System Changes and Interventions:Registry as a Clinical Practice Tool

Mike HindmarshImproving Chronic Illness Care,

a national program of the Robert Wood Johnson Foundation

Bureau of Primary Health CareHealth Disparities Collaboratives

October 24-26, 2002 Dallas TX

Clinical Information 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 facilitates individual patient care planning.

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!

What a Registry Should Be

Should: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!

What a Registry Should NOT Be

Should not: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

Making the Registry “Real” in Your PracticeThe Software

• If not using PECS, try out other products. (see registry comparison document on ICIC website)

• Install software.

• Identify training resources .

Making the Registry “Real” in Your PracticeThe 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.

Making the Registry “Real” in Your PracticePopulating 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.

Making the Registry “Real” in Your PracticeGathering 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.

Making the Registry “Real” in Your PracticeUsing 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.

Making the Registry “Real” in Your PracticeUsing 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.

Making the Registry “Real” in Your PracticeUsing 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?

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.

•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

Keys to Successfrom Other Collaborative Teams

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

Please Visit Our Web Site for Downloadable Information on

Registries:

www.improvingchroniccare.org