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in the first half of 2006 to about 8 percent in 2012. Overall cervical cancer screening rates rose from 79 percent to about 90 percent during the same time frame.

In addition to overseeing preventive care, Kaiser Permanente’s EMR system monitors ordering of medical interventions and dispensing of medications with barcoding for safety assurance. The system also includes an oncology knowledge database built by pharmacists that is integrated with lab and pathology information. “It has reduced safety events, simplified our referrals to clinical trials, and helped increase enrollments in these trials. Information from our EMR is used to assess practice patterns and provides alerts when those patterns do not match with treatment guidelines,” Schottinger said. She added that the EMR also helps ensure adherence to medications by informing practitioners when patients last refilled their medications. Patients not properly refilling their medications are followed up with phone calls.

Kaiser Permanente has used the data collected in its EMR system to modify its practice protocols. For example, it reviewed the outcomes of patients with breast cancer given docetaxel/cyclophosphamide who were older and had more comorbid conditions, such as diabetes. In this population, the neutropenia rate with this regimen was around 28 percent, so Kaiser Permanente modified its CSF protocol for that patient population.

“Looking at our regimens with our EMR will really help us improve the safety of the care that we deliver,” Schottinger stressed.

Prioritizing Cancer Prevention

Another measure that could reduce costs is more effective cancer prevention. Brawley noted that “we don’t have a culture in American medicine that actually favors prevention. Instead we treat—even when we prevent heart disease, we treat hypertension.”

McClellan added that even when preventive measures are offered free of charge, as they are in Medicare, 30 to 40 percent of the population does not use screening tests for cancer, which the evidence base suggests would be helpful. Brawley noted that uninsured individuals and those with lower educational status tend not to receive potentially life-saving cancer screening measures, such as Pap tests. He added that about half of the women who die from cervical cancer never had a Pap test.

Schottinger said Kaiser Permanente has prioritized preventive care among its members, leading to greater tobacco cessation, for example.



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