Clinical Information Systems
The registry, an information system
that can track individual patients as well as populations of patients, is the
foundation for successful integration of all the elements of the Chronic Care
Model, according to the Institute for Healthcare Improvement.
The registry helps the team manage
chronic illness by anticipating problems and tracking progress. The system
provides access to a summary of patient data before and during the visit,
facilitating team dialogue and planning. During the visit, data are used to
empower the patient to manage his or her disease.
An important goal of the University of Cincinnati Academic
Health Center's Senior Leadership Group was to reduce the administrative
workload of clinicians by eliminating repetitive data collection. Consequently,
the group allocated funding for a comprehensive registry to support four of Cincinnati's five teams involved in the collaborative. (Cincinnati Children's Hospital Medical Center used its own registry product.)
For the collaborative, the Health Alliance purchased the
Patient Electronic Care System, a clinical information system and registry from
the Aristos Group. The system integrates evidence-based guidelines and best practices
with patient data and summarizes clinical information at the point of care.
Although the Patient Care Electronic Care System has been an
improvement, standardizing data entry to meet the needs of different office
practices remained an issue. The intent is to learn from this technology and
pave the way for a future electronic health record.
of Workflow: Data and Care Improvement
An important aspect of enhancing system change at Vanderbilt University Medical Center was integrating and improving its electronic medical
record through the plan-do-study-act process.
The team has a full-time programmer analyst who worked with
clinicians to plan and execute a chronic disease management system to improve
access to patient data.
The team also developed a dashboard to organize information on a computer so it is useful for the user. The
dashboard is part of the chronic
disease management system and tracks up-to-the-minute data of diabetes
patients, such as blood pressure, HbA1c and LDL levels, and whether the patient
has had a foot exam within the past 12 months.
The chronic disease management system also enables providers
to sort patient data by specific requirements, such as by A1c levels, allowing
comparisons of individual patient data within the total group.
In addition to these features, the team's Consolidated
Data Management (CDM) system
provides staff with a daily work list that indicates what patient-related needs are
to be accomplished for the date that is accessed. Tasks listed include
reminders to call or send letters to patients, to check results from the
previous visit, and more.
The list also includes alerts that indicate which patients are
overdue for lab tests and allow staff to retrieve patients' lab information and
The team is also developing a way to integrate
self-management data into the diabetes dashboard.
In addition to
the diabetes dashboard, a population view was developed that allows providers
to simultaneously view the dashboards of all their patients with diabetes to
see how well the providers are caring for their patients with diabetes.
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