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Linking Public Domain Disease Management Registry and an EMR for Diabetes Management and Reporting

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Rapid access to the latest in evidence-based medicine guidelines ... Review data with site personnel. Incorporate results into quality improvement plans ... – PowerPoint PPT presentation

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Title: Linking Public Domain Disease Management Registry and an EMR for Diabetes Management and Reporting


1
Linking Public Domain Disease Management Registry
and an EMR for Diabetes Management and Reporting
  • West Virginia University Department of Community
    Medicine
  • Office of Health Services Research
  • 04/22/2009

2
Special Thanks to Our Funders
  • This presentation was supported by
    Grant/Cooperative Agreement Numbers
    U32/CCU322734, U59/CCU324180-03, U50/CCU321344
    from the Centers for Disease Control and
    Prevention.
  • Its contents are solely the responsibility of the
    authors and do not necessarily represent the
    official views of the Centers for Disease Control
    and Prevention.

3
HEALTHeSTATE
  • Federally funded project to develop EMR
    specifically for community health centers
  • In West Virginia known as HEALTHeWV
  • EMR has evolved from system used at Walter Reed
    Hospital
  • In West Virginia use by several CHCs systems and
    all of our Health Rights (Free Clinics)

4
HEALTHeSTATE
  • WHAT IS HEALTHeSTATE / HEALTHeWV?
  • A unique patient-centered system that facilitates
    continuity of care across the spectrum of
    providers
  • Historically based on proven technology
    recognized by industry
  • A modified version of the award-winning interim
    military electronic health record
  • A means to reduce staff time spent on
    administrative tasks and improve clinical
    documentation
  • A customizable, Web-based technology application
    to meet patient, clinician, and staff needs and
    processes
  • Real-time clinical information to enhance
    clinical decision support

5
HEALTHeSTATE
  • WHAT DOES HEALTHeSTATE / HEALTHeWV SUPPORT?
  • The ability of West Virginia rural health care
    providers to deliver improved care at lower costs
    with better results
  • Rapid access to the latest in evidence-based
    medicine guidelines
  • Enhanced care for those suffering from chronic
    disease conditions, such as diabetes, cancer,
    asthma, heart disease, and lung disease
  • Increased patient safety by reducing error and
    redundancy and increasing legibility and clinical
    alerts
  • Affordable, full-featured electronic health
    records system for rural health care providers
    that creates and maintains patient records and
    improves patient/provider communications

6
Comparing EMRs and Registries
Both Registries and Electronic Medical
Records fall under the heading of Clinical
Information Systems
  • Electronic Medical Record
  • Stores all the data
  • Designed to hold data
  • Difficult to do data exchanges
  • Closed-source / proprietary systems
  • Should contain registry functions Often does
    not
  • Electronic Patient Registry (such as CDEMS and
    PECS)
  • Stores key pieces of data
  • Designed to hold and retrieve data (for tracking,
    reporting, QI)
  • Data exchange is a strength
  • Open-source / public domain systems
  • Collaborative/Sharing environment

7
Background on Office of Health Services Research
  • OHSR Intro
  • Partnerships with Health Centers
  • Comparing EMRs and Registries
  • National Collaboration
  • About CDEMS
  • Work with EMRs/EHRs
  • CDEMS Developments (Demo)
  • Future Registry Plans Web Applications
  • Recent Publication Analysis

8
The Care Model Our Reference Point
9
Clinical Information System Support
  • Clinical Information System Support
  • Guidance in use of electronic patient registries
    / EMRs as quality improvement tools
  • Registry support
  • Set-up
  • Laboratory interfaces
  • Training and on-going support
  • Customizations and special reporting
  • Plan data transfers across systems (EMR to
    registry)
  • Limited EMR support
  • Assisting sites in using EMR effectively
  • Developing reports in EMR
  • Exporting EMR data for reporting and analysis

10
Support Desk
Allows us to work with health center
providers staff and view their computers
  • Providing remote support has allowed our
    office to
  • Be more responsive to registry users
  • Improves the quality of the visits we
    make

Support Desk Available at support.wvuohsr.org
11
Data and Educational Support for Registry and
EMR Users
  • Data Support
  • Review data with site personnel
  • Incorporate results into quality improvement
    plans
  • Generating special reports
  • Educational Support
  • Evidence-based education for providers/staff
  • Stanford Chronic Disease Self-Management Program
  • Curriculum development and presentation

12
Growth in Partnerships Over Time
13
State-wide Partnerships
Map available at http//www.hsc.wvu.edu/som/cmed/
ohsr/maps/OHSR_WV.aspx
14
National Support and Collaboration
Designed to facilitate collaboration, sharing,
problem solving
  • Registry basics Evaluation Use of data for QI
    Data exchanges EMR issues

