Transcript Data Entry and Maintenance

Clinical Information
Systems
Sacopee Valley Health Center
August 16, 2007
Session Aim
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Brief overview of the Chronic Care Model
Cost of chronic disease
Using clinical information systems to improve
outcomes of patients suffering chronic disease with pre
planning and identifying patients at risk.
Chronic Disease
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A chronic condition lasts a year or longer, limits
what one can do and may require ongoing care.
More than 125 million Americans have at least
one chronic condition and 60 million (21% of the
population) have more than one condition.
The number of people with chronic conditions is
projected to increase from 125 million in 2000 to
171 million in the year 2030.
What accounts for this
dramatic growth in chronic
conditions?
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The large population of baby boomers is aging, and their health is
beginning to deteriorate.
Advances in medical science have helped extended our life span,
leaving more people vulnerable to age related chronic illness such
as cancer, Alzheimer's disease, osteoporosis, heart disease.
10% of patients in one survey reported that in the last year they
were not able to see a primary care physician when they felt it was
necessary.
22% of those who have insurance report that it does not cover all
the types of care they need. This percentage represents an
estimated 21 million Americans with chronic conditions
In a recent survey 16% of respondents (an estimated 16 million
people) have been warned by a pharmacist about a possibly harmful
interaction between medications they were prescribed by one or
more physicians.
Prevalence of Chronic
Conditions
157 M
125 M
Current 2000
Projected 2020
Multiple Chronic Conditions
81 Million
60 Million
2000
2020
Out-of-Pocket Costs
$1,106
>3
Chronic
Conditions
$621
$369
$182
None
1 Chronic
Condition
2 Chronic
Conditions
Direct Costs
$1.07
Trillion
$510
Billion
2000
2020
Current deficiencies in
management of chronic illness
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Rushed practitioners not following
established practice guidelines
Lack of care coordination
Lack of active follow-up to ensure the best
outcomes
Patients inadequately trained to manage
their illnesses
How to improve the system
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The crucial factor in improving chronic
illness care is a clinical database that has
the critical information that a provider
needs to have for a productive interaction
with a patient
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Clinical information systems such as
registries (PECS) and electronic health
records (EHR) enhance the quality, safety,
and efficiency of patient care and office
workflow
A registry or list of patients and their
related data is a tool for tracking individual
and population clinical care information
Definition
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A registry is a computer application that
stores disease-condition specific individual
and population-based information to
support care management, outreach,
quality improvement, and outcome
research.
Planning for a registry
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WHO
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WHAT
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Will it be entered?
WHERE
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Data do I need to get my reports?
WHEN
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Will be entering it?
Will it be entered?
WHY
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When what I do works so well?
Use the registry to provide clinical
support
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Registries support physicians by providing
printed patients reports,
Identifying patients that are overdue
Generate reminders and care-planning tools for
individual patients
Provide feedback to care team, leaders and
affiliated organizations
Help identify potential medication interactions
A formulary can reduce out of pocket expenses
Workflow Analysis: Who/When
Do Registries Work
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In the VA, programs with improved HbA1c
results, had computerized diabetes
reminders, engaged patients with self
management, and involved the providers
in quality improvement.1
Use of physician reminders, performance
feedback, and structured care
management were all associated with
improved diabetes process, but not
improved outcomes.2
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Clinician’s responses to a survey assessing their
use of CCM components was significantly
correlated to improvements in HbA1c values and
ratios of total cholesterol to HDL cholesterol.
Clinician’s responses were also associated with
patient reported measures of improved care
processes.3
1. Jackson GL, Yano EM, Edelman D et al. Veterans Affairs primary care organizational characteristics associated
with better diabetes control. Am J Manag Care 2005; 11(4):225-37.
2. Mangione CM, Gerzoff RB, Williamson DF et al. The association between quality of care and the intensity of
diabetes disease management programs. Ann Intern Med 2006; 145(2):107-16.
3. Nutting PA, Dickinson WP, Dickinson LM, Nelson CC, King DK, Crabtree BF, Glasgow RE. Use of Chronic Care
Model Elements Is Associated with Higher- Quality Care. Annals of Family Medicine 2007; 5(1):14-20.
Measuring Progress
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Measurement is a critical part of testing
and implementing changes
Measures tell a team whether the changes
they are making actually lead to
improvement
Measurement for improvement should not
be confused with measurement for
research
Measurement for
Research
Measurement for
Learning and Process
Improvement
Purpose
To discover new knowledge
To bring new knowledge
into daily practice
Tests
One large "blind" test
Many sequential, observable
tests
Biases
Control for as many biases
as possible
Stabilize the biases from
test to test
Data
Gather as much data as
possible, "just in case"
Gather "just enough" data
to learn and complete
another cycle
Duration
Can take long periods of
time to obtain results
"Small tests of significant
changes" accelerates the
rate of improvement
PDSA
Variables
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CHANGE:
A deliberate introduction into
a process in order to achieve
a higher level of performance
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EVENT:
Something that happens
which may affect
performance of the process.
TRACKING
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The Improvement Tracker allows you to track any of the
measures currently available in the Topics area of
IHI.org. Just select the measure you want to track (or
create your own custom measure), set your aim, and
enter your data. The Improvement Tracker automatically
graphs your data. It lets you create reports, and even
customize them for various audiences — your team, your
CEO, your community.
Improvement Tracker allows you to track predefined
standard measures in several topic areas, with more
being added periodically. Additionally, you can create
your own custom measures to track any data you want!
http://www.ihi.org/ihi/workspace/tracker/