Using a registry to identify patient needs

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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

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What is a registry all about?
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Before the Visit

• A registry identifies care needs for a patient
  population and assists outreach efforts to meet
  those needs on an ongoing basis.

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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.

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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.

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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.

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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?

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Improving Care

• Individual patient improvement
• Monitor performance
• Guide change
• Population improvement
• Monitor performance
• Guide change

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Registry Design

• Consider the data that makes up a registry

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Registry Design
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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.

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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)?

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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)?

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Events

• Date of service
• Result

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Data Capture

• Does your current system already have
  opportunities for you to capture registry data?

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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

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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)

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Document Management System
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Going Paperless
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Document Management
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Document Management System
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Workflow Integration

• How do you integrate a registry into office
  workflow?

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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.

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Workflow Examination

• How to examine your office workflow to find
  opportunities for registry integration.

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Identify registry related information.

• Front Office

• Back Office

• Patient Identifier
• Patient Demographics

• Guideline-based Measures
• Smoking status
• 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

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Who handles registry related information in your
office?

• Front Office

• Back Office

• Receptionist
• Billing
• Transcription
• Office manager

• Medical Assistant
• Nurse
• Care manager
• Providers

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When and how do they handle registry related
information?

• Front Office

• Back Office

• Patient Check-in
• Telephone Conversations
• Mail
• Faxes
• Email

• Loading patients
• Appointments
• Reviewing results
• Outreach

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In what format is the information received or
kept?

• Not Electronic

• Electronic

• Paper
• Mail
• Fax
• patient delivered
• Verbal
• Patient call
• Call report from facility

• Email
• Electronic fax
• Secure web portal to external facility
• EMR data
• PMS data

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What is done with the information received?

• Front Office

• Back Office

• File it
• Route to Provider
• Route to Consultant
• Route to Patient

• Review and sign-off
• Take action
• Order test
• Prescribe medication
• Schedule Follow up
• Route to Staff
• Route to Consultant
• Route to Patient

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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.

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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.

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Recruiting Patients for Registry Participation

• Use patient interaction with the registry to
  boost productivity and outcomes.

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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.

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Make it easy

• Step-by-step guide to the electronic enrollment
  process.
• Links from your practice homepage to the
  ReachMyDoctor registry.

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Make sure it works

• Update data frequently enough that patients dont
  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.

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Thank you!

• Questions?