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Outpatient Safety Net Harnesses Electronic Health Data

Doctor with tablet


25 June 2014. The Kaiser Permanente health plan in Southern California, headquartered in Pasadena, established a follow-up monitoring system for plan members visiting doctors’ offices or outpatient clinics that scans its electronic health records database for gaps in outpatient care. A team from Kaiser Permanente’s Southern California network, led by regional quality and clinical analysis director Michael Kanter, described the system yesterday in the online journal eGEMS.

The monitoring system, called the Outpatient Safety Net Program, aims to provide a quality assurance step for ambulatory patients — those needing routine (non-emergency) medical care, but not requiring hospitalization — covered by the Kaiser Permanente plan. The system scans Kaiser-Permanente’s health records database for particular conditions or events, such as potentially harmful drug interactions or missed diagnoses, across a range of medical conditions.

The plan’s health records database, known as HealthConnect, covers all 9.3 million plan members nationwide and offers patients a personal health record, including versions for mobile devices. In Southern California, Kaiser Permanente has 3.7 million members making 12 million ambulatory visits to 6,000 physicians each year.

The Outpatient Safety Net Program is different most other follow-up systems that focus on emergency care or hospitalized patients, but outpatient care represents the overwhelming majority of interactions between clinicians and patients. “More than 98 percent of interactions with patients occur in outpatient settings,” says Kanter in a Kaiser Permanente statement. “and the Outpatient Safety Net Program leverages the power of electronic health records to target care gaps by scanning for things like medication interactions or needed follow-up tests.”

A key feature of Outpatient Safety Net is its no-blame nature. The program, say its developers, does not track events or actions of individual physicians, nor are data used to evaluate physician performance. The system likewise imposes no extra reporting burdens or interruptions of patient-clinician workflow.

Outpatient Safety Net started in 2006, and through 2012 the program developed 24 different surveillance routines covering a variety of conditions. The three main types of surveillance are:

– Diagnosis detection, for example, timely follow-up of abnormal pap smears

– Medication and lab monitoring, such as increase appropriate hypertension medication use among patients with diabetes

– Other follow-up care, such as timely follow-up of failed hearing screenings for newborns

The authors say the Outpatient Safety Net framework developed by Kaiser Permanente can be applied by other health plans, even those without extensive or integrated health records.

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