Case Study: Breast Cancer Screening Better Care through Coordinated Teams and Health Information Technology

March 27, 2009

Kaiser Permanente has become a national leader in breast cancer screening, demonstrating the improved quality of care that results from coordinated health teams and electronic information sharing. Information technology is helping caregivers coordinate activities throughout the organization. Clinicians and staff are using these new and constantly improving IT tools to communicate and coordinate with each other between departments and with patients. These strategies made Kaiser Permanente’s Southern California region the national leader in breast cancer screening rates in 2008.*

The Importance of Early Screening and Detection

Women have a 13.2 percent lifetime risk of being diagnosed with breast cancer. That risk increases to a 1-in-7 chance as women reach their 60s. Unfortunately, too many women delay mammography or are not screened at recommended intervals. Reasons for delay include making the time, avoidance of discomfort, lack of understanding, fear of diagnosis, body image/self-consciousness issues, mobility, and geographic issues. Because 96 percent of all early-stage breast cancers are curable, actions such as early screening, detection, and treatment can reduce the death rate by 20 – 50 percent.

Engaging the Patient: A Coordinated Approach with an Informed Personal Touch

Addressing these many challenges required identifying new ways to engage women in breast health. Using an electronic database, we sent out routine notification letters to women who were due or overdue for their mammography screening. Even with simultaneous educational and awareness campaigns, the multidisciplinary care teams found that more direct and personalized interventions were required to increase the number of women receiving mammograms.

To go beyond sending reminders, care teams began conducting active outreach programs. Up-to-date clinical information, tied to an electronic scheduling system, allows trained call center staff to make phone calls and personally contact women who have not scheduled their mammography appointment. The call center staff then is typically able to schedule an appointment on the spot.

Recognizing that this outreach may not be enough to overcome resistance, many care teams added in-reach strategies to encourage all Kaiser Permanente staff and caregivers to check whether a patient they are interacting with needs a screening appointment, and then schedule it for them immediately. Kaiser Permanente HealthConnect™ (electronic health record) notifies physicians, clinicians and employees if a patient is due or overdue for a mammography screening. This electronic notification has been coupled with an internal campaign to create a "pink culture." Some medical centers have created incentive programs (movie tickets, drink vouchers and other giveaways) to encourage all staff and clinicians to participate in these efforts and remind women of their pending or overdue mammogram at every point of service.

As a result of these in-reach efforts, women are more frequently sending us testimonials about their positive experiences in being convinced to get their mammogram at unusual "touchpoints," such as ophthalmology (see testimonial at left) and allergy (see video testimonial on kp.org/future) exams.

Implications for Policy/Health Care Reform

These early results illustrate how coordinating activities among various health providers throughout the care delivery system, and equipping caregivers with real-time information, can support patient care and improve outcomes. Maximizing information for the clinician means optimizing care for the patient. Done well, a computerized system supports clinician efforts to spend more time with patients, have better information about their care, and spend less time with traditional paperwork. Health information policy for the United States must include incentives not only for implementing electronic medical records in provider offices, but also for developing the skills of the people who use the tools and for coordinated use of information systems among providers. The value of information technology is directly related to how caregivers and staff use it and whether it supports information sharing between settings of care.

The right information systems and the right delivery system reform will create care teams that are able to coordinate care across every point of service—the physician’s office, laboratory, pharmacy, hospital, on the phone, and even online—thus providing patients with affordable, well-informed, customized and compassionate care.

At Kaiser Permanente, we’re well on our way to achieving this vision. To learn more about Kaiser Permanente’s use of electronic health information, visit http://kp.org/future.

 

Quality Compass® 2008. National Committee for Quality Assurance (NCQA). For more information, see: http://xnet.kp.org/newscenter/pressreleases/scal/2008/100308screening.html

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