registries: clinical perspective
DESCRIPTION
Registries: Clinical Perspective. J. Marc Overhage, MD, PhD, FACP, FACMI Chief Medical Informatics Officer Siemens Health Services. Definitions. - PowerPoint PPT PresentationTRANSCRIPT
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Registries: Clinical Perspective
J. Marc Overhage, MD, PhD, FACP, FACMI
Chief Medical Informatics Officer
Siemens Health Services
www.amia.org
Definitions
• EHR: “An electronic record of health-related information on an individual that conforms to nationally recognized standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization”
• Focused on the care of individuals, with the purpose of collecting, sharing, and using health information for the benefit of that individual
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Definitions
• Registry: “An organized system that uses observational study methods to collect uniform clinical and other data to evaluate outcomes for a population defined by a particular disease, condition, or exposure, that serves one or more predetermined scientific, clinical or policy purpose”
• Focused on a population and designed to fulfill specific purposes
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Alike ..
word processing spreadsheet
Word processingDocuments that don’t require calculationsFancy documentsFlyersResume
Spread sheetsFinancial formulasDatabase insertsMacrosTimesheetsGraphs
TablesCell CalculationsChanging fonts, colors, shading, etcWord processing
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… but different
EHR Registry
Decision supportPatient care alertsSupports team careIntegrates with other systemsAutomates workflow ReportsPatient Education
Single purpose - PHMFocus on data and outcomesGroup care (disease or preventive care management)In-reach/Out-reachProactive CareImproved efficiency through population healthRegulated Outcome reporting
General, multi-purposeA complete record of patient clinical encounterBillingComputers not pencilsOne patient at a timeRules based diagnosisProvider tool
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Stage 2 MUACOs
Stage 3 MUPCMHs
3-Part Aim
Registries to manage patient
populations
Team based care, case management
Enhanced access and continuity
Privacy & security protections
Care coordination
Privacy & security protections
Patient centered care coordination
Improved population health
Registries for disease
management
Evidenced based medicine
Patient self management
Privacy & security protections
Care coordination
Structured data utilized
Data utilized to improve delivery
and outcomes
Data utilized to improve delivery
and outcomes
Patient informed
Patient engaged, community resources
Stage 1 MU
Privacy & security protections
Basic EHR functionality,
structured data
Utilize technology to
gather information
Improve access to information
Use information to transform
Meaningful Use
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A Significant Shift in the Healthcare Business Model is Underway
Being responsible for those who seek our services
Avoiding the sickest chronic patients
Treating all patients the same
Offering care at centralized facilities
Maximizing the use of resources & assets
Emphasizing volumes
Treating individuals when they get sick
Individual care providers
Best efforts
Being responsible for the needs of the community
Keeping groups of people healthy
Emphasizing outcomes
Applying appropriate levels of care at the right place
Offering care at sites convenient to patients
Customizing healthcare for each patients
Creating venues to provide special chronic care services
Collaborative teams of providers
High reliability organizations
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Key Technology Components Will Be Required
• An electronic health record that spans the continuum of care• A revenue cycle and contracts management application that spans the
continuum of care• Care management systems that span the continuum for individuals
and populations• Rules engine, workflow engine, and intelligent displays of data that
enables intelligent processes across the continuum, defined by best practices
• Sophisticated business intelligence and analytics• Systems that enable interoperability between closely affiliated providers• Technologies that support the engagement of patients• Services that enable maximum leverage of health care IT investment
Our vision is focused around key technology components that are crucial to support accountable care.
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Interoperability
• “The ability of any EHR to exchange valid and useful information with any registry on behalf of any willing provider at any time in a manner that improves the efficiency of registry participation for the provider and patient and does not require significant customization to the EHR or the registry system”
• Any EHR should be able to exchange data with any registry, and any registry should be able to exchange data with any EHR
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Data Quality
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Registry Uses
Research
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Patient tracking and outcomes
Think Patient Centered Medical Home
Think Patient Centered Medical Home
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Research
Garrison et al Value Health. 2007;10(5):326-35.
RCT
Efficacy and safety in a small population with a restricted study protocol
Real world information to make health care decisions for large populations within defined budgets
Patient Population
GAP
Real World Data
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Quality Improvement Initiatives
Assembles data needed for reporting
Monitors status relative to a program
Provides insight on gaps Submits data
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Major Goal QI Tool Description
Care delivery and coordination
Patient lists Lists of patients with a particular condition who may be due for an exam, procedure, etc.
Automated notifications
Prompts provider or patient when an exam or other action is needed.
Decision support tools Provide recommendations for care for an individual patient using evidence-based guidelines.
Population measurement
Population level standardized reports
Provides an analysis of population-level compliance with QI measures or other summaries (e.g., patient outcomes across the population)
Benchmarking reports Compares population-level data for various types of providers.
Population level dashboards
Provides snapshot look at QI progress and areas for continued improvement.
Quality Improvement Tools – Examples
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Trends
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Gaps
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Registry Disease/Condition Area
Functionalities Implemented
AHA Get With The Guidelines
Heart failureStroke
Decision support (guidelines)
Communication tools Patient education materials Real-time quality reports
with benchmarks Transmission to 3rd parties
MaineHealth Clinical Improvement Registry
Diabetes Patient care ‘gap’ reports Decision support Transmission to 3rd parties
National Comprehensive Cancer Network (NCCN)
Cancer Patient care ‘gap’ reports Center level reports Education materials
Examples of QI Registries and QI Tools
18
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Examples of Clinical Registry Software
• CDEMS: Chronic Disease Electronic Management System http://www.cdems.com/
• For an excellent review of 16 registry products by the California HealthCare Foundation, try this: http://www.chcf.org/documents/chronicdisease/ChronicDiseaseRegistryReview.pdf