Diabetes Management System Dorothy K Russell MS MT ASCP

Diabetes Management System Dorothy K. Russell, MS, MT(ASCP)

Diabetes Management System aka: DMS • Collection of RPMS tools designed to assist IHS and Tribal staff involved with care and management of patients with diabetes or prediabetes • Primarily a patient focused application • Also provides program evaluation & monitoring functionality

Diabetes Management System Chronology • 1984 -1999 RPMS tools to assist DM program available, but in separate menus • 2000 DMS V 1. 0 – Roll & scroll • 2006 Prediabetes Register & Audit • 2007 DMS V 2. 0 – Roll & scroll and GUI (Visual Diabetes Management System)

DMS Features • Diabetes register • Health summary enhancements – Diabetes Flowsheet – Diabetes Patient Care Summary (aka DM Supplement) • DMS Patient Management Interface • DMS Reports & Letters

DMS Features • Qman, PCC Reports (PGEN, VGEN, BMI) • Automated Diabetes Audit report and. rec file creation for Web Audit • Mailman bulletin notification of new cases • Prediabetes register • Prediabetes audit report

DMS Features • Full access to all PCC data regardless of how it was entered – Ancillary applications (e. g. Pharmacy, Lab, Radiology, etc. ) – PCC data entry – EHR – Interfaces

IHS Diabetes Register • Automatically installed on all systems • List of patients diagnosed with: – Type 1 or Type 2 diabetes • Gestational DM, Prediabetes, Metabolic Syndrome usually in separate register(s) • Tool to help DM program managers follow patients and prevent loss to follow-up

Health Summary • • Snapshot of patient’s clinical history Numerous types available Locally customizable Displayed / printed via PCC, Behavioral Health, EHR

Diabetes Flowsheet • Spreadsheet containing important DM related events • Typically contains labs, but may also be used for other data elements Date BP A 1 C CHOL LDL HDL TRIG 4/18/08 140/90 6. 8 230 140 48 380 9/10/07 138/86 7. 7 243 155 43 370 2/3/07 148/98 9. 0 260 160 40 375

Diabetes Patient Care Summary • • AKA – DM Supplement Last page of health summary Contains all diabetes audit elements Reminder to providers of important DM standard of care items that may need attention • Like the diabetes audit, the supplement uses certain DM related taxonomies

Prediabetes Supplement • Released with Health Summary patch • Logic consistent with prediabetes standards and prediabetes audit

Triggering Events for DM Supplement and Flowsheet • Presence of a diabetes diagnosis on problem list (ICD codes 250. 00 -250. 93) • Diabetes diagnosis during previous year(s) – Precise number of DM diagnoses needed and time frame now controlled locally through use of Health Summary Site Parameters File

DMS Patient Management Interface • Patient focused … one patient at a time • VA List. Manager display containing numerous management tools – Display options for laboratory test, medications, visits, health summary, etc. – Edit options for DM register data, problem list – Patient focused reports • Case summary, patient letters, diabetes audit for current patient, health summary browser

DMS Patient Management Interface (PM)

DMS Letters & Reports • Follow-up report & Letters – Allows user to generate list of DM register patients needing specific diabetes related services and/or patient letter • Access to Case Management System (CMS) reports – Case summary, master list, general retrieval report (GEN) … user provided specifications • Access to PCC Management Reports, including Body Mass Index (BMI) reports

Qman • PCC database query utility … data fetcher – Ad hoc reporting of patients with (or without) certain demographic or clinical attributes – Numerous output types • • • Display Print Count Age distribution report Mailing labels Template (cohort) creation

Diabetes Audit Report • Analyzes compliance with IHS diabetes standards • Utilizes 2006 IHS Standards of Care for Patients with Type 2 Diabetes • Shares certain logic with GPRA report • Paper & electronic versions • Can eliminate manual audit process • Web audit now available • Requires quality data recording and entry into PCC

