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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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