1. Let’s Talk Informatics
More than a Registry:
Making Life Easier…Improving Data Quality…Effecting Practice Change
Peggy Dunbar & Robin Read
June 28, 2018
Bethune Ballroom, Halifax, Nova Scotia

2. One Person One Record project.
Please be advised that we are currently in a controlled vendor environment for the
One Person One Record project.
Please refrain from questions or discussion related to the

3. Informatics…
utilizes health information and health care technology to enable patients to receive best treatment and best outcome possible.

4. Clinical Informatics…
is the application of informatics and information technology to deliver health care.
AMIA. (2017, January 13). Retrieved from infomatics/clinical-informatics

5. Objectives
At the conclusion of this activity, participants will be able to…
Identify what knowledge and skills health care providers will need to use information now and in the future.
Prepare health care providers by introducing them to concepts and local experiences in Informatics.
Acquire knowledge to remain current with new trends, terminology, studies, data and breaking news.
Cooperate with a network of colleagues establishing connections and leaders that will provide assistance and advice for business issues, as well as for best-practice and knowledge sharing.

6. Objectives
At the conclusion of this session, participants will be able to…
Discuss how the Diabetes Care Program of Nova Scotia (DCPNS) Registry evolved to meet the needs of front-line staff
Describe the rule-based approach to Registry design and its impact on data capture, data quality, and user acceptance
Explain the reporting functionality that supports communication with referring providers, and the identification of patient groups for targeted interventions/initiatives
Explain the current project aimed at “optimizing use” by care providers in 38 Diabetes Centres across the province (It will be E.P.I.I.C!)

7. Conflict of Interest Declaration
We (Robin and Peggy) do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device, health care informatics organization, or other for-profit funder of this program.
Speakers are to update the Conflict of Interest Declaration as it applied to them.

8. Starting with common language…
Diabetes Care Program of Nova Scotia (1991)
A former DHW Provincial Program now in the NSHA
Mission: to improve the health of Nova Scotians living with, affected by, or at risk of developing diabetes.
Activities:
Act in an advisory capacity; recommend service delivery models
Works across NSHA and the IWK
Establish standards and guidelines
Specialty populations; complications prevention/management; recommended processes & structures;
Diabetes Surveillance and Monitoring:
Surveillance cycle—collect, analyze, interpret, disseminate… to effect change
Disease burden, provincial/zone trends
Uptake of approved standards and system outcomes
…build relationships, level the playing field, grow potential, celebrate/share innovation, balance urban and rural perspectives…

9. Starting with common language… (cont’d)
Diabetes Centres (multi/inter-disciplinary teams)
Are located province-wide (38+)
Operated/funded by the NSHA and IWK
Support Primary and Specialty Care Physicians
Conduct individual assessments and provide individual/group education/supports
Determine appropriate treatment plan, and assist with implementation
Monitor for Diabetes complications development and progression
Promote and support self-care

10. DIABETES CENTRES IN NOVA SCOTIA

11. Starting with common language… (cont’d)
DCPNS Registry/Information Management System
“an authoritative list of one kind of information”
“organized system for collection, organization, storage, and communication of information…programmed to produce regular reports”
more than 1 application (2014—added NSIPP)
More than a Registry…Database(s) and Application(s)

12. DCPNS Registry (as a Database)
< age 19 data since 1992
All referrals to Diabetes Centres since 1994
On-site application since 2002 (decentralized)
Provincial and local reporting
To March 31, 2017:
~ 107,000 individuals (all types DM & PreDM)
Add ~ 3,500 new cases per year
Over 45,000 visits per year
160+ users

13. For over 25 years, the DCPNS has focused its work on quality improvement
“The enhancements to local level reporting are the direct result of engagement with our stakeholders (front line diabetes educators, specialist and generalist physicians, and program managers), learning from others, and wanting to actively build capacity and “value in data” in our Registry users.”
The Program has actively supported the capacity to generate, interpret, and act on local data…

14. DCPNS Registry (Information Management System)

15. Registry Objectives: To…
help determine the magnitude of Diabetes (DM) in NS
improve the quality, consistency, & completeness of the data collected,
enhance local capacity to collect, analyze, interpret, and use data to influence program practices,
allow the collection of comparative data across Centres/zones (and hopefully, provinces)
generate evidence in support of best/promising practice approaches, and
reduce documentation efforts through the use of standard and custom reports.

16. DCPNS Registry Evolution 1992 1998 2001 2004 2006 2008 2013 2014 2016
FoxPro application
Centralised entry at DCPNS
1992
dBase IOC component (stand alone)
pilot sites (testing)
1998
DCPNS Registry (2 components together)
Client installation P2P network use
2001
Windows 2003 Terminal Server
3 DCs use 1 installation of the DCPNS Registry in DHA 3
2004
•Interface with Meditech
(Phase I: demographic and visit data)
2006
DCPNS Server (35 DCs on one server)
Interface with Meditech (Phase II: lab data)
2008
Interface with STAR (Phase I: demog/visits)
Interface with IWK Meditech (Phase I: demog/visits data)
2013
•DCPNS Registry migration to CAISIS platform. • Added NSIPP module
2014
•Interface with Cerner Lab (Phase II for Central Zone)
•HL7 futures?
2016