Diabetes Audit cont. • Requires numerous taxonomies with some needing local maintenance – Drug • Insulin, ACE/ARB drugs, Metformin drugs, etc – Lab test • A 1 C, Lipids, UACR, Creatinine, etc – Education topics • DM nutrition, DM exercise, etc • Taxonomy setup guide available

Prediabetes Audit • Utilizes IHS Guidelines for Care of Adults with Prediabetes and/or Metabolic Syndrome in Clinical Settings (Sept 2008) • Requires taxonomy setup • Not annual requirement as is the Diabetes Audit

DM New Case Bulletin

Visual Diabetes Management System … aka DMS GUI • • GUI = Graphical User Interface Windows based in lieu of roll-&-scroll Most DMS functionality available in GUI Requires LAN based database & workstations Requires MS Office Two components – server & client Separate from Patient Chart application and EHR Distributed with DMS v 2 – June 2007

Visual DMS

Visual DMS Special Login Requirements

DMS GUI uses same A / V codes as classic RPMS

DMS GUI Initial Screen

DMS GUI Expanded Menus

Taxonomy update via roll & scroll

Taxonomy update via DMS GUI

DM Audit via roll & scroll

DM Audit via GUI

Break Time

DMS Data Requirements Lab • Laboratory Tests – Glycemic control: HGb. A 1 C – Lipids: Cholesterol, LDL, HDL, Triglyceride – Renal function: Creatinine, GFR – Proteinuria: Albumin/Creatinine Ratio • Test results must be in PCC – Directly from Laboratory Package – Automatically via reference lab interface – Manually entered via PCC data entry

DMS Data Requirements Exams • Examinations – Dental Exam – Diabetic Eye Exam – Diabetic Foot Exam – Depression Screening Exam

DMS Data Requirements Patient Education • Patient education evaluated by audit: – Nutrition – Exercise – Other • DM topics vs DMC topics • Requires proper recording & data entry • Education protocols available on IHS website – http: //www. ihs. gov/Non. Medical. Programs/Health. Ed/

DMS Data Requirements Health Factors • Tobacco – Current Smoker, Previous Smoker – Current Smokeless, Previous Smokeless – Smoker in Home, Non-tobacco user • TB Status – Tx Complete – Tx Incomplete – Tx Unknown – Tx Untreated

DMS Data Requirements Health Factors cont. • Glucose Self Monitoring – Yes, No, Refused • Barriers to Learning • Learning Preference • For a complete list of Health Factors & Exams, see 2008 Health Factors & Exam Code documentation guide

DMS Register Creation (1) If IHS Diabetes register is not present on system, use option to install the IHS Diabetes Register IHS option

DMS Register Creation (2) Next, add users needing access to the DM register AU option

Switch to DMS – Roll & Scroll or GUI

DMS Data Retrieval • Qman – PCC Query Utility – Subject … usually Living Patients or Register – Attribute … demographic or clinical – Condition … is, greater than, during, etc. – Value … Chicago, hypertension, 200, etc. • Qman outputs – Display, count, special outputs • Qman training part of PCC Outputs Class

DMS Data Retrieval • Health Summary – DM Supplement – DM Flowsheet • Canned reports … require few, if any, decisions by user • GEN (General Retrieval) reports … allow user to customize report • Diabetes Audit … paper & electronic

Minimum Security Keys for DM • Qman – AMQQZMENU, AMQQZCLIN • CMS – ACMZMENU, ACMZ EDIT, ACMZ MANAGER, ACMZ DELETE PATIENT • DMS – BDMZMENU, BDMZEDIT, BDMZ REGISTER MAINTENANCE

Support Resources for DMS • Level 1 - Local resources – Supervisor – RPMS Site Manager • Level 2 – Area Support – RPMS help desk • Level – OIT (Albuquerque) – Help Desk: (support@ihs. gov) – IHS Website • RPMS Feedback Page