The Benefits of Online Care

By Dr. Peggy Latare
Interviewed by Melissa Moniz
Wednesday - March 04, 2009
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Dr. Peggy Latare
Chief of Family Medicine and Chief of Bariatric Surgery at Kaiser Permanente and Physician Champion at kp.org

Interviewed by Melissa Moniz

What are your responsibilities with Kaiser’s online services?

I helped to implement our general electronic medical records between 2004 and 2007. Part of it includes our kp.org member section, which started in 2005. Kp.org offers our members free access to more than 40 online health services and tools at the click of a button. Today I am still the physician leader for the member portal of kp.org because it’s my favorite. It’s very unique, member-focused and an amazing system to have in place. It’s been groundbreaking in the medical field. I think the biggest advantage of the member portal is that it allows Kaiser members to see parts of their medical record and send secured e-mail messages to their physicians and care team. As a physician, I am thrilled about bringing healthcare information into an individual’s home.


 

Have there been new features added for members since it began in 2005?

Yes, there’s a long list of new, free features, but one of the highlights is access to lab test results, which continues to be our most popular feature. Members enjoy having immediate access to their lab results instead of having to make a follow-up appointment with their physician to retrieve them. The lab result section is very comprehensive, as it not only shows you the test result but also allows you to click on the name of the test for its definition and what it means. Clicking on the result number will tell you what the normal range is, and there is another feature that allows you to chart your range over time. Another feature added was secure messaging from member to doctor or care team, which we knew would be popular. We’ve also added a feature for members that allows them to view their current medications, a list of their ongoing health conditions and allergies, and healthcare monitoring. We also have alerts set up in our system that say when someone is due for a checkup.

A Kaiser patient browses the kp.org site

How are the physicians, nurses and other KP staff involved?

Since 2004, we have done all of our documentation through electronic medical records - all of our visits, progress notes and ordering are sent electronically. All of our results come back electronically. We receive secure messages from our patients, so we’re constantly reading and replying to e-mails. More people are choosing to send an e-mail because unlike a phone call, they aren’t limited to our clinic hours and I can respond to e-mails at any time of the day. It’s a very convenient feature for both physicians and members, but we do specify that it’s not for urgent problems. E-mails often are used for follow-up questions to a visit.

On average, how long does it take a patient to receive a reply to a message sent?

Our policy is 48 hours, but we tend to do a lot better than that. Some of our staff do not work over the weekend, so sometimes patients won’t get a reply back until Monday. And again, this is for non-urgent questions.

Has this reduced the number of patients physically coming into the clinic for care?

The electronic medical record and secure messaging feature gives our busy members a convenient option to receive care. The clinical database, history and information we have on our patients allows us to provide a lot of care over the phone and through e-mail. There is, and always will be, care that needs to be done face-to-face and members who prefer the clinic appointment. If someone has a rash or something very serious, we would encourage them to come in. If someone has been coughing for three weeks, then I’d like to listen to their lungs.

So there’s a lot that we can do online, but there’s certainly things we have to do in person.


What has been the response from patients using the online system thus far?

I think our members have been satisfied with the number of features we’ve been able to release. The response has been especially positive for the lab tests and secure messaging. The most popular features are labs, medication and secure messaging.

What we found and what other companies have found is patients want more information made available to them. We used to think that it was important for the doctor to see results first, come up with a medical plan and then see the patient. We release almost everything now, and that’s a direct result of our patients and members telling us they want more. They feel it’s their information, and they want it as soon as it is available. It’s mostly cancer-related tests that aren’t made immediately accessible for patients so doctors can sit with the patient to explain things in person. I think it’s scary to get a cancer result at home sitting at your computer without having a medical professional explain it to you.

Are there plans to expand on online care?

The Kaiser national team is always adding new features. The two big features on the horizon are adding X-ray results and pathology results. X-ray results are a little more difficult because they are all text, and a radiolo-gist is needed to read and make sense of the text. It’s the same with pathology results for biopsies. These test results are not like a lab test result with numbers that allow you to compare yours to the normal range.

There’s a Kaiser in California that’s piloting the X-ray results, and they’re finding that patients are really happy with it because a note will accompany the X-ray to explain the results. We also did a small pilot with our Hawaii Kai clinic, where patients were able to book their appointments online. Right now all of our members can request an appointment; however, this new feature allows the patients to see the schedule and pick available days and times for their appointment. We would like to expand that into more of our clinics.

 

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