Computers & Hardware

Computerized Alerts and Reminders Contribute to Clinical Quality Improvement

The ‘medical home' model of health care is viewed by many as one of the most promising avenues on the road to providing better patient care while reducing medical costs. As more insurers, corporations and physician groups test the medical home concept, it is moving beyond theory into practice. Vital to the concept's success is the ability to automate certain patient care processes for preventive care and chronic disease management, without placing an undue burden on the caregiver.

Centralized Point of Care

The medical home provides a centralized point of care for patients and the coordination of their treatment. Computerization of processes such as physician alerts and patient reminders is an essential part of this environment. Studies* show that physician groups implementing an automated system of alerts and reminders delivered higher quality of care to patients, whether they went in for basic care, visited specialists, or required hospitalization. Along with improving the performance of their practices, physician groups in the study also reduced their costs for overall patient care.

If you have an electronic medical records (EMR) system in your practice, it may already have the functionality you need for computerized alerts and reminders. If not, or if you haven’t yet adopted an electronic medical records (EMR) system, you can set up automatic alerts and reminders with the help of a database software application known as a Patient Registry. It doesn't require special expertise or training to implement, and what's more, Medicare (PQRI) and other Pay-for-Performance (P4P) programs are now providing financial incentives to use a Patient Registry with alerts and reminders in your practice. When you look for the right software for your practice, there are four areas of functionality you should expect in a reliable system of Alerts and Reminders, described in this article.

Alerts to Caregivers

At the point of care, the system should identify patient-specific suggestions, screening tests, exams, and other preventive services in support of disease management as well as preventive and wellness patient care. The conditions for displaying alerts may be set or modified by the provider, to follow established guidelines or other requirements. Alerts must be individualized to address a patient's specific clinical situation, and the system should be able to document that a preventive or disease management service has been provided, or overridden, and document the reasons. For example, after a patient has had a complete hysterectomy, the system should be able to remove alerts for an annual pap smear.

Reminders to Patients

Providers should have a straightforward way to create, update, and individualize the rules for patient reminders in the same way as they would for physician alerts. Between healthcare visits, patients should receive automatic notifications of preventive services, tests, or behavioral actions that are due or overdue. The system should have the capability to send notifications by letter or email, and then record their delivery. For patients that prefer to be notified by telephone, the system would generate a printed patient list.

Individualized Patient Visit Plans

Visit Plans bring relevant patient information together with guidelines for managing each patient's conditions at the point of care. The Visit Plan includes a summary of the patient's key clinical indicators (medications, test results), with suggestions to be presented at the point of care. In situations where the computer system is not used at the point of care, Visit Plans can be printed in advance, allowing clinical personnel to prepare for each visit, and providing alerts. It should be possible to print Visit Plans for one or all of the patients scheduled for a particular day, or for a period of time over the course of treatment.

Prepared and Ad-hoc Patient Care Reports

Easy access to relevant reports, both prepared and ad-hoc, helps physicians identify patients who need special attention. These reports measure changes in the practice's performance and results against clinical guidelines. For example, if a physician can view a report monitoring diabetic patients with glycated hemoglobin (HbA1c) over 8%, he can quickly determine if they are receiving proper care with regular testing and proactive disease management, regardless of whether they have a scheduled appointment or what brings them to the office.

Benefits of Easy Automation

• Demographic data and patient problem information should be obtained from the practice's billing system or an integrated EMR system, with no need for separate data entry.
• Clinical information can be obtained from an integrated EMR. Although Alerts and Reminders can often be generated without access to clinical information (using only age, sex, and codes from the billing process), the value of utilizing lab results is clear.
• Patient data can be entered or updated quickly, without interrupting the process of care.
• The computer system generates automatic reminders whether or not a patient has a scheduled appointment.
• Providers can specify or cancel patient reminders, or change treatment description and frequency recommendations, at any time, without programmer assistance.

If you are moving toward the medical home concept, now you can automate certain patient care processes for preventive care and chronic disease management, without placing an undue burden on you and your practice. With these guidelines in mind, you can implement a computerized system of alerts and reminders in your practice, and be on the road to providing better overall patient care while reducing medical costs.

Highlighs of Two Studies

*Use of reminders for preventive procedures in family medicine.
Robert W. Shepherd, MD., Canadian Medical Association Journal

• Hospital Center for Family Medicine
• 5883 patients
• 1-year study of computerized reminders for preventive care
• Up to 42% improvement in delivery of preventive services

Use of reminders for preventive procedures in family medicine. Robert W. Shepherd, MD. CMAJ. 1991 Oct 1;145(7):807-814. [PubMed]

*A computerized reminder system to increase the use of preventive care for hospitalized patients.
Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ.

Department of Medicine, Indiana University School of Medicine, Regenstrief Institute for Health Care, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis 46202, USA.

• General Medicine Service
• 6371 patients
• 18-month study of computerized reminders for four preventive therapies
• 53.6% of patients eligible for preventive measures identified
• 51.4% improved ordering rate for patients indicated for a flu vaccination

New England Journal of Medicine. 2001 Sep 27;345(13):965-70. PMID: 11575289 [PubMed - indexed for MEDLINE]

* VersaForm currently offers several medical software applications which can be downloaded at no charge from the company's website: Medical Software.

Mr. Landau is founder and CEO of VersaForm EMR Software. VersaForm designs and develops medical practice management, Electronic Medical Records and clinical software to enable healthcare organizations to use computer and network systems for greater efficiency.

Article Source: ArticlesBase.com - Software Plays an Integral Role in the Emergence of the ‘Medical Home’