1. Sentinel / Data capture How can data for How can data for quality development and research be retrieved from 12 different Electronic Patient Record systems in Denmark?

2. Sentinel / Data capture in general practice TriggerDatabase 12 EPR systems (The doctor’s patient file system) -Patient identification -Date - Diagnosis codes -Prescription codes -Disbursement codes -Lab. result codes Data capture project -1 SentinelDatabase Sentinel/Data capture module Sentinel/Data capture module Pop-up screen Data are transferred automatically from the EPR system to the sentinel database The denominator (number of patients) comes from the EPR system

3. Sentinel / Data capture Generel Practice Database SDU Odense EPR system Profdoc MediCare EPR system MedWin Clinic 1Clinic 2 Clinic 1 Clinic 2Clinic 3 Other EPR systems DanNet KMD 1Clinic Clinic 2 Communication via Health data network

4. Indicators for diabetes quality of care in general practice Six of the indicators are automatically sent to the national NIP database 1. Prevalence of diabetes in the clinic 2. Foot examination during the last year? 3. Ophthalmologist examination during the last year? 4. Microalbumin in urine? 5. Hb A1c 6. Cholesterol in blood 7. Blood pressure 8. Agreement with the patient of individual treatment goals 9. Reduction of a high level of Hb A1c 10. Reduction of a high blood pressure 11. Reduction of a high level of cholesterol 12. Conversation with the patient about his/her lifestyle

5. The pop-up screen

6. Diabetes quality assurance in general practice The doctor only has to register the diagnosis for diabetes T90 in his patient file The doctor only has to register the diagnosis for diabetes T90 in his patient file Once a year a pop-up screen will appear during the patient contact and the doctor has to fill in the pop-up Once a year a pop-up screen will appear during the patient contact and the doctor has to fill in the pop-up All other data are automatically transferred to the database All other data are automatically transferred to the database

7. Feedback to the doctors Example from one clinic (Double click to mark the link, right click, and select “open hyperlink”) www.dak-e.dk/flx/dak_e_it/diabetes_forloebsydelsen/demo/

8. Feedback to the doctors Example from one clinic (Double click to mark the link, right click, and select “open hyperlink”) www.dak-e.dk/flx/dak_e_it/diabetes_forloebsydelsen/demo/

9. Feedback to the doctors Example from one clinic (Double click to mark the link, right click, and select “open hyperlink”) www.dak-e.dk/flx/dak_e_it/diabetes_forloebsydelsen/demo/

10. Feedback to the doctors Example from one clinic (Double click to mark the link, right click, and select “open hyperlink”) www.dak-e.dk/flx/dak_e_it/diabetes_forloebsydelsen/demo/

11. Feedback to the doctors Example from one clinic (Double click to mark the link, right click, and select “open hyperlink”) www.dak-e.dk/flx/dak_e_it/diabetes_forloebsydelsen/demo/

12. Feedback to the doctors Example from one clinic (Double click to mark the link, right click, and select “open hyperlink”) www.dak-e.dk/flx/dak_e_it/diabetes_forloebsydelsen/demo/

13. Feedback to the doctors Example from one clinic (Double click to mark the link, right click, and select “open hyperlink”) www.dak-e.dk/flx/dak_e_it/diabetes_forloebsydelsen/demo/

14. The diabetes quality project Which advantages does the GP obtain from participating in the diabetes quality project? Which advantages does the GP obtain from participating in the diabetes quality project? Overview of his population of diabetes patients, especially patients with suboptimal treatment of their diabetes Overview of his population of diabetes patients, especially patients with suboptimal treatment of their diabetes Benchmarking his performance with that of his colleagues Benchmarking his performance with that of his colleagues Graphs of results for discussion with his patient Graphs of results for discussion with his patient

15. Sentinel / Data capture Data about quality of care are available to the doctors Data about quality of care are available to the doctors Since April 2008 the doctors can see their feedback data online by using Sundhed.dk and a secure session transfer (admission) Since April 2008 the doctors can see their feedback data online by using Sundhed.dk and a secure session transfer (admission) Data are updated every weekend Data are updated every weekend

16. The demand for quality can be very high - ”Fresh milk to the end user”!

17. Other quality assurance projects Examples Examples Atrial fibrillation Atrial fibrillation Patients treated with benzodiazepines Patients treated with benzodiazepines Many more projects Many more projects

18. Others quality assurance projects

19. Other quality assurance projects Examples Examples Atrial fibrillation Atrial fibrillation Patients treated with benzodiazepines Patients treated with benzodiazepines Many more projects Many more projects

20. Others quality assurance projects

21. The Data capture module for research purpose Data from the patient-doctor contact are necessary Data from the patient-doctor contact are necessary Further questions are often necessary too Further questions are often necessary too

22. Possibility for research and research projects

23. Research possibilities and projects Data capture can give you: Data capture can give you: Structured information (automatically) Structured information (automatically) Non structured information can bee retrieved by the pop-up screen Non structured information can bee retrieved by the pop-up screen It is possible to make different projects by making different questionnaires in the pop-up screen It is possible to make different projects by making different questionnaires in the pop-up screen It is possible for the researcher to define when the pop-up should bee shown for the doctor It is possible for the researcher to define when the pop-up should bee shown for the doctor

24. Research possibilities and projects Structured information is: Structured information is: Data about diagnoses Data about diagnoses Data about prescriptions Data about prescriptions Data about processes during the consultation Data about processes during the consultation Data about Lab. tests Data about Lab. tests Patient identification (CPR number) Patient identification (CPR number) Time stamp for the activity Time stamp for the activity

25. General Practice in Denmark Several research projects have started Sentinel registration of the distribution of contacts to GPs has started Henrik Schroll, Senior researcher, PhD, head of the National Quality Unit – IT department University of Southern Denmark

26. Thank you for your attention DAK-E IT