Transcript What a Registry Can do for the Practice Team

Clinical Information Systems
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Adapted from Improving Chronic Illness Care
www.improvingchroniccare.org
The Care Model
Community
Health System
Health Care Organization
Resources and
Policies
SelfManagement
Support
Delivery
System
Design
Informed,
Productive
Empowered Interactions
Patient
Decision
Support
Clinical
Information
Systems
Prepared,
Proactive
Practice Team
Improved Outcomes
You are
here
If a productive patient-clinician
interaction is at the heart of good
visit, then information
is the life blood flowing throughout
that interaction
Currently Information Available
During the Interaction Tends to Be:
• focused on the paper record
• disorganized
• disease/procedure-centered
versus patient-centered
• responsive to the past interaction
versus forward looking
What would be more helpful?
Clinical Information System
System Change Concepts
•Provide timely reminders for providers and patients.
•Identify relevant subpopulations for proactive care.
•Facilitate individual patient care planning.
•Share information with patients and providers to
coordinate care.
•Monitor performance of practice team and care
system
What is needed in terms of technology?
The technology is not the issue!
It could be a :
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•
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shoebox full of 3x5 cards
a paper log of patient data
spreadsheet
simple database
web or LAN-based repository
electronic medical record
What is the Issue?
Functionality!
Whatever you use must be able to
deliver information that supports the
practice team in the delivery of
individual and population-based care
For many of us, it will be a
registry.
A registry is a list of patients and their relevant
clinical data that can be sorted by a condition or
set of conditions in order to improve and
monitor the care of the population
What a Registry Should Be
• be quick to implement
• be simple to use
• be organized by patient; not disease, but responsive to
disease populations
• contain only data relevant to clinical practice
• when necessary, make data entry simple and efficient
• be easy to update from other automated data sources
• assist with internal and external performance reporting
• guide clinical care first, measurement second!
What a Registry Should Not Be
• try to emulate data load & functionality of an
EMR
• require an advanced training operate and
maintain
• not become the “obsession” of practice activity
Can I use my EMR for what I
need to do? Yes, if…
• It provides access to lab data, dx test
results, and across settings in your
system.
• Guidelines and prompts are included for
needed services
• You can identify populations and
subpopulations of patients
Can I…(cont.)
If…
• Allows stratification of patients
(complexity, disease severity for case
management services)
• Captures outcomes by provider
• Captures all critical clinical information
Reminders
Timely reminders for providers and patients
Prompts to deliver evidencebased care. They can be
delivered :
1. At the time of visit
2. Through population reports
3. Via exception reports
Populations and subpopulations
Relevant for proactive care.
Population-Based Care
• Goal: Maximize the health outcomes of a
defined population (all patients for one
clinic, a provider panel, patients at risk)
• Efforts are made to assure that all
relevant members of a population receive
needed services
• Use info systems, planning and outreach
Individual Patient Care
Planning
Individual Care Planning
• Having the right information readily
available at the time of the encounter
(patient summaries)
• Having the right tools to create and track
treatment plans both clinical and selfmanagement
• Ensuring the all routine care is delivered
at the appropriate time
Manifestations of care planning
• Summaries provided to patients
• Description of patient actions and
provider actions
• Shared care plan
Share information
To coordinate care
Avoiding miscommunication
Ensure understanding of the care
processes across all parties
Reduce duplication of effort by care
providers
Eliminate frustration caused by uncertainty
of who is delivering what care when!
Monitoring performance
Of the provider and system
Use the CIS to:
1. Create population-specific reports
2. Facilitate external reporting
requirements
3. Create dashboard reports of the practice
as a whole
CIS: Facts vs. Fears
Fear: Why do we have to have a registry?
