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  A registry includes clinically useful and timely information on all patients.  Information system provides reminders and feedback for providers and patients.  Registry can identify relevant patient subgroups for proactive care.  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 4Organize 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: 4be quick to implement 4 be simple to use 4 be organized by patient; not disease 4 be integrated into daily clinical activities 4contain only data relevant to clinical practice and performance measurement 4when 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: 6try to emulate functionality of an EMR 6contain “mountains” of data 6require an advanced computer degree to operate 6require a lot of upkeep and maintenance 6be limiting to one disease or condition population 6not 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 ICD9 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.

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 Keys to Success from Other Collaborative Teams

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

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