System Changes and Interventions: Registry as a Clinical Practice Tool

1. System Changes and Interventions:Registry as a Clinical Practice Tool Mike Hindmarsh Improving Chronic Illness Care, a national program of the Robert Wood Johnson Foundation Bureau of Primary Health Care Health Disparities Collaboratives October 24-26, 2002 Dallas TX

2. ClinicalInformation System: Registry • A registry includes clinically useful and timely information on all patients. • Information system provides reminders and feedback for providers and patients. • Registry can identify relevant patient subgroups for proactive care. • Registry facilitatesindividual patient care planning.

3. What a Registry Will Did For the Practice Team • Identify patient populations and sub-populations in need of routine care • Organize data from disparate information sources (automated, paper record, patient visit) • Track care of individuals and populations of patients • Provide patient summaries at time of visit • Produce exception reports for population care planning • Enable feedback to team on population outcomes • Automate care reminders • Allow queries of data to target at risk sub-populations • Helped providers feel more organized during chaotic day!

4. What a Registry Should Be • Should: • be quick to implement • be simple to use • be organized by patient; not disease • be integrated into daily clinical activities • contain only data relevant to clinical practice and performance measurement • when necessary, make data entry simple and efficient • be easy to update from other automated data sources • guide clinical care first, measurement second!

5. What a Registry Should NOT Be Should not: • try to emulate functionality of an EMR • contain “mountains” of data • require an advanced computer degree to operate • require a lot of upkeep and maintenance • be limiting to one disease or condition population • not become the focus of practice activity

6. Making the Registry “Real” in Your Practice The Software • If not using PECS, try out other products. (see registry comparison document on ICIC website) • Install software. • Identify training resources .

7. Making the Registry “Real” in Your Practice The Registry Manager • Identify best person on team to manage the registry. • Choose person with computer skills and interest. • Define roles and responsibilities for manager. • Secure training for manager as needed. • Highlight registry’s importance to rest of team. • Train a registry manager back-up.

8. Making the Registry “Real” in Your Practice Populating the Registry • Use billing data and ICD9 codes to identify specific populations. • Download names and contact information into registry. • Identify other automated data sources. (e.g. labs, Rx) • Establish process for regular population updates.

9. Making the Registry “Real” in Your Practice Gathering Clinical Data • Define the relevant clinical data needs. • Use the visit for collecting non-automated data. • Develop and test data capture process. • Develop and test data entry process.

10. Making the Registry “Real” in Your Practice Using Data at Point of Care • Establish process for producing patient summary data for use at time of visit. (acute or planned) • Ensure summary is on chart . • Does the summary work for various patient types? • Ensure new data is captured on the summary. • Develop process for new summary data to be entered into registry.

11. Making the Registry “Real” in Your Practice Using Data for Care Reminders • Establish what you want “reminding” about. • Determine how you want to be reminded. (i.e, exception reports or individual patient prompts) • Identify team member responsible for monitoring reminders. • Create process for responding to reminders. (i.e., who calls patient, when and for what purpose) • Create process for updating/modifying reminders.

12. Making the Registry “Real” in Your Practice Using Data to Monitor Performance • Determine what types of population reports are needed and reporting intervals. • Establish process for creating customized reports. • Who will generate reports? • Who receives reports? • Do the reports facilitate continued improvement?

13. Keys to Successfrom Other Collaborative Teams • Organization of health care – senior leadership supports the time involved in registry upkeep. • Delivery system design – data form is clear, data entry role is assigned, data review time allotted. • Decision support – data entered and retrieved is clinically relevant, and used for patient care. • Community linkages – are a good source of much needed technical support.

14. Keys to Successfrom Other Collaborative Teams • Committed team with at least one competent and responsible in charge of data collection and review • Care management as a team approach • Regular repetitive review with each clinical group • Dedicated time each week for primary team • Ongoing enthusiastic repetition and reinforcement to other clinical teams • Make steady small changes regularly

15. Barriers to Registry Implementation • Lack of onsite available computer expertise • Inability to use other databases to generate registry or download into registry • Difficulty identifying certain populations • Lack of consistency between providers • Time – data entry, monthly review • Lack of perceived value added

16. Please Visit Our Web Site for Downloadable Information on Registries: www.improvingchroniccare.org