Generic Patient Registry
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.
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.
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.
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.
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).
are automatically assigned to the "anticoag" registry,
based on two criteria:
prior visit to any anticoagulation clinic
to any emergency department or inpatient unit
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.
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.
The next registry, still in the process of being implemented, tracks
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:
>6 and <21
ICD-9 code 314
>6 and <21
taking ADHD medications
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.
continue to offer some functionality, most importantly automated
paging, that is not available from the Epic EMR.
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