Clinical Information Systems:
Establish a Registry
- Choose or develop an electronic or manual registry.
Electronic Method:
Choose a computer application that allows for flexible data handling and reporting. Make sure the application makes it easy to get patient information into and out of the system. It should also be easy to transfer information to and from other systems (e.g., billing, lab, appointments), or even have a direct interface with these systems.
Manual Method:
Develop a card file or notebook that can be used to track patient information.
- Decide on what data to include in the registry, based on the essential elements of good chronic conditions care. (See Decision Support.)
- Document how you established the data elements on a template, so that new staff can replicate the process.
- Build the registry by using an existing information system to identify the majority of patients with the specific chronic disease.
- Share the list of patients with the specific chronic condition with the practice team to eliminate miscodes. Have team "clean" the list by noting patients who do not have the specific chronic condition listed, who have long since moved out of the area, or who have died. Some groups perform a chart audit to clean the registry.
- Document the process of identifying patients as "inactive."
- Choose software that can capture needed data from existing computer systems and is within budget.
- Visit a clinic with a well-implemented patient registry.
- Keep manual data entry to a minimum. Whenever possible, transfer information electronically from systems like appointments and billing.
- Remember that a registry is NOT an automated medical record. A registry is a repository of essential care elements based on a care guideline.
- Identify team members with good computer skills to manage the registry and train others how to use it.
- Use precise and consistent definitions for each key measure. Make sure you capture information required by accrediting bodies or managed care organizations.
- Start small, but make sure the system lets you add new data elements as guidelines change providers become more sophisticated. Don't overwhelm people with too much information at first.
- Don't forget to include the following, which are cultural indicators that can help you reach migrant and homeless patients and other underserved populations:
- Ethnicity
- Language
- Insurance coverage
- Patient mobility
- Make sure that your registry will also be useful for reports:
- Quality Improvement projects
- Provider feedback
- Grant applications
- Financial management
- HEDIS
- Special populations
- Keep the template simple and easy to use.
- Many of the existing systems (especially Excel-and Access-based) also have easy-to-use data import features.
- Try to include all patients, even if the practice doesn't recognize or claim them. Most providers dramatically underestimate the number of patients with chronic conditions in their patient population.
- Work with information systems expert to develop ways to update the registry monthly, based on billing, pharmacy, and lab data.
- Review the registry for accuracy. If too many people with chronic conditions are missed, providers won't trust the registry.
- In many cases, it takes an actual patient visit to determine if someone should not be in the registry. However, many organizations have found most inaccuracies through a chart audit.
- Tie the registry update process to standard forms to be completed when a patient dies or is removed from the clinic roster.
- Place a tab in chart, color-coded stickers to identify records of people with chronic conditions.
- Ensure patient confidentiality. (Don't write or type "Diabetic" or "Asthmatic" on the outside of the chart.)
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