li></ul>DATA
    30. 30. What Has this Meant for Kaiser Permanente’s Members? <ul><li>Dramatically lowered cardiac disease mortality </li></ul><ul><li>Improved use of preferred drugs </li></ul><ul><ul><li>COX-II inhibitor story </li></ul></ul><ul><li>Better Syndromic Surveillance </li></ul><ul><ul><li>Rotavirus Vaccine and Intussusception </li></ul></ul><ul><li>Data about Clinician Performance </li></ul><ul><li>Improved Clinical Research Capabilities </li></ul><ul><li>More to Come </li></ul><ul><ul><li>Adult oncology standardization and protocol improvement </li></ul></ul>