If You Build It, Will They Come? The Kaiser Permanente Model Of Online Health Care

Silvestre, Anna-Lisa; Sue, Valerie M.; Allen, Jill Y.

doi:10.1377/hlthaff.28.2.334

Cited by 123 publications

(96 citation statements)

References 4 publications

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“…Most published experiences with engaging patients online have occurred in integrated health systems that have resources and business models to support adoption, implementation, and maintenance of the personal health record. [6][7][8][9] For example, between 2002 and 2009, Kaiser Permanente and Group Health Cooperative of Puget Sound made major investments to promote online services, resulting in uptake by 27% and 58% of patients, respectively, over 6 to 9 years. …”

Section: 3mentioning

confidence: 99%

Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

Krist

Woolf

Bello

et al. 2014

The Annals of Family Medicine

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PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODSWe conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively.RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake.CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. 2014;12:418-426. doi: 10.1370/afm.1691. Ann Fam Med INTRODUCTIONE lectronic personal health records hold great promise for improving health. High-quality personal health records can facilitate connectivity between patients and clinicians, allow patients to view their medical record, support online clinical and administrative transactions, deliver essential resources to promote informed decision making, and more actively engage patients in care. 1 In the United States, regulations developed by the Office of the National Coordinator and the Centers for Medicare and Medicaid Services to strengthen the functionality of electronic health record systems (meaningful use regulations) encourage practices to engage patients in care through information technology, such as personal health records. 2,3Although patients appear interested, 4,5 practices cannot meet this need without infrastructure, workflow, and cultural changes. Most published experiences with engaging patients online have occurred in integrated health systems that have resources and business models to support adoption, implementation, and maintenance of the personal health record. [6][7][8][9] For example, between 2002 and 2009, Kaiser Permanente and Group Health Cooperative of Puget Sound made major investments to promote online services, resulting in uptake by 27% and 58% of patients, respectively, over 6 to 9 years. 419...

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Section: 3mentioning

confidence: 99%

Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

Krist

Woolf

Bello

et al. 2014

The Annals of Family Medicine

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“…33,34 Motivating even more patients to use a personal health record with advanced functionality may require practices to make major changes. To understand the value and relevance to care, patients may need information about the tool, how it works, and why it is important for them.…”

Section: -Month Data Collection Int Er Ac T Ive Pr E V Ent Iv E He mentioning

confidence: 99%

Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial

Krist¹,

Woolf²,

Rothemich³

et al. 2012

The Annals of Family Medicine

101

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PURPOSE Americans receive only one-half of recommended preventive services. Information technologies have been advocated to engage patients. We tested the effectiveness of an interactive preventive health record (IPHR) that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational resources, and generates reminders. METHODSThis randomized controlled trial involved 8 primary care practices. Four thousand fi ve hundred patients were randomly selected to receive a mailed invitation to use the IPHR or usual care. Outcomes were measured using patient surveys and electronic medical record data and included IPHR use and service delivery. Comparisons were made between invited and usual-care patients and between users and nonusers among those invited to use the IPHR.RESULTS At 4 and 16 months, 229 (10.2%) and 378 (16.8%) of invited patients used the IPHR. The proportion of patients up-to-date with all services increased between baseline and 16 months by 3.8% among intervention patients (from 11.4% to 15.2%, P <.001) and by 1.5% among control patients (from 11.1% to 12.6%, P = .07), a difference of 2.3% (P = .05). Greater increases were observed among patients who used the IPHR. At 16 months, 25.1% of users were up-todate with all services, double the rate among nonusers. At 4 months, delivery of colorectal, breast, and cervical cancer screening increased by 19%, 15%, and 13%, respectively, among users.CONCLUSIONS Information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery. Engaging more patients to use systems could have important public health benefi ts. Ann Fam Med 2012;10:312-319. doi:10.1370/afm.1383. INTRODUCTIONA mericans receive only one-half of recommended preventive services.1 Among the various causes is poor access to reliable information. Patients need evidence-based information about what is recommended-tailored to their individual risk factors (eg, age, sex, co mbordities, prior testing, family history, health behaviors)-and presented in an understandable format.2 They need reminders when services are due, guidance to deal with inconsistent recommendations, and access to decision aids for choices that require shared decision making. [3][4][5] To act on their choices, patients need written plans and logistical details. 6,7 Clinicians often lack time and resources to provide this information. 8 One proposed solution is to harness the power of information technology, especially personal health records. For the purposes of this article, personal health records are broadly defi ned as health information systems used by patients, whereas electronic health records (EHRs) are systems primarily used by clinicians. 313 INT ER AC T IVE PR E V ENT IV E HE A LT H R ECOR Dgive patients direct access to the EHR of their clinician, 9,10 which is empowering, speeds access to results, and enables patients to discover inaccuracies in their medical record. The next gene...

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“…In the US, Kaiser Permanente has had success in securing two-thirds of its 3.4 million members to sign up for online appointment booking, viewing test results, and e-mail. 16 Similarly, the Veterans Health Administration has also registered large numbers online, with over 600 000 users making over 20 million 'visits' over the internet by 2008; with the most popular service being online repeat prescription requests; 17 but uptake on this scale has yet to be replicated in the UK.…”

Section: Introductionmentioning

confidence: 99%

Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

et al. 2015

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BackgroundOnline access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. AimTo assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. Design and settingA systematic review was conducted that focused on all studies about online record access and transactional services in primary care. MethodData sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012. The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. ResultsA total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved selfcare, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. ConclusionWhile the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so.

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If You Build It, Will They Come? The Kaiser Permanente Model Of Online Health Care

Cited by 123 publications

References 4 publications

Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial

Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

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