Health information technology improves quality of care, study shows

Secure patient-physician e-mail messaging improves the effectiveness of care for patients with diabetes and hypertension, according to new research by Kaiser Permanente. The study, published in the July issue of Health Affairs, shows that health information technology improves quality of care scores.

The study observed 35,423 patients with diabetes, hypertension, or both, in Kaiser Permanente's Southern California region, finding that use of secure patient-physician messaging in any two-month period was associated with statistically significant improvements in HEDIS (Healthcare Effectiveness Data and Information Set) care measurements. Results included 2.0 percentage-points to 6.5 percentage- points improvements in glycemic, cholesterol and blood pressure screening and control.

"Putting patients and their data at the center of care allows Kaiser Permanente to improve health care quality, access and cost," said George Halvorson, chairman and CEO, Kaiser Permanente. "This data proves that health IT can be a fundamental component of accomplishing those three critical goals."

More than 556,000 secure patient-physician e-mail threads, containing more than 630,000 messages, were logged throughout the study.  Patients initiated 85 percent of those threads, which shows that health IT is empowering patients to better manage their health care. Kaiser Permanente's secure e-mail tool, called "E-mail my doctor," is one of the most popular features of the My Health Manager (www.kp.org/myhealthmanager) comprehensive personal health record. My Health Manager, used by more than 3 million Kaiser Permanente members, provides patients with secure and timely access to lab test results, medication information and refill capabilities, summaries of their health conditions, appointment scheduling, and other important health information with just the click of a mouse.

Kaiser Permanente previously found that 75 percent of all patient-physician e-mail encounters addressed ongoing medical problems or care plans. The leading reasons patients contact physicians are to discuss changes in a health condition, lab test results, a new condition, drug dosage adjustments, or the need for a new prescription.  Other research (Dr. Yi Yvonne Zhou et al, American Journal of Managed Care, 2007) found that patients who use secure e-mail were 7 percent to 10 percent less likely to schedule an office visit, and 14 percent less likely to contact their physician by phone compared to those not using online services.  

This study is one of the first to show that these electronic communications have a measurable positive effect on patient outcomes, in addition to improving efficiency.  Kaiser Permanente physicians participating in the study reported that the use of secure e-mail messaging has been highly successful for diabetes patients, enabling them to follow medical instructions to the letter. Physicians also are encouraging patients to schedule an appointment if they raise issues via e-mail that are too complex or lengthy to address using that medium.  

"Kaiser Permanente members using My Health Manager send more than 870,000 secure messages to their clinicians each month," said Terhilda Garrido, co-author of the study and vice president, health information technology transformation and analytics, Kaiser Permanente. "Physicians are using the tool to connect with their patients like never before, sending nearly 3.5 million messages to patients between January and April this year, and empowering them to take better care of themselves and manage their total health."

"There are a lot of reasons that patients contact their care teams. It is important to keep the lines of communication open, while not inconveniencing patients by playing phone tag or bringing them into the office unnecessarily," said Michael Kanter, MD, co-author of the study and regional medical director of quality and clinical analysis, Southern California Permanente Medical Group. "We have always felt that use of secure e-mail messaging is a huge patient satisfier and an efficient way of handling many routine care issues.  Now, with this study, we can also state that secure e-mail improves clinical outcomes for patients."