Thursday, July 31, 2008

Practice Reminders

The flowsheets from the Vermedx® Diabetes Information System (VDIS) give providers information when a lab test is done. However, one of the big problems in diabetes (and other chronic diseases) is that many patients don't get the tests they need on time. Part of the reason for this is that the schedule for when tests are needed is complicated. Each of the four basic tests (A1C, cholesterol, serum creatinine, and urine protein) have a different due date that depends on the date and the level of the previous result. The rules are hard to remember and doctors and nurses don't have a good way to keep track of them.

So, we programmed the VDIS to scan the database of results looking for patients who are overdue for one of the tests. When it finds one, it produces a simple report to the practice that says, basically, "Hey! This patient is getting lost! Get a hold of them and bring them back under care!"

A full size sample of the report can be seen here.

Practice Reminders arrive at the practice 30 days after the test was due. If the practice has a protocol or standing orders, the office staff can call the patient, order the lab tests, and schedule an office visit for a few days after the tests. At the visit, the provider can review the results with the patient face-to-face and together they can make a plan based on current information. This is often much better than getting the tests after the visit and writing a letter or playing phone tag.

Practice Reminders are a Value Added service that a Health Information Exchange can provide at low cost. Stay tuned for some other examples of ways to use HIE to improve care.



Wednesday, July 30, 2008


Flowsheets, the systematic recording in chronologic order of findings and facts about a particular patient, are a great way to maintain and improve the quality of care - especially for patients with chronic disease. Doctors (and other providers) love to have flow sheets - but they hate to make them. Personally, I spend a huge fraction of every day in the clinic updating the lists with medications, vital signs, lab results, etc.

One of the main stimuli for developing the Vermont Diabetes Information System was to lessen the burden of keeping the flowsheet. It started back in the early '90s when Charlie asked the lab at our hospital to make flowsheets of the key lab results for patients with diabetes. That simple idea evolved over more than 10 years and two NIH grants into an automatic system that includes the patient's test results no matter which laboratory they use, and provides guideline based advice to the primary provider to help them stay organized. Here is the current version:

(A full size pdf file is here.)

It arrives in the office the morning after the lab test is done - often before the official lab report. And, it has more than just the latest result for a single test - it has the last 4 results for all of the major diabetes tests plus advice based on the American Diabetes Association guidelines. The doctors and nurses liked these "value-added" laboratory reports and they became the basis for other HIE-based products and services which I will write about soon.



Monday, July 21, 2008

Top US Counties for Diabetes

Because so much of laboratory-based HIE comes out of the world of diabetes, these data are very interesting. They come from the CDC's county-level prevalence estimates here.