Kaiser Permanente's switch to an electronic health records system in Hawai'i appears to be transforming the way healthcare is delivered, with members cutting office visits and boosting doctor contacts through telephone calls and e-mail.

A Kaiser study published by the medical policy journal Health Affairs explores some of the benefits of having patients' medical records readily available for doctors for decision-making purposes, and online for members to view and track their health.

One result may be more efficient patient contact, with Kaiser members using more telephone calls and e-mails instead of office visits. From 2004 to 2007, office visits per member declined 26 percent, while scheduled telephone visits surged more than eightfold.

E-mail messaging jumped nearly sixfold from 2005 to 2007. Overall, there was an 8 percent increase in patient contacts and access.

"The data shows consumers do want other ways of contacting their their physicians for care," said Catherine Chen, one of the study authors and manager of National Clinical Systems Planning and Consulting at Kaiser Permanente's headquarters in Oakland, Calif.

"We were really surprised at the big shift."

The results were published as the Obama administration pushes for more doctors and hospitals to adopt electronic records. The stimulus bill signed last month includes $17 billion of incentives to help make the information technology more affordable for doctors.

Prior studies have noted links between electronic health records and patient safety improvements, better coordination of care and better documentation.

Locally, the Hawaii Medical Service Association has tried to help physicians acquire the electronic medical record software and systems through $20 million in funding. Kaiser began implementing its KP HealthConnect electronic medical records in 2004 with two secure systems — one being a system for internal management of member information.

Kaiser made another system available online for members, allowing them to go on the Internet to look at lab results, prescriptions, past visit information, appointment scheduling and e-mail links with doctors. Of Kaiser's 222,594 members, almost one quarter, or 50,293, have registered for online accounts.

The e-mail function was attractive to members, with 51,000 messages being sent in 2007. Lab tests have been viewed 250,664 times.

"That feature has been hugely successful from the patient side," said Grant Okawa, associate medical director, knowledge management for Kaiser's Hawai'i region. Okawa said the amount of information available to doctors is also a bonus, with physicians being able to view patients' medical histories, allergies, hospital admissions, test results, prescriptions and other information.

"Having access to medical records at all times really has significantly changed the way I practice," said Okawa, who was in Madison, Wis., yesterday.

"With the phone and my computer, I have full access to my patient records, and I can take care of them from here."

The study found that the total number of patient contacts through office visits, telephone calls and e-mails rose to 5.61 contacts per member in 2007 from 5.18 three years earlier.

Because of data limitations, the researchers weren't able to directly tie whether the electronic records were resulting in improved patient care. But there are patient surveys showing most outpatient satisfaction generally remained the same or was better during the study period.

Moreover, an informal poll of 22 of Kaiser's primary-care physicians found that about six in 10 said the quality of care is better now, Okawa said. Other anecdotal information includes patients discovering breast cancer after a physician reviewed records and discovered a mammography hadn't been done, and a kidney specialist who was able to sift through thousands of patient records and take proactive steps for members who potentially had problems.

"He is able to actually look at data coming out of the electronic medical record system and figure which patients are at risk for going on dialysis," Chen said.

She said there are cost savings and health benefits to members if problems like that can be identified and dialysis avoided.