1. Importance of a Registry Amy Belisle, MD Laura Brann, Program Manager, CIR Eric Anderson, Dir. Quality Data Management Chapter Quality Network (CQN) Asthma Pilot Project

2. Amy Belisle’s Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. Disclosure Slide Laura Brann’s Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. Eric Anderson’s Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity.

3. Identify patient populations Help manage patients Prepare for patient visits using evidence based protocols Provide “opportunistic care” Track quality indicators Identify gaps in performance Help sustain long-term quality care We need a registry to…

4. Informed, Activated Patient ProductiveInteractions Prepared, Proactive Practice Team Improved Outcomes Delivery System DesignDecisionSupport Clinical Information Systems Self- Management Support Health System Resources & Policies Community Health Care Organization Chronic Care Model MaineHealth Clinical Improvement Registry

6. 1152 Active Users 124 MaineHealth Practices 508 MaineHealth Providers January 2010 Other users: Mercy Primary Care Center sites SOCHS PHO (Maine Covenant) Maine Health Alliance (Northern Maine Medical Center Pines Health Care Service Maine Coast Memorial Hospital Mayo Regional Hospital Kennebec Regional Health Alliance, etc… MaineHealth CIR Statistics

7. Current patients in the CIR ~21,000 Diabetes ~12,000 Asthma (7k adult/5k pediatric) ~15,000 CVD ~8,000 Depression ~1,000 HF (all clinical counts) Preventive Health: ~66,000 Pediatric (0-18 years) ~168,000 Adult (18 or older) with no other chronic illness

9. Data……….. Collection Entry Validation Reporting Use for Quality Improvement

10. Data……….. Collection Entry Validation Reporting Use for Quality Improvement

11. Nurse/Medical Asst: Verify CIR/Visit Summary is up to date Print VS if needed, place with chart. (May want to highlight where information/updates are needed) Include with chart any paperwork needed Patient Service Representative: Reminder call before appointment Provider: In process of visit, review Visit Summary report where information is needed, add/update on the visit summary all necessary information Document referral (if applicable) to Asthma Educator or Specialist for persistent uncontrolled asthma and/or considers MMC PHO Care Manager for additional support. Provider gives completed VISIT REPORT to Clinical Staff. Nurse/Medical Asst: Obtain parent/guardian signature on School Plan; Nurse/Medical Asst/Patient Services Representative: Data Entry in CIR from Visit Summary Report New visit summary report printed. Indicate missing information for provider review at next visit. If labs/tests ordered, the test information is entered into the CIR upon receipt and a new Visit Summary Report printed. Newly Diagnosed Patient with Asthma requires: Initial Data Entry into CIR Severity Classification Action Management Plan and/or School Plan Peak Flow Baselines Patient Education Sample Asthma PCP Visit Report Process Roomer/Nurse/Medical Asst: Record all applicable data on the CIR Visit Summary and in the Medical Record Ask/document any information needed: (ex Immunizations, tobacco exposure, ht, wt, BP, Process is complete!

15. Data……….. Collection Entry Validation Reporting Use for Quality Improvement

16. Data……….. Collection Entry Validation Reporting Use for Quality Improvement

17. For the patient Self Care report Patient mailings/reminder letters Internal Reporting Progress report Patient Clinical Reminder report Visit Summary External Reporting PQRI PTE NCQA

18. Reports: Insert (in this order) Pediatric Asthma Progress Report Patient Clinical Reminder Report Visit Summary Patient Self Care Mailings/letters PQRI PTE NCQA

23. Include drill down progress report

31. Important things to know Where to get more information… There are some costs $120 every 3 years for secure ID $240/year per provider To get your practice set up on the CIR Paperwork Business Associate Agreements Service Level Agreements Practice Start Up Packet Identify a practice CIR lead

32. I have no relevant financial relationships with the manufacturer(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. disclosure statement

33. For more information: Contact your PHO, Practice Manager or CIR Program Manager BrannL1@mmc.or Questions?

34. Nurse/Medical Asst: Review chart for VS (Visit Summary) or print from the CIR; Check CIR database to see if latest visit and tests have been entered; If missing, document lab/test values on VS Report Indicate on VS where information is needed Attach Visit Summary and any additional forms to be completed (Action/School Plan) and lab/Test reports to front of chart. Patient escorted to exam room by Roomer. Patient Service Representative: Reminder call before appointment to bring diary/log, meds, peak flow meter, spacer, etc. RECORD ALL APPLICABLE DATA ON BOTH THE VISIT REPORT & IN THE APPROPRIATE AREA OF THE MR: Provider: Review areas of (VS) Visit Summary report where information is needed, add or update on the visit summary including but not limited to Condition, Medications, Allergies/Adverse drug reactions, patient asthma status (if symptom free less than 14 days); Evaluate patient level of understanding of asthma, meds, management plan, etc.; Complete and explain zones, meds asthma management plan for home and school; Prescribe spacers for inhalers, peak flow meters for kids > 5; Emphasize importance of follow-up visits for reassessment/ education; and Refer to Asthma Educator or Specialist for persistent uncontrolled asthma and/or considers MMC PHO Care Manager for additional support. Provider gives completed VISIT REPORT to Clinical Staff. Nurse/Medical Asst: Provide asthma education (i.e., use of peak flow meter, inhalers, etc.); Obtain parent/guardian signature on School Plan; Nurse/Medical Asst/Patient Services Representative: Data Entry in CIR from Visit Summary Report New visit summary report printed. Indicate missing information for provider review at next visit. If PFT’s ordered, the test information is entered into the CIR upon receipt and a new Visit Summary Report printed. Process is complete. VERIFY PATIENT ID. RECORD DATA ON BOTH THE VISIT REPORT & IN THE APPROPRIATE AREA OF THE MEDICAL RECORD: Roomer/Nurse/Medical Asst: Ask about any missing information: Flu and Pneumonia Immunizations/updates Any ED Visit or Hospital Admission (date & reason) Triggers, smoke exposure Obtain HEIGHT, WEIGHT, BLOOD PRESSURE and PEAK FLOW for kids > 5 years old; Document Peak Flow, technique and effort on encounter form and visit summary where applicable; and Calculate peak flow zones, update plan. Give patient blank diary to record home Peak Flow and assesses patient technique on inhalers and spacers and instructs as needed. Newly Diagnosed Patient with Asthma requires: Initial Data Entry into CIR; Severity Classification; Action Management Plan and/or School Plan; Peak Flow Baselines; Patient Education Sample Asthma PCP Visit Report Process