Generic Patient Registry

Business problem
An ever-growing number of chronic conditions need careful management. Insurers provide incentives for physicians to meet specific targets. Web sites comparing physicians on process measures and outcomes are popping up every day. All this pressure means that care teams need good tools to identify and track groups of patients.

Why not use the EMR?
Electronic medical record systems are meant to track information about individual patients. They may not be designed to track groups of patients. While the Epic® EMR has tools for assigning patients to lists, it can be easier to track groups of patients outside the EMR, and it is not possible to send automated pages from Epic.

Designing a flexible, multi-use registry
Combining our experience with registries (Integrated Clerkship Registry and Chronic Disease Registries) with automated alerting such as ADT Event Alerts, we built a "generic" registry application.

At its heart, this application is very simple. Medical record number and some notes are stored for each selected patient, as well as any registry-specific data tables. Any patient can be included in as many of these registries as necessary.

Anticoagulation registry
Patients taking anticoagulant (blood-thinning) medication (warfarin) need very careful monitoring. It is especially critical that anyone who is admitted to the hospital and is already taking warfarin is identified immediately, since hospital patients are often given heparin (another anticoagulant).

Patients are automatically assigned to the "anticoag" registry, based on two criteria:

• A prior visit to any anticoagulation clinic
• Admission to any emergency department or inpatient unit

As patients are admitted to an emergency room or inpatient unit, they are identified for the ADT Event Alerts process. At the same time, they are matched with anticoagulation clinic visit data from the Epic outpatient EMR.

If a patient has had any prior visits in an anticoagulation clinic, an e-mail alert is sent to a list of clinical staff including pharmacists, so immediate action may be taken.

Attention-Deficit Hyperactivity Disorder
The next registry, still in the process of being implemented, tracks ADHD patients. A combination of patient age, diagnosis and current medications are used to identify ADHD patients and add them to the registry for tracking and management:

• Age >6 and <21
• and ICD-9 code 314
      OR
• Age >6 and <21
• and taking ADHD medications

Outcomes

• The generic patient registry provides a flexible, easy to configure tool for creation of new registries, with no concerns about overlap between registries. This is a major advance from our first-generation chronic disease registries.
• Registries continue to offer some functionality, most importantly automated paging, that is not available from the Epic EMR.

Lessons learned

• As the organization becomes ever more experienced with the Epic EMR, it is unclear how much need there will be for registries. Clinicians are understandably eager to do as much as possible in the EMR, and push tools like patient lists to provide as much registry-like functionality as possible.

Posted 28 August 2008