National Progress in Utilizing Clinical Information Systems for Chronic Disease Quality Improvement

1. National Progress in Utilizing Clinical Information Systems for Chronic Disease Quality Improvement West Virginia University Department of Community Medicine Office of Health Services Research Kansas Department of Health and Environment Diabetes Prevention and Control Program CDC Diabetes Translation Conference 04/22/2009

2. Acknowledgments

3. Special thanks to the Washington State Department of Health

4. Chronic Disease Electronic Management System • Open source, public domain patient registry for disease management and reporting • Developed by the Washington State Dept of Health • Used across the United States • Customizable based on user needs • Exchanges data with other systems • Highly ranked in “Chronic Disease Registries: A Product Review” available at: http://www.chcf.org/documents/chronicdisease/ChronicDiseaseRegistryReview.pdf About CDEMS

5. The Care Model – Our Reference Point

6. 1) Monitor patient care Structure & checklist for standardized approach to care Reminders for patients and providers Facilitates care planning for individual patients Gaps in care can be identified for action 2) Monitor health center / provider performance Summarizes population level data Documents outcomes for UDS, PQRI, quality certifications, pay-for-performance reimbursements 3) Tool for transitioning to EMRs and/or supplement to EMR reporting Low-cost alternative for tracking quality of care Benefits of using CDEMS

7. National CDEMS Support Group Designed to facilitate collaboration, sharing, problem solving • Registry basics; Evaluation; Use of data for QI; Data exchanges; EMR issues Map available at: http://www.hsc.wvu.edu/som/cmed/ohsr/Maps/CDEMS_Group.aspx

8. Group Membership (formed July 2007) April 2008: • 55 support group members • 18 states • Members included program implementation staff and technical support staff April 2009: • 97 support group members • 21 states • Expanding membership to: • More registry users • Health educators • Other chronic disease programs (cardiovascular, asthma)

9. Stories to Share… Ways in which CDEMS is being used across the United States

10. Washington State Department of Health • CDEMS used for 5 conditions in the WA State Collaborative to Improve Health • Diabetes • Asthma • Hypertension • Obesity Prevention and Treatment in Children • Medical Home for Children with Special Health Care Needs • Joint Medical Home Collaborative being formed between WA State DOH and WA Academy of Family Physicians • CDEMS developments: NCQA / HEDIS / PQRI reporting; increased reporting flexibility; data validation routines

11. Utah Diabetes Prevention and Control Program • Utah DPCP administers State Certification for 18 DSME Programs • Offers CDEMS as one way of addressing care improvement • 5 of the 18 use CDEMS to manage patient data • CDEMS also used for annual outcomes reporting • Example: Pre/Post-program HbA1c results

12. Kansas Diabetes Prevention and Control Program • Implementing CDEMS in 90 locations across the state • Diverse settings (safety net clinics, farmworker program, home health agencies, local health department, Indian health clinic) • Various conditions (diabetes, diabetes with disabilities, cardiovascular cohort, arthritis) • Applied “push software program” to CDEMS sites to retrieve data to a central repository • DPCP has the ability to query aggregate data statewide, regional, or by clinic • Outcomes: 50% improvement (2005-2008) in key diabetes indicators

13. Detroit Medical Center • Established a pay-for-performance incentive program (12 practices; Blue Cross patients) • Focus: Chronic disease management • Diabetes • Asthma, COPD • CHF, CAD • Well-Child • CDEMS helpful in getting private practice physicians to understand population-focused disease management • Helps identify patients that “fall through the cracks” • Benchmarking care against national care standards

14. Integrated Health Partners • Using CDEMS to: • Standardize data received from various EMRs • Create a common taxonomy, which in-turn allows for cross-organization reporting, analysis, and quality improvement • Developed standard data protocol for use by EMR vendors when writing-out data for import into CDEMS • Built data exchange tools to: • Receive data • Check for validity • Conduct analyses

15. Akron Children’s Hospital • Using CDEMS for pediatric diabetes and pediatric asthma quality of care • Program designed to insure continuity of care across home, school, and community • Tracking educational progress • Tracking goals and outcomes from diagnosis until adulthood • Also using CDEMS for American Diabetes Association program recognition • Potential for registry use to be replicated to main hospital campus

16. Rhode Island Department of Health • Health Systems Coordinator (within DPCP program) provides all sites with continuity in CDEMS training, updates, and support • In-state collaborative includes: • Asthma • Cardiovascular • Colorectal • Diabetes • Diabetes Prevention

17. Johns Hopkins University • Implementing CDEMS in the Trinidad and Tobago Health Sciences Initiative • Potential for expansion into the Pan-American Health Organization Caribbean Diabetes Improvement Collaborative • Partnered with WVU OHSR to modify CDEMS for use at point of care • Data entry directly into Progress Note • “Stoplight” reporting for patients and providers • Integration with retinal photography and point-of-care lab equipment • JHU School of Nursing: AADE-7 measures

18. West Virginia Bureau for Public Health &WVU Office of Health Services Research • CDEMS is used by the following WV BPH chronic disease programs: • Diabetes Prevention and Control • Cardiovascular Health • Asthma Education and Prevention • Currently partnering with 51 care sites, and growing • Focusing on quality of care, across various CIS • Improved Outcomes: “Electronic Patient Registries Improve Diabetes Care and Clinical Outcomes in Rural Community Health Centers”* • Finding registry functions weak/missing in some systems • CDEMS developments: Progress Note data entry; flow sheets; additional reporting features; EMR data exchange • *Available at: http://www3.interscience.wiley.com/cgi-bin/fulltext/121585395/PDFSTART

19. Different Stories, but Shared Traits • In each case, Quality Improvement is the driver • Many needs center on reporting, data exchanges, and overall registry functionality • In each case, CDEMS is an applicable solution • National CDEMS Support Group allows for increased collaboration, sharing, and communication • Participants being different needs and perspectives to the group • Created a learning environment

20. How to Join the Group • Contact one of the following: • Jackie Gianunzio jackie@CDEMS.com • Kate Watson KWatson@kdheks.gov • Adam Baus abaus@hsc.wvu.edu • Visit www.CDEMS.com for meeting minutes and presentation materials • If you’re already a member, invite someone that might benefit from participating

21. Contact Information Adam Baus, MA, MPH Program Coordinator, Sr.; Clinical Information Systems Support West Virginia University Department of Community Medicine Office of Health Services Research (304) 293-1083 abaus@hsc.wvu.edu Kate Watson, MA, MPA Program Manager Kansas Department of Health and Environment Diabetes Prevention and Control Program (785) 291-3739 KWatson@kdheks.gov