Better health care with better IT, part 3: Keys to success

Previous entries in this series on using IT to improve patient outcomes introduced the conundrum of health care outcomes research, and some of the challenges that of implementation. This entry reviews some of the lessons learned, which could prove useful to other organization in similar situations, and anyone trying to integrate a health IT structure to support processes of care or measurement.

The keys to Kaiser Permanente's joint replacement registry success include:

1. Benchmarking with existing registries, in this case joint replacement registries in Sweden and Norway. During development this gives you a sense of the elements needed to gather good data.

2. Participating surgeons who maintain and "own" the data are supportive of the registry, and invested in its success. A project of this scale and complexity cannot be forced onto clinicians by management if it is going to survive and thrive.

3. Smooth integration with existing workflow. Data gathering cannot present an additional level of work, or a laborious chore that gets in the way of providing patient care. From the physical space where data is entered, to which data are entered, the process must feel reasonable, efficient and comfortable.

4. Data must be validated to ensure rigor, and have quality control mechanisms built into the process of data gathering and entry. Not only does this ensure data validity, but it also makes those entering the data confident that there are checks to ensure their accuracy, and gives future analysts an additional level f confidence in their findings.

5. Teams running the registry, and surgeons whose data comprise the registry must receive regular and useful feedback. Those involved need to know that their additional efforts are being noticed, that someone is actually doing something with the fruits of their labor.

In addition to involving participating surgeons in the initial design and implementation phase, incentives to encourage participation by surgeons included:

-Ability to be involved in research

-Confidential profiles could be generated for a surgeon's own practice

-The ability to use registry data in the event of a recalls or advisories.

Finally, the data allow Kaiser to review the quality of their work. They learned, for example, that their 5-year survival for hip replacements was 97.3%, based on 21,548 cases, with the leading causes of revision being instability (44%) and infection (20%). They were able to conclusively identify the greatest risk factors for complications such as revisions (young age, diabetes) and infections (being overweight, diabetes). In the event of a recall, patients can be identified, adverse events monitored, revision rates tracked. In other words, this is useful data wit real world benefits to patients, clinicians, researchers, and administrators.

The true magic behind Kaiser's joint replacement registry is that it seamlessly integrates IT into an existing processes of care, that front line workers were involved in the design and implementation of these processes, and the reasons for gathering the data, and redesigning care processes to accommodate data collection were explicitly understood and endorsed by all involved.