Clinical Information Systems:
Establish a Registry
A system that records all relevant patient care information is often referred to as a "registry." Providers can use the registry to record critical elements of the care plan, produce quick care summaries at the time of a visit, and enter data to alter the care plan as needed. A patient registry is most useful when patient data are available to the provider at the point of the patient visit, when decision support is most needed.
- 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 diabetes 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 diabetes.
- Share the list of diabetes patients with the practice team to eliminate miscodes. Have team "clean" the list by noting patients who are not diabetic, 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 diabetes 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 diabetes 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.
- Flag gestational diabetes as appropriate.
- Use the following definition: patients with diabetes (Type 1 and Type 2) who were continuously enrolled during the year and who have at least one visit to the clinic within the past calendar year are considered clinic patients unless there is documentation that the patient has transferred to another practice or has moved from the area. In addition, clinics with managed care plans should try to include patients with diabetes who have no documented medical visit to the clinic, and who have been assigned to the clinic for 12 months, with no more than a 45-day drop in coverage.
- 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, and/or "Foot Exam" sticker to identify records of person with diabetes.
- Ensure patient confidentiality. (Don't write or type "Diabetic" on the outside of the chart.)
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