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Diabetes Management System

Diabetes Management System. Dorothy K. Russell, MS, MT(ASCP). Diabetes Management System aka: DMS. Collection of RPMS tools designed to assist IHS and Tribal staff involved with care and management of patients with diabetes or prediabetes Primarily a patient focused application

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Diabetes Management System

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  1. Diabetes Management System Dorothy K. Russell, MS, MT(ASCP)

  2. Diabetes Management Systemaka: DMS • Collection of RPMS tools designed to assist IHS and Tribal staff involved with care and management of patients with diabetes or prediabetes • Primarily a patient focused application • Also provides program evaluation & monitoring functionality

  3. Diabetes Management SystemChronology • 1984-1999 RPMS tools to assist DM program available, but in separate menus • 2000 DMS V1.0 – Roll & scroll • 2006 Prediabetes Register & Audit • 2007 DMS V2.0 – Roll & scroll and GUI (Visual Diabetes Management System)

  4. DMS Features • Diabetes register • Health summary enhancements • Diabetes Flowsheet • Diabetes Patient Care Summary (aka DM Supplement) • DMS Patient Management Interface • DMS Reports & Letters

  5. DMS Features • Qman, PCC Reports (PGEN, VGEN, BMI) • Automated Diabetes Audit report and .rec file creation for Web Audit • Mailman bulletin notification of new cases • Prediabetes register • Prediabetes audit report

  6. DMS Features • Full access to all PCC data regardless of how it was entered • Ancillary applications (e.g. Pharmacy, Lab, Radiology, etc.) • PCC data entry • EHR • Interfaces

  7. IHS Diabetes Register • Automatically installed on all systems • List of patients diagnosed with: • Type 1 or Type 2 diabetes • Gestational DM, Prediabetes, Metabolic Syndrome usually in separate register(s) • Tool to help DM program managers follow patients and prevent loss to follow-up

  8. Health Summary • Snapshot of patient’s clinical history • Numerous types available • Locally customizable • Displayed / printed via PCC, Behavioral Health, EHR

  9. Diabetes Flowsheet • Spreadsheet containing important DM related events • Typically contains labs, but may also be used for other data elements

  10. Diabetes Patient Care Summary • AKA – DM Supplement • Last page of health summary • Contains all diabetes audit elements • Reminder to providers of important DM standard of care items that may need attention • Like the diabetes audit, the supplement uses certain DM related taxonomies

  11. Prediabetes Supplement • Released with Health Summary patch • Logic consistent with prediabetes standards and prediabetes audit

  12. Triggering Events for DM Supplement and Flowsheet • Presence of a diabetes diagnosis on problem list (ICD codes 250.00-250.93) • Diabetes diagnosis during previous year(s) • Precise number of DM diagnoses needed and time frame now controlled locally through use of Health Summary Site Parameters File

  13. DMS Patient Management Interface • Patient focused … one patient at a time • VA ListManager display containing numerous management tools • Display options for laboratory test, medications, visits, health summary, etc. • Edit options for DM register data, problem list • Patient focused reports • Case summary, patient letters, diabetes audit for current patient, health summary browser

  14. DMS Patient Management Interface (PM)

  15. DMS Letters & Reports • Follow-up report & Letters • Allows user to generate list of DM register patients needing specific diabetes related services and/or patient letter • Access to Case Management System (CMS) reports • Case summary, master list, general retrieval report (GEN) … user provided specifications • Access to PCC Management Reports, including Body Mass Index (BMI) reports

  16. Qman • PCC database query utility … data fetcher • Ad hoc reporting of patients with (or without) certain demographic or clinical attributes • Numerous output types • Display • Print • Count • Age distribution report • Mailing labels • Template (cohort) creation

  17. Diabetes Audit Report • Analyzes compliance with IHS diabetes standards • Utilizes 2006 IHS Standards of Care for Patients with Type 2 Diabetes • Shares certain logic with GPRA report • Paper & electronic versions • Can eliminate manual audit process • Web audit now available • Requires quality data recording and entry into PCC

