HONOLULU – Specialty physicians can better coordinate the care of patients with chronic diseases using electronic health records and providing e-consulations, according to results of a Kaiser Permanente project.

A five-year quality improvement project conducted in Hawaii by Kaiser Permanente demonstrated that nephrologists can take a more active role in managing kidney disease by using EHRs to coordinate care among primary and specialty care providers. In the project, nephrologists consulted remotely with primary care doctors to help manage patients at risk for end-stage renal disease.

Brian J. Lee, MD, and colleagues at Kaiser Permanente developed a new system that allowed nephrologists to use electronic laboratory results to rank more than 10,000 kidney patients who had not yet been referred to a specialist by their risk for kidney failure. The nephrologists monitored the patients who were most at risk to make sure they were getting care in line with evidence-based treatment recommendations and relied on Kaiser Permanente's EHR system, HealthConnect, to evaluate next steps, such as providing an e-consult to the patients' primary care physicians.

"We want to provide the best and most comprehensive care that we can to our patients," said Geoffrey Sewell, MD, president and executive medical director of the Hawaii Permanente Medical Group, whose 410 physicians provide care for 222,594 Kaiser Permanente members in Hawaii. "Our integrated system of primary and specialty care physicians working together provides complete care – from the prevention of disease to the management of acute and chronic illness. This coordinated care program is made possible by KP HealthConnect, a system that supports the decisions we as physicians make with our patients every day."

In many cases, the nephrologists recommended more intensive specialty care. In others, the primary care physician was given the treatment plan necessary to avoid the need for a referral. Results of  the project showed an increase in early intervention for high-risk patients and a reduction by two-thirds of the number of late specialist referrals – those occurring within four months of the onset of end-stage renal disease.

"The goal with kidney disease is to detect it early enough to make changes that will slow the disease down. If you're more likely to end up with kidney failure, we want to reach you in time to help prepare you for successful dialysis treatment," said Lee, a nephrologist with Kaiser Permanente Hawaii. "Patients who have a chance to consult with a nephrologist well before the onset of kidney failure are less likely to be hospitalized and more likely to survive longer. Our patients are more successful in starting dialysis when they are able to choose the type of dialysis or transplant with their physician, have a dialysis access implanted, start treatment outside of the hospital before becoming very ill and be educated and psychologically prepared for it."

"This pilot illustrates the benefits of leveraging technology and the expertise within a multi-specialty group practice," added Lee. "In the past, specialists have been limited to helping only those patients who were referred to them. Now that we can use databases to identify disease trends and populations and electronic health information to provide data on individual patients, our specialists can proactively find and recommend treatments for patients who could really use their help."