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					USING A REGISTRY TO
IDENTIFY PATIENT NEEDS
Lessons from IPIP Initiatives in Colorado

Gregory E Sharp MD
Ideal Family Healthcare
Woodland Park, Colorado
What is a registry all about?
Before the Visit
A registry identifies care needs for a patient
population and assists outreach efforts to
meet those needs on an ongoing basis.
At the Visit
A registry helps prepare for planned visits
and guides the delivery of services at these
visits to ensure that the appropriate and
complete array of services are provided in
as efficient a manner as possible.
After the Visit
A registry assists in the ongoing work of
moving patients and populations toward
better health by establishing and
maintaining a system for monitoring
performance and guiding change.
Proactive Care

 Identify what patient or population needs you
  want to examine
 Decide how you want to perform outreach
 Decide how often you will perform the work
  of evaluating need and doing outreach.
Protected Health Information
Protected Health Information
Guiding Care

 Identify which visits you want to employ
  planned care.
 How will you bring the registry into planning
  for these visits?
 How will you use the registry to guide the
  visit?
 How will you use the registry to direct care
  after the visit and into follow up (care
  management)?
 How will you do this efficiently?
                               Protected Health Information
Protected Health Information
Protected Health Information



                               Protected Health Information
Improving Care

 Individual patient improvement
   Monitor performance
   Guide change
 Population improvement
   Monitor performance
   Guide change
Registry Design




Consider the data that makes up a registry
Registry Design
Patient Identifier

 Registries are databases which requires
  that each patient have a unique identifier
  or “key”.
     Cannot use name or Insurance ID# because these
      may change
     SSN may raise security issues
 Consider using a “chart #” from your
  Electronic Health Record or Practice
  Management System.
Patient Demographics

 What core fields will you need to recognize
  the patient within the registry (names, DOB,
  SSN, or insurance ID)?
 What fields will you need to perform outreach
  (phone numbers, mailing address, or email)?
Measures

 How will you identify a patient as having a
  condition or need (Asthma, Diabetes, or
  Preventive Care)?
 What are the data guidelines or measures for
  the condition or need (A1c, blood pressure,
  foot exam, smoking status)?
Events

 Date of service
 Result
Data Capture




Does your current system already have
opportunities for you to capture registry data?
Practice Management System
or Electronic Health Record
 may already have assigned unique patient
  identifiers.
 may have exportable patient demographics.
   Name
   Mailing address
   Phone numbers
   Email
Practice Management System
or Electronic Health Record
 may allow you to query
  (search) for conditions of
  interest by ICD-9 code
   250.** for Diabetes.
 may allow you to query for
  events
   CPT codes for preventive visits
   vital signs (blood pressures,
    smoking status)
   Medication Lists (aspirin,
    statin use)
Document Management System

                      Paper
                    Document




      Electronic    Document
        Health     Management    Registry
       Record        System




                    Electronic
                    Document
                     Library
                                                                                                         Paper
                                                                                                       Document




        Going Paperless                                                                   Electronic
                                                                                            Health
                                                                                           Record
                                                                                                       Document
                                                                                                       Managem
                                                                                                          ent
                                                                                                        System
                                                                                                                    Registry




                                                                                                       Electronic
                                                                                                       Document
                                                                                                        Library




•Contact Policy or HIPPA Release signed
                                                         Office Organizer               •Stores electronic documents in a single
 by patient                                                                              networked location.
•Faxed lab or radiology report                                                          •Simplifies access to documents across
•Consultant note received by mail.        •Names documents in standardized and           the network and allows for document
                                           searcheable format                            search and backup capability
•Patient home blood pressure readings
                                          •Creates required folders for storing         •Provides simple means of compiling and
                                           documents on network                          exporting patient records to external
                                          •Provides document routing functionality       entity in paper or electronic format
                                           for provider review and signature
                                          •Capture discreet data values for export to
                                           EMR or Registry

             Paper Document                                                                            Document Library
                                                                                              Paper
                                                                                            Document




      Document Management                                                      Electronic
                                                                                 Health
                                                                                Record
                                                                                            Document
                                                                                            Managem
                                                                                               ent
                                                                                             System
                                                                                                           Registry




                                                                                            Electronic
                                                                                            Document
                                                                                             Library




