About Kaiser Permanente HealthConnect

Transcription

European Conference on SNOMED-CT
October 2, 2006 | Copenhagen, Denmark, EU
Kaiser Permanente
HealthConnect
A large scale EHR deployment
using SNOMED-CT
•Andrew M. Wiesenthal, MD, SM
•Associate Executive Director, The Permanente Federation
About Kaiser Permanente
•Largest nonprofit health plan in US
• Integrated health care
delivery system
• 8.5 million members
• 12,000+ physicians
• 140,000+ employees
• 8 regions serving 9 states and D.C.
• 32 hospitals and medical centers
• 430+ medical offices
• *$31 billion annual revenues
* 2005 revenues
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© Kaiser Permanente, 2006
About Kaiser Permanente HealthConnect™
• We are deploying virtually all major applications in the
Epic product suites:

Clinicals—inpatient and ambulatory, and inpatient pharmacy
Access—scheduling, registration and ADT
Revenue Cycle—billing and claims
eHealth
Enterprise Foundation—synchronization software
Managed Care—utilization management and referral management
• The largest civilian deployment of an electronic health
record in the world.
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Scope of KP HealthConnect
Web Access Portal
Care Delivery Core
Ancillaries
Health Plan
Finance
Scope of KP HealthConnect Suite
Outpatient
Pharmacy
Scheduling
Inpatient
Scheduling
Admission, Discharge
and Transfer
Lab
Registration
Radiology/
Imaging
Pharmacy
Clinicals
Emergency
Department
Operating Room
Others
(immunizations,
EKG, dictation)
Clinicals
Billing
Billing
Data Warehouse / EDR Enterprise Data Repository
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Referral & Utilization Management
Outpatient
Membership/
Benefits
General
Ledger
Claims
Processing
Capital
Planning
Benefits
Accumulation
Financial
Reporting
Pricing
System
KP HealthConnect Delivers the KP Promise
Quality Our Patients
Can Trust
High Quality
• We have clinical information
available 24/7.
• Our clinical outcomes are
unsurpassed.
• Our clinicians know in real-time
the recommended best
practices.
• We are the national leaders in
patient safety.
• We enhance our research to
support evidence-based care.
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Personal & Convenient
Service
Personal
• We have and use up-to-date
clinical, social and patient
preference information.
• We provide patients information
for shared decision making.
• We enhance personalized care.
Convenient
• Our patients access information
via telephone, Web and email.
• We actively support our patients’
participation in their own care.
• We minimize wait times and outof-pocket costs with efficient
access to care.
• We achieve superior integration
and continuity of care.
Affordable
Health Care
Affordable
• We reduce the cost of care and
improve visit experiences.
• We eliminate waste associated
with paper medical records and
missing medical records.
• We eliminate costly in-person
services unless medically
necessary or desired by the
patient.
• We streamline IT and
administrative processes and
costs
Progress to Date
• More than 4 million members have a partial or complete
EpicCare® Ambulatory record
All members will have one by mid-2008
• On-line functionality for members (MyChart®) is live in 7 out of
our 8 regions
1.7 million members are currently registered to access KP
HealthConnect through kp.org
• Two KP hospitals are now live with EpicCare® Inpatient
30 more hospitals will go live by 2009 (including hospitals currently
under construction)
• By the end of 2006, our Practice Management (Access & Revenue
Cycle) deployments will be complete
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Conformance to Standards
• KP HealthConnect is based on an array of existing and emerging
national (US) and international standard vocabularies
• Chief among these standards is SNOMED-CT
• Others include:

LOINC—laboratory
DICOM—images
RxNORM—pharmaceuticals
NIC, NOC, NANDA—nursing assessment vocabularies
• We have assembled all of these into a logical hierarchy we call
CMT, or convergent medical terminology
• All intersystem messaging is HL-7 compliant
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Standardized Vocabularies vs. ICD and CPT
• Richer, more granular expression
• More familiar to clinicians
• Hierarchical, group-able, and susceptible to
concatenation
Ideal qualities for decision support, analysis,
and population-based clinical and public health
intervention
• Greater clarity across interfaces
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How Does it Work?
• Epic software is organized around a set of Master Files
• Visualize spreadsheets of terms

Name
Unique identifier
Aliases/synonyms
Maps to other data/classification schemes (ICD, CPT)
• The key Master Files are:
Diagnosis (around 40,000 SNOMED-CT terms)
Procedures (around 100,000 terms—includes
supplies)
Anatomy
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How Does it Work?
• When a clinician documents care, the software
constrains entry technique and choice in certain
categories

Chief complaint
Vital signs
Physical findings
Assessment/Diagnosis
Plan
Orders
Patient instructions
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How Does it Work?
• When a clinician uses the chart for longitudinal
purposes, entry technique and choices are also
constrained
Problem list
History
Medical, Surgical, Family, Social
Allergies
Immunizations
Medication management
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Why do it This Way?
• We are implementing an EHR, not a vocabulary
• We need to enable clinicians to document in a
language that sounds right
• Extraction of data for financial, performance
management, and research purposes is a crucial
derivative function of the EHR
• SNOMED-CT and the group of vocabularies in
our CMT offer the most robust solution to this
problem set
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What are the Problems?
• We are among the first to do this
• Publicly available SNOMED-CT has large gaps
Certain diagnostic categories
Procedures and supplies
Mappings to classification schemes of financial
importance in the US
ICD, CPT
• SNOMED did not (does not) have the internal resources
to fill those gaps rapidly
The process of requesting or uploading new terms has
been difficult
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What Does it Look Like?
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Key Chart Elements are Encoded
Allergies
Chief
Complaint
Vital Signs
Health
Risks
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Medications are Encoded
Prescribed at
our pharmacy
Patient
reported
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Patient “Snap Shot”
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Documenting Review of Systems with Encoded Elements
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Documenting Review of Systems…
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Documenting Review of Systems…
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Documenting Physical Examination with Encoded Elements
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Free Text is also Possible
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Encoding Allows for Alerts
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Granular Encoding in Medication Ordering
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…Also Allows for Alerts by Drug Name…
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…Or Drug Class
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Orders Can be Associated with Diagnoses
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Documentation can be Structured into Historical Flows
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In the End…
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•
•
•
•
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The Holy Grail
Physicians Document
Nurses Document
Data is created
Systematic Feedback Occurs
Improved Health Outcomes and Operational
Efficiencies are Possible
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What Has this Meant for Kaiser Permanente’s Members?
• Dramatically lowered cardiac disease mortality
• Improved use of preferred drugs
COX-II inhibitor story
• Better Syndromic Surveillance
Rotavirus Vaccine and Intussusception
• Data about Clinician Performance
• Improved Clinical Research Capabilities
• More to Come
Adult oncology standardization and protocol
improvement
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