Diabetes+Registry

Standard workflow for DM registry use:

Introduction to the Diabetes Registry
 * 1) At patient intake:
 * 2) Nurse/MA enters weight, BP, Height (if not already entered), updates smoking status if needed in DM registry within PCIS. If need be to optimize clinic flow this can be updated after the provider encounter.
 * 3) Nurse/MA prints out DM registry report and sticks on front of chart
 * 4) During visit in exam room:
 * 5) Provider reviews DM registry report with patient
 * 6) Provider orders due interventions as highlighted by clock icons (i.e. foot exam, optho visit, labs, vaccines, etc.)
 * 7) Provider addresses items that are out of target range as highlighted by light bulb icons (BMI, HgbAIC, LDL chol, etc.)
 * 8) Provider updates changes to DM registry report in pen on printout
 * 9) At patient discharge: Nurse/MA updates DM registry in PCIS with changes noted by provider.

Diabetes Improvement teams at Concord, North Richmond, Pittsburg, and Richmond have used the Diabetes Registry since 2005 to improve care for patients during busy clinics. The Chronic Care Improvement Project is now organizing trainings for all staff in all eight ambulatory care clinics.

What will the Registry do for me?

__Patient Perspective:__
 * Lab results displayed on one page when I see my provider.
 * Timely test reminders so less chance of missing something.
 * Possibly fewer blood draws because tests are tracked in an organized fashion.
 * More time to talk, because my provider isn’t thumbing through the chart.
 * Improved quality of life from improved diabetes control.
 * Good control reduces risk of early disability and death.

__Clinician / Clinic Staff Perspective:__
 * Staff quickly see missing or out of range tests and referrals at the point of care.
 * Improved morale through expanded nursing roles.
 * Analyze whole patient panel, see which patients are at goal, versus who may need more intervention.
 * Look at your practice as a whole and get see what areas you’re doing the best in and what areas it might need improvement. Fulfill recertification requirement for practice improvement.
 * Communicate better with other clinical staff in our system. We will all be literally “on the same page” about how the patient is doing, what their goals are, what is needed.
 * Ability to “automate” routine functions so patients get tests and referrals as indicated, not based on provider memory, clinic pace, etc.
 * Personal pride and satisfaction of improving care/ providing quality care.

=Health Plan Perspective= · Improved communication with PCPs- (All on the same page). · Ability to target expensive patients for intensive care management.
 * Ability to “automate” routine functions so patients get tests and referrals as indicated (improved quality of care).
 * Improved HEDIS scores (better quality may attract more members).

=System/QI Perspective=
 * Meet outside regulator’s requirements for Quality Improvement.
 * Decrease expensive avoidable complications of diabetes.
 * Utilize the most expensive staff (doctors) in a more efficient manner.
 * Improved access by decreasing the burden on providers at the point of care.

Step by Step Guide

1) __Access CCRMC Intranet:__

Click Icon on desktop OR type “__CCHS__” in Internet Explorer browser file open window.

2) __Log-in to Intranet:__ User name is first initial and up to 7 digits of last name. The first time you’ll use a standard password, then you’ll be prompted to choose your permanent password Your permanent password must be at least 6 digits with at least one of those being a number NOTE: IS recommends resetting “Preferences” to “Active X” to allow faster response time. Click on Preferences under “Logout”, then select ActiveX (see below) and hit “Save”. 3) __From “Applications” choose PCIS__ Before clicking, the letters “ PCIS (Windows) ” are red. After clicking, the letters “ PCIS (Windows) ” turn green. Wait patiently! If you click again you’ll get a second PCIS screen. 4) Once __in PCIS__ you can go to “ALUS” to find any provider’s profile on any date OR if you are a provider with a clinic “ Today’s Schedule ” will show your profile. 5) Nurses can click “Today’s Schedule” and select any Provider’s schedule that day (black circle), then hit “Refresh” (red box) or Alt R for those who prefer shortcut keys.
 * NOTE:** The top row of buttons are patient specific, the bottom row are general information.

6) __PCIS Main Screen__ will show you the problem list which providers can edit by using the __“Encounters”__ button (bottom right) and checking which diagnoses should go on the problem list.

7) From the __main PCIS screen__ you can also edit __Social conditions__ and __Allergies__

8) You can enter the __Diabetes Registry__ by A. Picking a clinic schedule: (Today’s Schedule or ALUS) and then selecting a diabetic patient to view. That will get you to the Main page for that patient with their problem list, and access to meds, encounter list etc. Choosing “Diabetes Registry” button will get you to the “Point of Care” view for that patient. OR B. Choosing __“Patient Groups”__ and then “Search for”: __ALLDM__ and “PCP” : __PCP name__ and you should see some data on all diabetic patients for that provider. 1)Selecting an individual patient will get you to the Main page as A. above and then choosing “Diabetes Registry” button will get you to the “Point of Care” view for that patient. OR 2) You can highlight a patient row and press the "Clinical View" button to get to the "Point of Care" view OR C. Hit __“F6”__ and put in name or MRN to get an individual patient. Choosing __“Diabetes Registry”__ button will get you to the “Point of Care” view for that patient.

To close the diabetes registry screen, click on the close button at the right bottom corner. 9) Lab values, immunizations, and some retinal exam data flow automatically into the Diabetes Registry. Weight, BP & foot exam need to be entered manually. You can alter any of the interventions in the __Point of Care View,__ by using the “Add” button”. If __YOU__ entered data incorrectly you can “Edit” an intervention; you can’t edit anyone else’s interventions. “Delete” will remove the entry from view but the entry will remain hidden in the system so that no one can tamper with records. “ Quick Entry” will allow multiple interventions to be added quickly and saved just once.

10) From the PCIS main screen or from DMR you can go to __“RX List”__ This can be sorted alphabetically or chronologically to show: All meds __filled__ at a CCRMC pharmacy or any PCN pharmacy for a CCHP member. This will not show Rx from outside pharmacy for TO or MO patients. This is not linked to RXM presently.

Other prescriptions or OTCs and herbals remedies etc. can be added in the lower box. This section is scheduled for revision so that the strength and instructions can be added.

The Rx. List can be simplified by checking “Do not show Duplicates”, or setting a time period for the Rx. The simplified list can be printed to send home with the patient if you need to indicate which medicines to stop or change the dosing, or if your instructions need to go to a caretaker.

10) __Conclusion:__ This registry is a work in progress. Currently it allows access to data when you do not have a chart available, and it offers an easy way to optimize care for diabetic patients. In the future, we plan to have an updated chronic disease registry. Stay tuned!

11) __Contact:__ for questions or comments, email Troy Kaji at tkaji@hsd.cccounty.us

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