With the ink from President Obama's signature having dried on the stimulus package two weeks ago, insurance companies have had some time to ponder their next steps.

One such insurer, Kaiser Permanente, published a pair of studies earlier this week that are intended to demonstrate that a comprehensive electronic health record can increase consumer convenience and satisfaction and provider efficiency while maintaining clinical quality. Additionally, the carrier found that connecting patients directly with their care providers and giving online access to important medical information was crucial to the adoption of online tools.

The first study, "The Kaiser Permanente Electronic Health Record, Transforming and Streamlining Modalities of Care," explored the impact of the KP HealthConnect. A comprehensive health information system, KP HealthConnect provides members information on ambulatory care patient contacts, including outpatient, urgent care, emergency department visits, scheduled telephone visits and secure patient-physician e-mail messaging.

Based on Kaiser Permanente's 225,000 members in Hawaii, the study revealed that between the implementation of KP HealthConnect in 2004 and 2007, office visits per member decreased 26.2%, while total scheduled telephone visits per member increased nearly 900%. Secure e-mail, which began in late 2005, increased nearly six-fold by 2007.

In addition to the convenience of fewer office visits and the benefits of faster resolution of health issues, Kaiser Permanente found that e-mail and scheduled telephone visits saved consumers out-of-pocket expenses for travel, parking and time lost.

Technology is transforming the way health care is delivered, says Louise Liang, MD, study co-author and recently retired Kaiser Permanente SVP, quality and clinical systems support. "We must become more efficient and sensitive to the needs of the individual patient to improve our health care system. Our experience can inform other efforts to harness the power of health care IT."

The second study, "If You Build It Will They Come? The Kaiser Permanente Model of Online Health Care," charted the rate at which consumers are adopting online health services, what services they are using and the key factors that contribute to consumer acceptance of online health tools.

The study indicated that members get the greatest use out of a Web site that facilitates e-connectivity with their health care team, enables them to view key components of their medical records and conduct clinical transactions and provides information to make knowledgeable decisions about their health.

Additionally, Kaiser Permanente also examined challenges in the nationwide adoption of electronic health records, including financing issues, and the opportunities available to the federal government, regional health information organizations and health care organizations and providers, both small and large.

"This shift to online health services requires a paradigm shift within the health care industry, and large, integrated systems such as Kaiser Permanente have a responsibility to share learning and best practices," says study co-author Anna-Lisa Silvestre, VP of online services, Kaiser Permanente. "Knowing which online features are most popular, what adoption rate to expect and what factors will encourage acceptance of online health services, may prove useful, regardless of practice size, and it may move the issue of patient-centered health IT forward nationally."

Other key findings include:

• In 2007, there were nearly 33 million total visits to My Health Manager at kp.org, and an average of 90,315 visits per day—a three-fold increase from 2004

• Consistently ranked among the site's top-six-visited features between 2004 and 2007 were prescription refill, online appointment transactions, facility directory and health encyclopedia visits

• The most-visited feature on the Web site in 2007 was results of lab tests, which became widely available to members in 2006

• In 2007, 300,000 secure e-mail messages, on average, were sent to providers each month—an increase of 152% from 2006. Since the completion of the study, e-mail popularity increased even more, with an average of 500,000 e-mails sent from members to providers each month

• By 2007, 62% of members registered on kp.org accessed the site two or more times in a six-month period, up from 27.7% the previous two years

• Member registration data showed that consumers of all ages are using online health tools, with approximately 31.5% of Kaiser Permanente's 8.6 million members accessing secure features on My Health Manager

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