Disease registry: "Chronic disease tracking system" for those who cannot afford an EMR

For practices that do not plan to purchase an EMR and want to proactively manage the health of population, a registry can be used instead. This registry can be used to track a practice's diabetes patients, including their required labs and preventive services. This information can then be used to manage population health proactively.

A simple MS-Excel based Disease registry can be found here at AAFP.org. This file tracks interventions and clinical parameters that are important in diabetes management. In case problems are encountered, an alert is displayed. For instance, if the date of a patient's last A1C was more than 90 days ago, that date cell turns yellow as a warning; and turns red if more than 180 days ago.

Identifying all patients in the practice with a chronic disease such as Diabetes type 2 and initial data entry of this registry excel sheet are identified as major challenges to achieving a complete and functional disease registry. However, once the registry is complete, it provides many advantages:

• Proactive management of chronic diseases
• Use for preventive services and screenings such as Pap smears, mammograms, colon cancer screening etc. for general patient population
• Increased compliance with recommended services
• Improved patient care
• Document performance as part of p4p activities

Dr. David Ortiz who created this registry worksheet recommends:

• Start small, pick a chronic condition that you want to improve
• Involve your practice staff. Get their buy-in and agreement before operationalizing the plan

IT critical to improving care of patients with chronic diseases

There are those who suspect the power of health IT to significantly improve cost and quality of care. Quite likely they may also consider funneling multi-billion stimulus funding to HIT a colossal waste. Here is evidence that proves otherwise and might even force such detractors to rethink their opinion.

Results of a 5-year Medicare Physician Group Practice Demonstration study involving 10 large MD practices were published that attributed improved quality of care for patients with chronic diseases to use of HIT. This Medicare Physician Group Practice Demonstration study is also mentioned as the "first" P4P project to work directly with physician practices. Here are some impressive figures from this study.

* Geisenger improved care on all 32 categories that include continuing programs for diabetes and coronary artery disease, adult preventative care, and hypertension

* University of Michigan (UM) Family practice group improved care on 29 categories. Care improvements were made in areas that included diabetes, congestive heart failure, coronary artery disease, hypertension, and breast and colorectal cancer screenings.

* UM Family Practice group claims $2.9M in Medicare savings surpassing the CMS target

How did they get this done?

* Provided clinical decision support through alerts/reminders within the EHR

* Start small and then expand the program - First year focus on Diabetes. Congestive heart failure and coronary artery disease were included in second year. Hypertension in year three.

* Commitment of physicians and administrators within the practices

Reducing costs while improving care -- who says it can't be done!! Studies such as the one cited above have far-reaching consequences considering chronic diseases account for ~60% of the deaths worldwide and half of them can be prevented!