1.01ELECTRONIC MEDICAL RECORD SYSTEMS AND DISEASE REGISTRIES:

SELECTION ALONG THE SPECTRUM

Wayne T. Pan, MDMedical Director

Choosing a Chronic Disease

Registry

adapted from Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1:2-4.

Chronic Care Model (CCM)

CommunityHealth SystemSelf-Management SupportDelivery System DesignDecision SupportClinical Information Systems

from Improving Chronic Illness Care (ICIC) website (http://www.improvingchroniccare.org/change/model/components.html). ICIC is a national program supported by The Robert Wood Johnson Foundation with direction and technical assistance provided by Group Health Cooperative's MacColl Institute for Healthcare Innovation

Chronic Care Model (CCM)

Clinical Information Systems

organize patient and population data to facilitate efficient and effective care

How a Chronic Disease Registry (CDR) fits into the CCM

Health Systemcreate a culture, organization

and mechanisms that promote safe, high quality

care

Self-Management Supportempower and prepare

patients to manage their health and health care

How a Chronic Disease Registry (CDR) fits into the CCM

Delivery System Designassure the delivery of

effective, efficient clinical care &

self-management support

Decision Supportpromote clinical care that is

consistent with scientific evidence and patient

preferences

How a Chronic Disease Registry (CDR) fits into the CCM

Health Plan of San MateoCounty-organized Health System

55,000 covered livesincluding ABD

~300 participating PCPswith 1/3rd in county hospital clinics

8

Why a Health Plan?

Chronic Care Model:Help providers help patients manage their chronic conditions

UM can only go so far in managing costs

9

Data rich resources: claims, pharmacy, labs

Why a Health Plan?

Value-added program: attract other providers to our network

10

Why a Health Plan?

HEDIS studies: assist with capturing capitated services

Pay for performance

What are we looking for in a CDR?

Electronic connectivity

Ability to work with multiple chronic diseases

What are we looking for in a CDR?

Integrated clinical practice guidelines

Practice management assistance

What are we looking for in a CDR?

Affordable

Configurable, customizable

What are we looking for in a CDR?

Patient centered”ness”

Web-based, HIPAA compliant

What are we looking for in a CDR?

Technologically appropriate

Multi-plan capable

California HealthCareFoundationpublications

Using Computerized Registries in Chronic Disease Care

(CDC):How a registry supports

CDCEnsure regular follow-up by the care team

Embed evidence-based guidelines into daily clinical practice

Using Computerized Registries in Chronic Disease Care

(CDC):How a registry supports

CDCIntegrate specialist expertise and primary care

Provide timely reminders for providers and patients

Using Computerized Registries in Chronic Disease Care

(CDC):How a registry supports

CDCIdentify relevant subpopulations for care

Facilitate individual patient care planning

Using Computerized Registries in Chronic Disease Care

(CDC):How a registry supports

CDCShare information with patients and providers to coordinate care

Monitor performance of practice team and care system

Using Computerized Registries in Chronic Disease Care:

Differentiating Patient Registries

Source of Registry Application

Sponsorship

Using Computerized Registries in Chronic Disease Care:

Differentiating Patient Registries

Technology Hosting

Single or Multiple Condition

Using Computerized Registries in Chronic Disease Care:

Differentiating Patient Registries

Stand-alone/Integrated into an EMR

Source(s) of Patient Information

Using Computerized Registries in Chronic Disease Care:

Differentiating Patient Registries

Configurability

Affordability

California HealthCareFoundationpublications

Chronic Disease Registries:A Product Review

Considerations in Registry Selection

Overall disease management strategy

Direct vs. indirect costs

Data management

Return on investment (ROI)

Chronic Disease Registries:A Product ReviewRegistry Types

Build your own

Public domain software

Commercial registry software

Web-based patient-centered CDR

Electronic integration of laboratory, pharmacy, encounter,

claims and patient-entered data

Supporting Evidenced-basedMedicine

PatientPlanner attributes

Web-based

Configurable

Patient-centered

Ensure regular follow-up by the care teamEmbed evidence-based guidelines into daily

clinical practiceProvide timely reminders for providers and

patientsIdentify relevant subpopulations for proactive

careFacilitate individual patient care planningShare information with patients and providers to

coordinate careMonitor performance of practice team and care

system

PatientPlanner by

Visit Planner

Patient Planner: Provider Detail

Patient Planner: Provider Summary

Patient Planner: Site Summary

Patient Planner: Outreach

Barriers to implementation

Physician adoption

Upload of laboratory data from: Unilab/Quest LabCorp of America Local laboratories

Member recruitment

Resources

Data analyst with programming skills

Pilot physician offices Private practice Free-standing FQHC County hospital clinics

Future directions

E-prescribing

E-appointments

E-messaging

Multiple insurance plans working together

Thank you