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System Changes and Interventions: Registry as a Clinical Practice Tool Mike Hindmarsh Improving Chronic Illness Care, a national program of the Robert Wood Johnson Foundation Bureau of Primary Health Care Health Disparities Collaboratives October 24 -26, 2002 Dallas TX
Clinical Information System: Registry Ø A registry includes clinically useful and timely information on all patients. Ø Information system provides reminders and feedback for providers and patients. Ø Registry can identify relevant patient subgroups for proactive care. Ø Registry facilitates individual patient care planning.
What a Registry Will Did For the Practice Team 4 Identify patient populations and sub-populations in need of routine care 4 Organize data from disparate information sources (automated, paper record, patient visit) 4 Track care of individuals and populations of patients 4 Provide patient summaries at time of visit 4 Produce exception reports for population care planning 4 Enable feedback to team on population outcomes 4 Automate care reminders 4 Allow queries of data to target at risk sub-populations 4 Helped providers feel more organized during chaotic day!
What a Registry Should Be Should: 4 be quick to implement 4 be simple to use 4 be organized by patient; not disease 4 be integrated into daily clinical activities 4 contain only data relevant to clinical practice and performance measurement 4 when necessary, make data entry simple and efficient 4 be easy to update from other automated data sources 4 guide clinical care first, measurement second!
What a Registry Should NOT Be Should not: 6 try to emulate functionality of an EMR 6 contain “mountains” of data 6 require an advanced computer degree to operate 6 require a lot of upkeep and maintenance 6 be limiting to one disease or condition population 6 not become the focus of practice activity
Making the Registry “Real” in Your Practice The Software • If not using PECS, try out other products. (see registry comparison document on ICIC website) • Install software. • Identify training resources.
Making the Registry “Real” in Your Practice The Registry Manager • Identify best person on team to manage the registry. • Choose person with computer skills and interest. • Define roles and responsibilities for manager. • Secure training for manager as needed. • Highlight registry’s importance to rest of team. • Train a registry manager back-up.
Making the Registry “Real” in Your Practice Populating the Registry • Use billing data and ICD 9 codes to identify specific populations. • Download names and contact information into registry. • Identify other automated data sources. (e. g. labs, Rx) • Establish process for regular population updates.
Making the Registry “Real” in Your Practice Gathering Clinical Data • Define the relevant clinical data needs. • Use the visit for collecting non-automated data. • Develop and test data capture process. • Develop and test data entry process.
Making the Registry “Real” in Your Practice Using Data at Point of Care • Establish process for producing patient summary data for use at time of visit. (acute or planned) • Ensure summary is on chart. • Does the summary work for various patient types? • Ensure new data is captured on the summary. • Develop process for new summary data to be entered into registry.
Making the Registry “Real” in Your Practice Using Data for Care Reminders • Establish what you want “reminding” about. • Determine how you want to be reminded. (i. e, exception reports or individual patient prompts) • Identify team member responsible for monitoring reminders. • Create process for responding to reminders. (i. e. , who calls patient, when and for what purpose) • Create process for updating/modifying reminders.
Making the Registry “Real” in Your Practice Using Data to Monitor Performance • Determine what types of population reports are needed and reporting intervals. • Establish process for creating customized reports. • Who will generate reports? • Who receives reports? • Do the reports facilitate continued improvement?
Keys to Success from Other Collaborative Teams • Organization of health care – senior leadership supports the time involved in registry upkeep. • Delivery system design – data form is clear, data entry role is assigned, data review time allotted. • Decision support – data entered and retrieved is clinically relevant, and used for patient care. • Community linkages – are a good source of much needed technical support.
Keys to Success from Other Collaborative Teams • Committed team with at least one competent and responsible in charge of data collection and review • Care management as a team approach • Regular repetitive review with each clinical group • Dedicated time each week for primary team • Ongoing enthusiastic repetition and reinforcement to other clinical teams • Make steady small changes regularly
Barriers to Registry Implementation • Lack of onsite available computer expertise • Inability to use other databases to generate registry or download into registry • Difficulty identifying certain populations • Lack of consistency between providers • Time – data entry, monthly review • Lack of perceived value added
Please Visit Our Web Site for Downloadable Information on Registries: www. improvingchroniccare. org