Fact: Planned population-based care cannot be done
without knowing your patient population and its key
clinical data
Fact: Primary care teams that implement registries are
more likely to improve processes of care for all
chronic conditions
Fact: Teams with registries are less likely to lose patients
to follow-up, and more likely to improve patient
satisfaction as care improves
CIS: Facts vs. Fears
Fear: I don’t need anyone telling me how to practice! I’m
doing just fine with my patients!
Fact: Surveys show that providers consistently under
estimate the numbers of patients with chronic
disease in their practice
Fact: Surveys show that provider consistently over
estimate their performance measures on process
and clinical outcomes for chronically ill patients.
Fact: The two are interdependent.
Fact: Knowing you population of patients will help rectify
this disparity.
CIS: Facts vs. Fears
Fear: It’s just more work during our already hectic day!
Fact: Using a patient summary form from a Registry will
actually reduce charting time and make the visit run
more smoothly
Fact: The form gives a snapshot of past care, reminders
of needed care and planning for future care all at
the time of the visit
Fact: Teams with registries feel better prepared for visits
since they have the patient information when and
where they need it.
CIS: Facts vs. Fears
Fear: This will cost me a fortune and there’s no return on
investment!
Fact: Implementing a registry is simple, and there are
economies of scale as you add more patients.
Fact: Registries facilitate populations-based care which
improves outcomes and patient satisfaction
Fact: Planned care via the registry generates visits that
are typically of higher intensity while reducing
unexpected visits for acute exacerbations
Making Clinical Information
Work for You in Clinical
Practice
The Software
• Assess available software for appropriate
functionality
• Install the software.
• Identify training resources.
• Highlight CIS importance to rest of team
for buy-in
The Chronic Illness Data Manager
• Identify best person on team to manage the
disease management information.
• Choose person with computer skills and
interest.
• Define roles and responsibilities for manager.
• Secure training for manager as needed.
• Train a back-up.
Populating a Registry
• Use billing data and ICD9 codes to identify
specific populations or build prospectively.
• Download names and contact information
into registry.
• Establish process for regular population
updates.
Getting Clinical Data into the
Registry
• Define the relevant clinical data needs.
• Use the visit for collecting nonautomated data.
• Develop and test data capture process.
• Use chart audits judiciously.
• Develop and test data entry process
Using Data at Point of Care
• Establish process for producing patient summary
data for use at time of visit. (acute or planned)
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Make sure summary is replacing other data
capture processes to avoid double entry.
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Ensure summary is on chart or in the exam room.
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Does the summary work for various patient types?
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Ensure new data is captured on the summary.
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Develop process for new summary data to be
entered into registry.
Using Data for Care Reminders
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Establish what you want “reminding” about.
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Determine how you want to be reminded.
(i.e, exception reports or individual patient prompts)
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Identify team member responsible for monitoring
reminders.
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Create process for responding to reminders. (i.e.,
who calls patient, when and for what purpose)
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Create process for updating/modifying
reminders.
Using Data to Monitor
Performance
• Determine what types of population reports
are needed and reporting intervals.
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Establish process for creating customized
reports.
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Who will generate reports?
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Who receives reports?
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Do the reports facilitate continued
improvement?
Keys to Success from Others That
Have Implemented Registries
• Everyone understands the clinical utility and supports
the time involved in registry upkeep. Care
management using registry data is a team approach
• Dedicated time each week for primary team to use data
• Data forms are clear, roles are assigned, data review
time allotted.
• Data are clinically relevant, and used for patient care
first, and measurement second.
• Data can be shared with patient to improve
understanding of treatment plan.
Keys to success for using an
EMR
• Participate in purchase and design
decisions
• Work up to full functionality (don’t turn all
the reminders/prompts on at once!)
• Get help from leadership and make sure
the disease management needs are met.
Barriers to CIS use
• Lack of perceived value
• Competing business and productivity demands
• Lack of office flow expertise
• Lack of information support
• Lack of leadership support
For More Information:
Please visit Improving Chronic Illness
Care’s web site at
www.improvingchroniccare.org