Tuesday, September 16, 2008

Light Registries: All the taste -- none of the data entry

Recently Healthcare IT News published a story on the positive effects of a diabetes registry on the quality of care at Duke. They report that Duke has used DocSite, a registry product, for about a year and has improvements in the achievement of “perfect care”(in which the patient is on time or on target for every guideline). They report a "doubling" of this rate (although they don't report the rate itself, which is notoriously low - often well below 5%.)

DocSite has been around a long time in various forms and has suffered in the past from a major limitation: somebody has to type in all the data: labs, visits, vitals, smoking status, you-name-it. This limitation has caused many practices to give up on chronic disease registries. However, there are two strategies that can help: one is to use the registry as a back end to an EMR that already has all the interesting data in machine-readable form. I suspect this what Duke is doing. Essentially, the DocSite decision support tools are bolted on to the EMR.

The alternative is to develop a lighter registry that contains only those data that are easily accessible. For instance, Vermedx depends primarily on laboratory data because they are almost always electronic from the moment they are generated. As other data types become available (vaccine usage, medications, vitals, etc.), they can be added to the system with a concomitant expansion of decision support capability. Until then (which still looks like a long way off for most Americans), a registry like Vermedx can provide huge benefits without requiring a tremendous effort in data entry. It can:
  • allow population views at various levels (practice, provider, geographic, age-based, etc.)
  • drive communications to the practice about exactly what to do next
  • drive communications to the patient about what to expect and how to get it
  • stimulate improvements in the essential office micro-systems that are at the root of Primary Care quality
  • identify patients who need extra attention from specialists, case-managers or other resources
  • connect the practice to lab results from outside institutions - even if the two institutions don't share any infrastructure
These advantages, which translate into huge savings for the system as well as improved quality of life for the patient, are how, as Blackford Middleton of the Center for Information Technology Leadership puts it,
“...diabetes registries are the only form of information technology-enabled diabetes management we found to be cost-beneficial when adopted for patients with Type 2 diabetes.”
The challenge now is how to get light registries in use now while everyone is so busy installing (or planning to begin to think about installing) large, complex EMRs. We need the savings and the quality improvement now! This is a case of the perfect being the enemy of the good.


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