Disease Management Using Practice Partner

1
Disease Management Using Practice Partner

• John Deere Medical Group of Waterloo, P.C.
• http//www.jdmg.com

2
Presenters

• Greg Hoekstra, D.O., A.B.F.P., Added
  Qualifications in Geriatric MedicineMedical
  Director John Deere Medical Group of Waterloo,
  P.C.
• Steve BantzNetwork Engineer, MCSE

3
About John Deere Medical Group of Waterloo, P.C.

• Family practice health center built by John Deere
  Health in 06/03/94.
• Seven Family Practice physicians, two P.A.s, and
  twelve nurses.
• On-site lab, radiology, and pharmacy.
• Over 30,000 visits a year.
• 550 diabetic patients.
• Electronic Medical Records since 1994

4
Practice Partner and JDMG

• After a thorough search, 1990 to 2001, JDMG
  elected to purchase Practice Partner.
• PMSI had over 600 installations nationwide at the
  time.
• JDMG went live May 3, 2001

5
Benefits of Practice Partner

• Reduced transcription costs.
• Clinic wide access to chart.
• Health maintenance.
• Lab interface.
• PPRNet
• Advanced reporting features.
• JDMG ADA/NCQA Physician Recognition

6
Advanced Reporting

• The entire patient chart is available and
  searchable electronically.
• All patient data can be extracted and analyzed.
• You cannot do disease management without the data
  good data.
• This presentation is about taking the reporting
  features of PP and advancing them into disease
  management strategies.

7
Disease Management Topics

• Focus on Diabetes Management.
• Using Practice Partner to improve the management
  of diabetic patients.

8
Focus on Diabetic patients

• JDMG chose to focus on diabetic patients.
• Common important for cost parameters to
  improve are agreed on - bonus
• Improvement in processes leads to improved
  outcomes.
• Key values tracked HGBA1C, LDL, Systolic blood
  pressure

9
Extracting and using data from Practice Partner

• Database Analysis

10
Target audience

• There are many ways to approach data analysis.
• Geared toward small to medium sized clinics.
• Low cost.
• You can do it.
• You own the data!
• 50 500 - 5000

11
Using Practice Partner to Manage Data 4 Steps

• Identify patients
• Extract data
• Format data
• Report on data

12
Identify patients Data sources

• From Practice Partner abnormal A1c random
  glucose 120 diabetic medications
• From central billing office patients with
  diagnosis of 250.xx

13
Identifying diabetic patients

• Lists from data sources were combined into a
  master list.
• Providers reviewed lists and charts to ensure an
  accurate diagnosis of diabetes.
• Patients were then flagged as diabetic with a
  custom field in Practice Partner demographics.

14
Identifying Diabetic Patients
A custom field was added to identify diabetic
patients.
15
Extracting the data Step 1
First, a patient inquiry is started within
Practice Partner to find all diabetics.
16
Extracting the data Step 2
Then, a data export is performed based on the
results of the inquiry.
17
Formatting the data

• The data extract results in a raw comma delimited
  text file.
• This text file needs to be formatted to make it
  useable.
• JDMG uses Microsoft Access 2002 to analyze and
  produce useful reports based on this data.
• The text file is brought into Access tables based
  on pre-determined import specifications.
• The Access database is a simple relational
  database that holds demographics, lab,
  medications and vital signs in its tables.

18
Microsoft Access
The data is brought into Access and placed into
tables at the left. Here, we are analyzing lab
values and systolic blood pressures for
diabetics. All tables are related by the patient
ID. As a result, useful reports can be created
that include multiple pieces of data.
19
Queries

• Formatted data now populates the tables.
• Queries are used to pick out desired data.
• Example most recent A1c.
• Right data, right format, right time

20
Sample Queries

• Each provider has built in queries for each
  tracked lab value, such as the A1c.

21
Reports continued

• Queries are used to pick out desired data and are
  the basis for useful reports.
• Reports can show tracked values per physician.
• Reports can also display a summary for the entire
  population.

22
Reports
Each provider has a set of built in reports for
each diabetes health maintenance item.
23
Sample Report
24
Summary Reports
Summary reports show how we are doing with the
entire population. Here, we see that almost 90
of our diabetic patients with JDH insurance have
a HGBA1C below 8.5
25
How JDMG Uses Reports

• Periodically, the providers get a list of their
  diabetic patients who are above our clinic goal
  which is an A1c
• Reports evolve with time and discussion.
• We started out with big lists. Too much to
  digest.
• Keep it simple.
• The Rule of Sevens

26
Use the 5 patient list

• For HGBA1C, we can track patients who are above
  our goal so they can be brought in and treated

Fictitious patient names
27
Now the meat

• Wheres the beef.
• More like a salmon going upstream
• Better reports enables docs to do what they do
  best
• Make medical decisions
• Help the patient to better function

28
Process of improving performance

• Does this sound like CQI??
• Measurable data
• Attainable goals
• 85 rule
• Important makes a difference to the patient
• Group less than 10
• Unavoidable data
• Irrefutable data
• Power of the group

29
Power of the group

• Irrefutable
• Clean
• Short
• The group will decide the movement
• Maybe we need to see patients more often
• Night time insulin
• Referral to local diabetes center for education

30
Results of our Project

• HGBA1C is a moving target
• HEDIS 20 9.5
• 90 of patients are below 8.5
• 81 of patients are below 8
• Local physician comments
• Diabetic patients want to hide
• JDH bonus

31
The Future

• Database usage will expand to track HEDIS
  measures
• Visual Basic.net support for interactive querying
  of the Access database through a friendly front
  end application.

32
Conclusion

• An EMR is vital for recording and retrieving
  critical patient data.
• Identify your patients
• Gather patient data
• Format patient data
• Report on patient data
• Change physician practice relative to care of
  diabetes/disease management.

33
Resources

• Where do I start?
• http//www.jdmg.com/emr.html

34
Questions and Answers Session