                                               Document
•Demographics                              Management System                 •Receive uploaded data from Document
•Clinical encounter data                                                      Management system to populate
•Immunization data                                                            registry data
                                 •EMR demographics provide s the seed        •Produce reports on measures and
•Medication Lists
                                  for Office Organizer database               trending for population to support
•Vital signs
                                 •Query exportable clinical data from EMR     quality improvement
                                 •Query document library for presence of     •Produce outreach reports
                                  consults, lab and radiology reports
                                 •Query for discreet data captured from
                                  paper or electronic reports
                                 •Reformat data from queries for upload to
                                  registry
             Electronic Health
                                                                                                         Registry
                  Record
Document Management System

                      Paper
                    Document




      Electronic    Document
        Health     Management    Registry
       Record        System




                    Electronic
                    Document
                     Library
Workflow Integration



How do you integrate a registry
into office workflow?
Workflow Integration

It will not work as an add-on. The office must
   be re-designed around the registry so that it
   becomes an integral part of how the work is
   performed.
Workflow Examination



How to examine your office workflow to find
opportunities for registry integration.
Identify registry related information.



 Front Office                  Back Office
  Patient Identifier           Guideline-based Measures
                                     Smoking status
  Patient Demographics              Depression screening
                                Clinical Data
                                     Blood pressure, weight
                                     Medications, immunizations
                                Procedures or Services
                                     Colonoscopy, Retinal Exam
                                     Diabetic foot exam
                                Laboratory Data
                                     A1c, Lipid Panel
                                Patient-Collected Data
                                     Self glucose monitoring logs
Who handles registry related information in your office?



 Front Office                  Back Office
  Receptionist                 Medical Assistant
  Billing                      Nurse
  Transcription                Care manager
  Office manager               Providers
When and how do they handle registry related information?



 Front Office                  Back Office
  Patient Check-in             Loading patients
  Telephone Conversations      Appointments
  Mail                         Reviewing results
  Faxes                        Outreach
  Email
In what format is the information received or kept?



 Not Electronic                   Electronic
  Paper                           Email
     Mail                         Electronic fax
     Fax
                                   Secure web portal to
     patient delivered
                                    external facility
  Verbal
                                   EMR data
     Patient call
     Call report from facility    PMS data
What is done with the information received?



 Front Office                  Back Office
  File it                      Review and sign-off
  Route to Provider            Take action
  Route to Consultant            Order test
                                  Prescribe medication
  Route to Patient
                                  Schedule Follow up
                                Route to Staff
                                Route to Consultant
                                Route to Patient
When is the best opportunity to
capture the data for the registry?
 Direct entry of data into registry at point of
  encounter.
 Collection of data in non-electronic format
  for manual entry when more convenient.
 Collection of data in electronic format for
  batch upload when more convenient.
Protected Health Information   Protected Health Information
Protected Health Information
Can capturing data for the registry
improve “what you do with it”?
 Route data to patients, providers or
  consultants more efficiently via email, e-fax,
  web portal or mail-merge.
 Improve organization of, and access to the
  data within your environment.
 Improve documentation of the office
  workflow for future clarity or areas for
  improvement.
      PHI
PHI
Recruiting Patients for Registry Participation




 Use patient interaction with the registry to boost
 productivity and outcomes.
Focus on the patient perspective

 Convenience of secured email access to practice.
      Appointment requests
      Billing questions
      Provider questions
      Result reporting
 Automated email reminders when guideline based care is
  due
 A secure place to keep their patient health record that they
  can access from anywhere with internet access.
 Shared care of chronic medical conditions like asthma,
  diabetes or heart disease
    Use flowsheets and graphs to aid shared decision making and
       track progress toward goals.
                  PHI




      PHI                     PHI




                        PHI



            PHI




PHI
Protected Health Information



                               Protected Health Information
Make it easy


 Step-by-step guide to the electronic
  enrollment process.
 Links from your practice homepage to the
  ReachMyDoctor registry.
Make sure it works


 Update data frequently enough that patients
  don’t get unnecessary reminders cluttering
  their email inbox.
 If you have not captured enough of the
  relevant data to have confidence in what the
  registry says then you will be unlikely to rely
  on it, and eventually you will stop using it.
Thank you!




        Questions?

				
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posted:10/8/2012
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