Title: Linking Public Domain Disease Management Registry and an EMR for Diabetes Management and Reporting
1Linking 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
2Special 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.
3HEALTHeSTATE
- 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)
4HEALTHeSTATE
- 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
5HEALTHeSTATE
- 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
6Comparing 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
7Background 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
8The Care Model Our Reference Point
9Clinical 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
10Support 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
11Data 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
12Growth in Partnerships Over Time
13State-wide Partnerships
Map available at http//www.hsc.wvu.edu/som/cmed/
ohsr/maps/OHSR_WV.aspx
14National 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
15About 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
16Benefits 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
17EMR 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
18CDEMS 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
19CDEMS Developments
- Point-of-care registry use
20CDEMS Developments
- Registry Flow Sheet
- Differs from the traditional Progress Note.
Displays a history of registry data for each
patient
21Registry 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
22HbA1c Reminder Letter
23CDEMS Developments
- Provider and Patient Notification Letters
24Uniform 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
25Future 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)
26Recent 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
27State-wide Improvements HbA1c
- Data are from Patients with DM across 21 health
centers
28Contact 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