KP Follows Data To Better Hip, Knee Replacements

By developing registries and tapping e-medical record data, Kaiser Permanente is improving outcomes for hip and knee implant patients.



At Kaiser Permanente, a recently released study about hip and knee replacement devices highlights how best practices can be developed (and discovered) and patient safety bolstered in large part through the gathering and analyzing of data in patient’s electronic medical records.

With 600,000 knee and hip replacements performed annually in the U.S. -- and with those numbers expected to grow as Baby Boomers age -- KP’s study advocates the development of a national registry to track procedures and patient outcomes in those surgeries.

That’s what KP’s been doing internally since 2001 when the healthcare provider first launched a registry to help track implant devices, surgical procedures, risks, complications, and other outcome data pertaining to tens of thousands of its own hip and knee replacement patients.

KP doctors on the front line were asked to document information about their hip and knee replacement patients pre- and post-operatively. When the project first kicked off, clinicians collected data using paper forms.

But over the years as KP rolled out its Epic-based KP HealthConnect e-medical record system for its 8 million patients, KP transitioned to collecting the data via electronic forms. The survey-type information collected by the surgeons was supplemented by additional data from patients’ EMRs.

“We can capture data in any encounter,” said Elizabeth Paxton, KP director of surgical outcomes and analysis and author of the implement registry study.

With the EMR in place, data about hip and knee patients was able to be collected and analyzed even when those patients were being seen by a KP doctor other than their surgeon. The compilation of all that data gives richness in the assessment of patient outcomes, enabling clinicians to electronically document for analysis problems that might’ve not been thought related to the surgery, such as signs of infection.

“It would be difficult to do this without an EMR. Paper charts are resource intensive,” said Paxton. “Paper is hard to capture data at different encounters, such as an ER or office visit,” she said.

Through analysis of the patient data, KP researchers found the three most common reasons for re-operations of ACL reconstruction of the knee were meniscus injury, stiffness and device removal.

The risk factors and outcomes also demonstrate how a registry can improve quality of care by providing feedback to physicians, said Paxton.

The registries also helping KP to more quickly spot potential implant device trouble. For instance, when a KP surgeon suspects a problem with an implement device based on trouble a patient is having, KP researchers can analyze EMR data to assess how other patients with the same device are faring.

In one situation, the analysis confirmed “a hunch” that a doctor had about a specific hip replacement device, that was eventually recalled, said Paxton.

KP’s orthopedic implant registry also was used to track eight recalls and advisories during the study period, which were critical in immediately identifying and following up with patients that were impacted.

The findings are helping in the development of best practices for KP doctors to consider when treating patients. “Surgeons rely on the information in the registry,” said Paxton. That includes findings showing that patients who had full knee replacements often fared better and needed fewer subsequent surgical revisions than patients who had only partial knee replacements.

Based on the success of the hip and knee replacement registry, KP has launched additional registries, including those tracking data for other types of implants, such as heart valves and stents. “Implants are high volume procedures where there are high risks and recalls,” said Paxton. On the horizon is a registry for OB-GYN clinicians to use for pelvic mesh patients.

KP’s work with its registries illustrates how tech savvy organizations can tap the power of EMRs can help their patients stay out of the hospital and get on the road to recovery sooner.

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