Transcript National Progress in Utilizing Clinical Information

National Progress in Utilizing Clinical
Information Systems for Chronic Disease
Quality Improvement
West Virginia University Department of Community Medicine
Office of Health Services Research
Kansas Department of Health and Environment
Diabetes Prevention and Control Program
CDC Diabetes Translation Conference
04/22/2009
Acknowledgments
Special thanks to the Washington State
Department of Health
About CDEMS
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Chronic Disease Electronic Management System
Open source, public domain patient registry for disease
management and reporting
◦ Developed by the Washington State Dept of Health
◦ Used across the United States
◦ Customizable based on user needs
◦ Exchanges data with other systems
◦ Highly ranked in “Chronic Disease Registries: A Product
Review” available at:
http://www.chcf.org/documents/chronicdisease/ChronicDiseaseR
egistryReview.pdf
The Care Model – Our Reference Point
Benefits of using CDEMS
1) Monitor patient care
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Structure & checklist for standardized approach to care
Reminders for patients and providers
Facilitates care planning for individual patients
Gaps in care can be identified for action
2) Monitor health center / provider performance
◦ Summarizes population level data
◦ Documents outcomes for UDS, PQRI, quality certifications, payfor-performance reimbursements
3) Tool for transitioning to EMRs and/or supplement to EMR
reporting
◦ Low-cost alternative for tracking quality of care
National CDEMS Support Group
Designed to facilitate collaboration, sharing, problem solving
• Registry basics; Evaluation; Use of data for QI; Data exchanges; EMR issues
Map available at: http://www.hsc.wvu.edu/som/cmed/ohsr/Maps/CDEMS_Group.aspx
Group Membership (formed July 2007)
April 2008:
• 55 support group members
• 18 states
• Members included program implementation staff and technical
support staff
April 2009:
• 97 support group members
• 21 states
• Expanding membership to:
• More registry users
• Health educators
• Other chronic disease programs (cardiovascular, asthma)
Stories to Share…
Ways in which CDEMS is being used across the United States
Washington State Department of Health
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CDEMS used for 5 conditions in the
WA State Collaborative to Improve
Health
Diabetes
 Asthma
 Hypertension
 Obesity Prevention and Treatment in Children
 Medical Home for Children with Special Health Care Needs
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Joint Medical Home Collaborative being formed between WA
State DOH and WA Academy of Family Physicians
 CDEMS developments: NCQA / HEDIS / PQRI reporting;
increased reporting flexibility; data validation routines
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Utah Diabetes Prevention and
Control Program
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Utah DPCP administers State Certification
for 18 DSME Programs
Offers CDEMS as one way of addressing
care improvement
5 of the 18 use CDEMS to manage patient
data
CDEMS also used for annual outcomes reporting
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Example: Pre/Post-program HbA1c results
Kansas Diabetes Prevention and
Control Program
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Implementing CDEMS in 90 locations
across the state
Diverse settings (safety net clinics, farmworker program, home
health agencies, local health department, Indian health clinic)
 Various conditions (diabetes, diabetes with disabilities,
cardiovascular cohort, arthritis)
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Applied “push software program” to CDEMS sites to retrieve
data to a central repository
DPCP has the ability to query aggregate data statewide,
regional, or by clinic
 Outcomes: 50% improvement (2005-2008) in key diabetes
indicators
Detroit Medical Center
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Established a pay-for-performance incentive
program (12 practices; Blue Cross patients)
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Focus: Chronic disease management
 Diabetes
 Asthma, COPD
 CHF, CAD
 Well-Child
 CDEMS
helpful in getting private practice
physicians to understand population-focused
disease management
Helps identify patients that “fall through the cracks”
 Benchmarking care against national care standards
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Integrated Health Partners
 Using CDEMS to:
 Standardize data received from various EMRs
 Create a common taxonomy, which in-turn allows for
cross-organization reporting, analysis, and quality
improvement
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Developed standard data protocol for use by EMR vendors
when writing-out data for import into CDEMS
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Built data exchange tools to:
 Receive data
 Check for validity
 Conduct analyses
Akron Children’s Hospital
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Using CDEMS for pediatric diabetes and
pediatric asthma quality of care
Program designed to insure continuity of
care across home, school, and
community
Tracking educational progress
 Tracking goals and outcomes from
diagnosis until adulthood
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Also using CDEMS for American Diabetes Association
program recognition
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Potential for registry use to be replicated to main hospital
campus
Rhode Island Department of Health
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Health Systems Coordinator (within DPCP
program) provides all sites with continuity in
CDEMS training, updates, and support
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In-state collaborative includes:
Asthma
 Cardiovascular
 Colorectal
 Diabetes
 Diabetes Prevention
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Johns Hopkins University
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Implementing CDEMS in the Trinidad and Tobago
Health Sciences Initiative
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Potential for expansion into the Pan-American
Health Organization Caribbean Diabetes
Improvement Collaborative
Partnered with WVU OHSR to modify CDEMS for use at point
of care
 Data entry directly into Progress Note
 “Stoplight” reporting for patients and providers
 Integration with retinal photography and point-of-care lab
equipment
JHU School of Nursing: AADE-7 measures
West Virginia Bureau for Public Health &
WVU Office of Health Services Research
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CDEMS is used by the following WV BPH
chronic disease programs:
Diabetes Prevention and Control
 Cardiovascular Health
 Asthma Education and Prevention
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Currently partnering with 51 care sites, and growing
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Focusing on quality of care, across various CIS
Improved Outcomes: “Electronic Patient Registries Improve Diabetes Care
and Clinical Outcomes in Rural Community Health Centers”*
Finding registry functions weak/missing in some systems
CDEMS developments: Progress Note data entry; flow sheets;
additional reporting features; EMR data exchange
*Available at: http://www3.interscience.wiley.com/cgi-bin/fulltext/121585395/PDFSTART
Different Stories, but Shared Traits
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In each case, Quality Improvement is the driver
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Many needs center on reporting, data exchanges, and overall
registry functionality
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In each case, CDEMS is an applicable solution
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National CDEMS Support Group allows for increased
collaboration, sharing, and communication
Participants being different needs and perspectives to the
group
 Created a learning environment
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How to Join the Group
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Contact one of the following:
Jackie Gianunzio
 Kate Watson
 Adam Baus
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[email protected]
[email protected]
[email protected]
Visit www.CDEMS.com for meeting minutes and
presentation materials
If you’re already a member, invite someone that might
benefit from participating
Contact Information
Adam Baus, MA, MPH
Program Coordinator, Sr.; Clinical Information Systems Support
West Virginia University Department of Community Medicine
Office of Health Services Research
(304) 293-1083 [email protected]
Kate Watson, MA, MPA
Program Manager
Kansas Department of Health and Environment
Diabetes Prevention and Control Program
(785) 291-3739 [email protected]