17. Registry Overview (current state)
Housed & Supported by NSHA Infrastructure
Active Directory credentials
MSI validation:
Date of death
Date of birth
HC#
Built and maintained by DCPNS staff
CAISIS platform (open source)
Web based (user friendly access)
Centralized database (share data on common patients)
Interfaces (Registration and Lab systems)
Auditable (meets PHIA requirements)

18. REGISTRY DEMO Rule-based approach to design
Provider/patient-friendly Registry features
Reporting functionality
impact on practice change

19. Registry Features Provider/patient-friendly Features
Dashboard features (quick access, visualization of patient info)
Graphing capabilities (sharing/engaging patients)
Lab/visit sorting
Alerts & reminders
Halos
Reports & labels
Rule-based Approach to Design:
VT (Visit Type) rules, e.g:
Type of diabetes
Visit type
Gender
Carry forward
Effected by Visit Type selection.
37 data points from the current and previous visit are used to carry forward data improving DQ and lessening charting effort.
Break here for demo

20. REGISTRY DEMO Reporting functionality impact on practice change
Using local data to drive quality improvement (practice change)

26. Demo-Durian Wasabi-NS100233-20/03/2016
Let’s use the current visit to show some provider/patient- friendly features within a visit…

30. these are all
auto-calculated
reducing users
effort .

33. Clinical Practice Guidelines based Decision Support Tool

34. Demo-Durian Wasabi-NS100233-20/09/2016
Now let’s add the new visit to demonstrate the carry forward

39. Auto calcs of BP avg, weight, goal weight, BMI

40. If > 1 year this too
would be flagged as per
CPG’s

48. Using Registry Data Locally: Provincially: DCPNS Grants
DC--since 2006/07 (35+ to date—usually 3-4/year)
Custom Reports--Responding to the “asks”
Blood Pressure & Foot assessments (quarterly)
Foot assessments—labels
A1Cs (pre and post), visits/DM type
Activity/exercise (quarterly)
Smoking status+labels
Active/inactive patient list by Dr.
Making “Custom” Reports “Standard” Reports—to run locally
Provincially:
Annual provincial, zone, DC-specific encounter/clinical indicator reports
Special Reports:
Linkages with other data sources (administrative data, provincial programs, and CCDSS).
Example, Diabetes and Lower Extremity Amputations in Nova Scotia, 2017
Research

49. Registry (as an Application): Sample Registry Reports—Local Use
Data Quality Reports:
Exception reports, active/inactive reports, etc.
Monthly statistics
Provider Reports:
Physician/Nurse Practitioner Report
Report sent following a DC visit
Family MD/NP-Patient List
Produced in confidence—supports relationship building, shared care
Advanced Clinical Indicator Report (local selection of indicator(s) and time frame)
Used for benchmarking and quality initiatives; group medical visits

51. Supporting Primary Health Care Partnerships
and Group Medical Visits
Improving Patient Care/Outcomes
Facilitating Shared Care

54. Advanced Clinical Indicator Report
Understanding your population
By age, diabetes type, treatment
Benchmarking
Targeting your interventions, e.g.
Transitioning youth
Elderly, over managed
Type 1, child-bearing years
Type 2, high risk foot assessments

57. Putting It All Together
DCPNS Annual Population
Report--Blood Pressure
DC Runs Quality Indicator Report
Criteria: BP > 130/80 mmHg
DCPNS
DC Grant
• Quality Improvement
DC #1 Compares
Population Figures
Initiates 9 mos Intervention:
• Produce Family Physician Patient List--q 3 months
• Letter to all MDs
• Implement patient BP card (allows comparison between--Dr. and DC)
• Use alert letter from DC
• Pre-post analysis

58. Looking to the Future:
Optimizing Use of the DCPNS Registry

59. What is the Optimization Project?
Optimizing “use” means:
Making use of the full reporting capabilities
Entering complete and accurate data/information
Target audience:
Diabetes teams (diabetes educators, clerical/support staff, and managers) across NS
Purpose:
To facilitate improved diabetes care delivery and outcomes

60. E.P.I.I.C! DCPNS Registry Optimization will be E.P.I.I.C! Educate
Populate
Illustrate
Innovate
Celebrate…doing things differently!

61. Project Bulletin, produced
every 2 months:
1st issue: June 2018

63. In summary We have talked about and demonstrated,
The evolutionary role of the DCPNS Registry
The rule-based approach to Registry design and its impact (on capture/quality/acceptance)
The provider/patient-friendly features
The reporting functionality, including examples of impact on practice change
Future plans for optimizing use of the Registry through our E.P.I.I.C work
We would like to thank you for your interest and welcome any comments or questions you might have

64. If you would like to find out more about us (DCPNS), or learn more about the Registry, please contact:
Robin Read:
Peggy Dunbar:
Website:
Recent publication:
“Diabetes Care Program of Nova Scotia – Celebrating Twenty Five Years of Improving Diabetes Care in Nova Scotia"

65. Thank you for attending this event.

66. Let’s Talk Informatics has been certified for continuing education credits by;
College of Family Physicians of Canada and the Nova Scotia Chapter for 1 Mainpro+ credit.
Digital Health Canada for 1CE hour for each presentation attended. Attendees can track their continuing education hours through the HIMSS online tracking certification application, which is linked to their HIMSS account.
Last slide when certification is achieved.