ABSTRACT
This chapter reviews the findings of the study, which further examines some of the multiple integrative issues raised by the preparation, partial implementation and ultimate withdrawal of the electronic medical record (EMR). Henry J Kaiser Permanente is the largest integrated healthcare programme in the United States of America. It comprises Kaiser Chiefs Health Plan and the Permanente Medical Group. Hawaii Kaiser Permanente region serves 234 000 members across the three largest islands in the state, with 26 primary healthcare teams in 15 clinics, and one hospital. Clinical Information System was a controversial choice of EMR, as some Hawaiian doctors preferred the proprietary system used in the Northwest region successfully for five years. Effective chronic disease management (CDM) is arguably a mark of well-integrated care. Much pre-implementation work was undertaken, especially at the first site. Internal consultants analysed systems and workflows. CIS obliged clinicians to become more accountable than with paper records.