  18. Diabetes Audit cont. • Requires numerous taxonomies with some needing local maintenance • Drug • Insulin, ACE/ARB drugs, Metformin drugs, etc • Lab test • A1C, Lipids, UACR, Creatinine, etc • Education topics • DM nutrition, DM exercise, etc • Taxonomy setup guide available

  19. Prediabetes Audit • Utilizes IHS Guidelines for Care of Adults with Prediabetes and/or Metabolic Syndrome in Clinical Settings (Sept 2008) • Requires taxonomy setup • Not annual requirement as is the Diabetes Audit

  20. DM New Case Bulletin

  21. Visual Diabetes Management System … aka DMS GUI • GUI = Graphical User Interface • Windows based in lieu of roll-&-scroll • Most DMS functionality available in GUI • Requires LAN based database & workstations • Requires MS Office • Two components – server & client • Separate from Patient Chart application and EHR • Distributed with DMS v2 – June 2007

  22. Visual DMS

  23. Visual DMS Special Login Requirements

  24. DMS GUI uses same A / V codes as classic RPMS

  25. DMS GUI Initial Screen

  26. DMS GUI Expanded Menus

  27. Taxonomy update via roll & scroll

  28. Taxonomy update via roll & scroll

  29. Taxonomy update via DMS GUI

  30. DM Audit via roll & scroll

  31. DM Audit via GUI

  32. Break Time

  33. DMS Data RequirementsLab • Laboratory Tests • Glycemic control: HGbA1C • Lipids: Cholesterol, LDL, HDL, Triglyceride • Renal function: Creatinine, GFR • Proteinuria: Albumin/Creatinine Ratio • Test results must be in PCC • Directly from Laboratory Package • Automatically via reference lab interface • Manually entered via PCC data entry

  34. DMS Data RequirementsExams • Examinations • Dental Exam • Diabetic Eye Exam • Diabetic Foot Exam • Depression Screening Exam

  35. DMS Data RequirementsPatient Education • Patient education evaluated by audit: • Nutrition • Exercise • Other • DM topics vs DMC topics • Requires proper recording & data entry • Education protocols available on IHS website • http://www.ihs.gov/NonMedicalPrograms/HealthEd/

  36. DMS Data RequirementsHealth Factors • Tobacco • Current Smoker, Previous Smoker • Current Smokeless, Previous Smokeless • Smoker in Home, Non-tobacco user • TB Status • Tx Complete • Tx Incomplete • Tx Unknown • Tx Untreated

  37. DMS Data RequirementsHealth Factors cont. • Glucose Self Monitoring • Yes, No, Refused • Barriers to Learning • Learning Preference • For a complete list of Health Factors & Exams, see 2008 Health Factors & Exam Code documentation guide

  38. DMS Register Creation (1) If IHS Diabetes register is not present on system, use option to install the IHS Diabetes Register  IHS option

  39. DMS Register Creation (2) Next, add users needing access to the DM register  AU option

  40. Switch to DMS – Roll & Scroll or GUI

  41. DMS Data Retrieval • Qman – PCC Query Utility • Subject … usually Living Patients or Register • Attribute … demographic or clinical • Condition … is, greater than, during, etc. • Value … Chicago, hypertension, 200, etc. • Qman outputs • Display, count, special outputs • Qman training part of PCC Outputs Class

  42. DMS Data Retrieval • Health Summary • DM Supplement • DM Flowsheet • Canned reports … require few, if any, decisions by user • GEN (General Retrieval) reports … allow user to customize report • Diabetes Audit … paper & electronic

  43. Minimum Security Keys for DM • Qman • AMQQZMENU, AMQQZCLIN • CMS • ACMZMENU, ACMZ EDIT, ACMZ MANAGER, ACMZ DELETE PATIENT • DMS • BDMZMENU, BDMZEDIT, BDMZ REGISTER MAINTENANCE

  44. Support Resources for DMS • Level 1 - Local resources • Supervisor • RPMS Site Manager • Level 2 – Area Support • RPMS help desk • Level – OIT (Albuquerque) • Help Desk: (support@ihs.gov) • IHS Website • RPMS Feedback Page

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