Map available at http//www.hsc.wvu.edu/som/cmed/
ohsr/maps/OHSR_National.aspx Minutes/Materials
available at http//www.CDEMS.com
15
About CDEMS
  • Chronic Disease Electronic Management System
  • Open source, public domain patient registry for
    disease management and reporting
  • Developed by the Washington State Dept of Health
  • Stems from the DEMS family of software
  • Highly ranked in Chronic Disease Registries A
    Product Review available at http//www.chcf.org/
    documents/chronicdisease/ChronicDiseaseRegistryRev
    iew.pdf
  • Used across United States for numerous chronic
    conditions

16
Benefits of CDEMS
  • Simple, no cost, flexible tool for tracking
    patient care
  • 1) Monitor patient care
  • Structure checklist for standardized approach
    to care
  • Reminders for patients and providers
  • Facilitates care planning for individual patients
  • Gaps in care can be identified for action
  • Progress note, flow sheet, reminder letters
  • 2) Monitor health center / provider performance
  • Summarizes population level data
  • Documents outcomes for UDS, PQRI, quality
    certifications, pay-for-performance
    reimbursements
  • Summary report
  • 3) Tool for transitioning to EMRs and/or
    supplement to EMR reporting

17
EMR Developments
  • Linking CDEMS with EMRs
  • Procedures in-place to export data from these
    EMRs to CDEMS for reporting and QI
  • HEALTHeWV/HEALTHeSTATE
  • Healthcare Management Systems (HMS)
  • AllScripts / A4
  • Supporting EMRs
  • Building QI and UDS reports
  • Electronic Health Systems (EHS)
  • MediNotes

18
CDEMS Overview Demo
  • Progress Note
  • quick reference for patient care indicators
  • -- Case management
  • -- Decision support
  • Guidelines/Graphs
  • used in patient education / self-management
  • Reporting Tool
  • benchmarking, evaluation, population
    patient level reports, patient reminder letters

19
CDEMS Developments
  • Point-of-care registry use

20
CDEMS Developments
  • Registry Flow Sheet
  • Differs from the traditional Progress Note.
    Displays a history of registry data for each
    patient

21
Registry Summary Reports
  • Example Step-wise Approach to using the Summary
    Reports
  • Identify specific pieces of data, such as of
    patients in need of an HbA1c
  • Next, find out who these patients are, using List
    Reports
  • Then, generate appropriate letters to contact
    those patients

22
HbA1c Reminder Letter
23
CDEMS Developments
  • Provider and Patient Notification Letters

24
Uniform Data System Reporting via CDEMS
  • Required reporting for all FQHCs
  • Diabetes
  • Proportion of patients with diabetes whose most
    recent HbA1c is within the following ranges
  • lt 7.0
  • 7.0 to 9.0
  • gt 9.0
  • Hypertension
  • Proportion of patients with hypertension whose
    most recent blood pressure is less than 140/90

25
Future Plans for Registry Use
  • Physician Quality Reporting Initiative (Centers
    for Medicaid and Medicare Services)
  • Interest from the WV Health Improvement Institute
    in using CDEMS in private practices
  • American Association of Diabetes Educators
    Self-Care Behaviors 7 (AADE7)
  • Collaborating with Johns Hopkins University in
    adding these measures to CDEMS for national use
  • National Black Lung Clinics Program (HRSA)
  • Committee formed, advocating that CDEMS is an
    appropriate tool for standardized data collection
  • Web-based applications
  • eAsthma Action Plan (WV-AEPP)
  • On-line Stroke Registry (WVU, EMS)

26
Recent Publication Journal of Rural Health,
Winter 2009
  • Electronic Patient Registries Improve
    Diabetes Care and Clinical Outcomes in Rural
    Community Health Centers
  • Purpose Examine effects of basic registry
    utilization on diabetes care processes and
    clinical outcomes according to level of registry
    use
  • Methods Pre-Post registry analysis of cohort
    patients from 6 FQHCs (N 661). Patients were
    included if they had 2 years of continuous care,
    including an office visit during the year prior
    to registry implementation (baseline) and during
    the year following implementation (follow-up).
  • Findings Registry assisted in significant
    improvements in care practices (12 of 13) and
    clinical outcomes (HbA1c, LDL, Cholesterol) in
    patients seen at health centers with at least
    moderate levels of registry utilization

Full-text available at http//www3.interscience.w
iley.com/cgi-bin/fulltext/121585395/PDFSTART
27
State-wide Improvements HbA1c
  • Data are from Patients with DM across 21 health
    centers

28
Contact Information
Cecil Pollard, Director (304) 293-1080
cpollard_at_hsc.wvu.edu Trisha Petitte, Assistant
Director, Health Improvement Consultant (304)
293-1084 tpetitte_at_hsc.wvu.edu Mary Swim,
Applications Programmer, Technical
Support (304) 293-1079 mswim_at_hsc.wvu.edu
Adam Baus, Program Coordinator, Sr., Technical
Support (304) 293-1083 abaus_at_hsc.wvu.edu
Nell Stuart, Health Improvement
Consultant (304) 276-3785 nstuart_at_hsc.wvu.edu
Marie Gravely, Health Improvement
Consultant (304) 482-6016 mgravely_at_hsc.wvu.ed
u
Office website http//www.wvuohsr.org
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