Khoury A 1998 "Support of quality and business goals by an ambulatory automated medical record system in Kaiser Permanente of Ohio."

Khoury A. Support of quality and business goals by an ambulatory automated medical record system in Kaiser Permanente of Ohio. Eff Clin Pract 1998;1(2):73-82.
"Kaiser Permanente of Ohio has developed [an electronic health record (EHR) application] to address the business and clinical needs of the organization. The system is currently used by 220 physicians and 110 allied health personnel. To support the quality initiatives of the organization, the system has been programmed to generate reminders, at the moment of care, on compliance with clinical guidelines. This article details examples of compliance improvements with guidelines for the use of aspirin in coronary artery disease, use of influenza vaccinations in members older than 64 years of age, and stratification of asthmatic patients into severity levels; it also summarizes other quality improvements. [The EHR] provides a data stream for electronic billing, which saves the organization the cost of manual billing. In addition, this system reduces operating costs, in particular the number of staff needed to deliver charts and the cost of printing forms. Cost-benefit analysis demonstrates that the system can produce savings in excess of maintenance costs."

To describe the use of clinical point-of-care reminders by Kaiser Permanente of Ohio and the effect of these reminders on compliance.

Type Clinic
Primary care and specialty care
Urban and suburban
Other Information
Thirteen ambulatory care locations in Cleveland and surrounding communities participated in the study.
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
Electronic patient records include dictated reports, laboratory results, medical messages, scanned documents (e.g., handwritten progress notes, treatment records, external documentation), problem list, and medications. "Two of the three contract hospitals for the managed care organization have data links, which include dictated notes, laboratory tests, radiology reports, and special procedure results."
Workflow-Related Findings
"Physician acceptance of the information management approach has allowed incorporation of the system into the routine care process, with the result that it is used for every patient encounter."
"Use of reminders, in conjunction with batch reports to physicians comparing their compliance with that of colleagues, usually brings about improvement in compliance. Financial incentives were also used in the aspirin-coronary artery disease intervention; this may have contributed to the increase in compliance from 72% to 81%."
Study Design
Study Participants
The study participants included Kaiser Permanente clinical and administrative personnel.