A treatment program that involved heavy use of electronic health records for patients at risk of kidney disease increased early intervention for high-risk patients and reduced by two-thirds the number of specialist referrals that were alarmingly late, according to a report. HMO Kaiser Permanente says its program helped specialty care physicians improve the health of high-risk patients by reviewing electronic health records and providing e-consultations and treatment plan recommendations. The report was published in the British Medical Journal.

Researchers say the quality improvement project demonstrated that specialists can take a more active role in managing the health of populations with kidney disease—or other chronic illnesses—by using electronic health records to coordinate care among primary and specialty care providers. In the project, nephrologists proactively consulted remotely with primary care doctors to help manage patients at risk for end-stage renal disease, researchers say.

A separate study funded by the National Cancer Institute showed that a reminder program using Kaiser electronic health record system boosted mammography rates by more than 17 percentage points. The program used electronic health records to identify women who would soon be due for a mammogram and reached out to them via postcards, automated voice messages and personal phone calls, according to the study published in the American Journal of Preventive Medicine.

In the kidney treatment study, nephrologists in Hawaii were able to take electronic laboratory results to rank more than 10,000 kidney patients not yet referred to a specialist by their risk for kidney failure. They monitored the patients who were most at risk to make sure they were getting care in line with evidence-based treatment recommendations. After identifying the at-risk patient population, the nephrologists relied on Kaiser’s electronic health record system called HealthConnect to evaluate next steps.

"The goal with kidney disease is to detect it early enough to make changes that will slow the disease down,” says Brian J. Lee, the study author and a nephrologist with Kaiser Hawaii. “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. 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.”

Researchers say the nephrologists used the electronic health records to review the patient's electronic medical record and to provide an electronic consultation to the patients’ primary care physicians. In many cases, the nephrologists recommended referral for more intensive specialty care. In others, the primary care physician was given the treatment plan necessary to prevent the need for referral. Kaiser says the five-year project increased early intervention for high-risk patients and reduced by two-thirds the number of late specialist referrals—those occurring within four months of the onset of end-stage renal disease.