Advantages of a Patient Registry in the Primary Care Setting

Certainly the federal government’s effort to dramatically change healthcare here in the United States is a hot topic. I have seen many articles online in healthcare blogs, financial sites such as the Wall Street Journal’s and Modern Healthcare’s, and in printed media, such as Time magazine. There are many points of view but all seem to focus on controlling costs while improving access. In my opinion, one key to success is improving access to primary care while focusing more on prevention and management of chronic diseases in this setting.Making the changes in the primary care setting will be difficult, to say the least. One tool that can help a lot is the patient registry, an IT tool that is much like a “to do calendar.” Registries range in features from one or two functions to multifunction. A simple one can be created by an individual using Microsoft Excel; you can find out how to do this in the April 2006 “Family Practice Management.”WellCentive is one company which offers multifunctional registries. No matter the complexity, though, the intent is to remind physicians about needed care for their current patients. For instance, a registry could remind a practice that patient X with type 2 diabetes is due for an a1c test within two weeks. Then a staff member can contact the patient if the patient has not already made an appointment and make arrangements for the test and other blood work before coming in to the office. This tool greatly expands the reach of the physician in prevention and management of chronic diseases as it helps get those patients who might otherwise neglect making appointments in to the office at the right time. Without this tool it was next to impossible for physicians to keep track of these forgetful patients.A simple registry as detailed in the April 2006 issue of “Family Practice Management (which you can find online for free, by the way) has only a few features, such as the patient name, contact information for the patient, the upcoming needed care and when it is due, if not past due. WellCentive’s online registry has all these features and much more. For instance:• Direct reporting to payers for pay-for performance• Collects both administrative and clinical data• CMS PQRI certified data collection and reporting• Point of care decision support• Patient portal• Population management toolsPhysicians who use online services such as this find that they pay for themselves while improving patient outcomes and income.There is much support for registries from a variety of sources. For example, the National Committee for Quality Assurance (NCQA) in its accreditation program for the patient-center medical home supports the use of registries for many of its standards. For example,• A system for managing patient data, such as preferred method of communication• Guidelines for evidence-based treatment• Lab reports and test resultsThe Patient Centered Primary Care Collaborative (PCPPC) also supports registries. Jim Clifford, a contact of mine at WellCentive (WellCentive is on the executive board of PCPPC), stated that at the March Medical Home Summit in Philadelphia, many physicians spoke in support of adopting registries instead of or in addition to Electronic Medical Records (EMR’s). I find this amazing, given that the federal government will be providing a substantial monetary incentive to practices adopting EMR’s. It may be that when HHS adopts its final rules for certifying which electronic systems qualify for the health stimulus that registries may be included.As you can see, registries have many potential uses. Let me provide an example of its use by a physician’s aid. The quote is taken from a white paper from the American College of Physicians on the patient-centered medical home:”The assistant notes that among the patients who need to be seen is Ms. Jones, a 67-year-old diabetic, who is due for a visit and needs her hemoglobin A1c checked. Dr. X’s assistant notes that the registry also has prompted her that Ms. Jones is due for her tetanus vaccine, mammogram, and a lipid profile. The assistant enters the laboratory orders on-line and contacts the patient to discuss the need for these laboratory tests, the mammography, and tetanus vaccine. Once she sets up an appointment with Dr X, the assistant schedules the laboratory tests for anytime the week prior to the appointment, as well as a mammography appointment for later on the same day as the appointment with Dr. X. On the day of Ms. Jones’ appointment, the clinical assistant makes sure that the laboratory results from the week prior are in the chart. Ms. Jones arrives for the appointment. Because Dr. X has an established standing order for routine vaccinations, the clinical assistant is able to provide Ms. Jones with the tetanus vaccine while Dr. X finishes up with the previous patient. The assistant also asks Ms. Jones to update her self-management goal checklist and to self- address a fold-over result notification card. As the assistant leaves the room, she takes Ms. Jones’s home glucose monitoring log to enter results into the registry database and reminds Ms. Jones to remove her shoes and stockings so that Dr. X can do a diabetic foot exam. The assistant enters representative glucose values from the log into the registry and checks off that a tetanus vaccination was provided. Later she will take the self-addressed fold-over card and place it in a weekly file to prompt her that there are outstanding test results pending.”Several sources report very good results with registries. For instance, in the November 4, 2005 edition of Medical Economics in an articles titled “Do disease registries = $$ rewards?” a physicians group stated that income from pay-for-performance measures had more than paid for its registries while at the same time greatly improving the management of its diabetic patients. Also, Dr. Terry McGeeney, CEO of TransforMed, an organization focusing solely on the patient-centered medial home states that “the true value of a registry is that diseases can be prevented, not just managed” and “the day has passed when an uncontrolled diabetic is only managed when he/she presents to the office.”A registry is an excellent tool to be used along with other tools from the Lean Toolbox to effectively reduce waste at a primary care site while greatly improving patient outcomes. In my review I have only indicated a few of the many possible uses of a registry. With a team of representatives from a practice you can select an appropriate registry for your practice and adapt it to your work habits. I concur with the PCPPC that a practice adopt a registry right away as the returns will be immediate and will grow over time as more functions of the registry are used. Even more can be achieved if a quality engineering consultant is used in the initial adoption phases of the registry.