Chronic disease management – tracking and quality improvement – is the one promise an EHR makes that rarely delivers. To be fair, almost all of the EHRs on the market offer functionality that can be leveraged to accomplish this goal, but the content must be originally created by each healthcare organization. Enabling chronic disease management is an important mission. Probably one of the most important missions an EHR can have. I will share why creating chronic disease management tools is important, the reasons why it is often overlooked, and what you can do to fix the situation.
Why is this important?
Once upon a time, I visited a children’s hospital to review their orthopedics specialty tools. Our goal was purely to learn and understand what happens to children in orthopedics hospitals. I had the privilege to witness the surgery of a 13 year old girl named Lucy, and then looked deeper at the process. This was Lucy’s sixth surgery and is now pretty routine for her. As a father, this hit me incredibly hard.
Imagine your child has Scoliosis. From a non-clinical person I’ll summarize. Lucy’s spine was twisted severely during growth. For older children who have little growth left, the spine will be fused. Nine months later they return to hard physical activity with only minor long-term impairments. For a 10 year old diagnosed with severe scoliosis, things happen differently. Adjustable Harrington rods are attached to the spine of the patient. See, the child is still growing and fusing the spine will freeze this growth. If the spine is fused at this age there will not be room in her chest cavity in adulthood for her organs resulting in severe complications.
These adjustable rods should be adjusted every 4-6 months to adjust her growth. Each surgery has a host of things to prepare for to allow the surgery to have on time. If a patient misses or is late for the appointment, they’ll lose out on the growth for the rest of her life.
To track these appointments, the healthcare organization kept the patient records in a binder kept by one of four nurses. Each nurse was responsible for a cohort of patients and were heavily involved in the lives of the family. Above the desk of each nurse was a filing system labeled by month. Each month held the records of the patients that the nurses needed to reach out to in order to schedule the patient’s next appointments. As the patient received a new surgery, the book was moved to the next month of contact.
Now imagine what happens if the nurse wasn’t able to come to work for a large period of time. What would happen if the nurse made a mistake and missed the contact by a month or two. What happens if the record was misplaced, or someone accidentally removed the record? Imagine a fire. This patient does not receive the care they require and therefore are affected for the rest of their lives.
Chronic disease management can address this risk, and raise the bar. I could tell you similar stories about diabetes, heart disease, dermatology biopsies, asthma, kidney disease, HIV, Parkinson’s disease, and others. These can all be managed to great effect using the chronic disease management tools within your EHR.
Why is this overlooked?
Chronic disease management is hard on the surface. A lot of technology, organizational stamina, determination, and culture needs to come together to make it happen.
A well-crafted EHR with robust reporting capabilities needs to be installed. Most mid-sized organizations in the US only recently installed their EHR once the HITECH act was signed into law in 2009. For them, the technology to even undertake this mission was only recently available.
Most healthcare vendors I’ve been a part of are wary of offering this content out of the box due to liability. Therefore all content must be created originally by each organization. Since they’re recreating the wheel, they need to think of all of the lessons learned themselves. All of this takes physician involvement – a group is usually focusing on treating patients in real time.
What can you do to fix the situation?
Launch chronic disease management registries, quality metrics, and associated quality improvement tools!
- Find a consulting firm that has setup disease registries, patient cohort management, quality improvement, care access, and best practice alerts before in the EHR you have installed. This firm will help you avoid some of the common pitfalls other healthcare organizations have hit.
- Enlist a physician champion from each specialty to design the quality tracking metrics and reasonable organizational goals for their largest disease cohorts.
- Design reporting registries that list all patients from the disease cohort along with these quality tracking metrics.
- Build reports displaying trends over time matched against the organization goals.
- Create operational plans involving tracking and responding to these goals, patient outreach, and physician compliance.
- Build out decision support tools like best practice alerts to encourage physicians to take additional appropriate actions to support the disease management.
What are the benefits of tackling chronic disease management?
- You will save a lot of lives.
- You will improve the quality of life for many patients suffering from chronic diseases.
- You will reduce the total cost of care as patients manage their treatment better.
- You will improve your organization quality metrics which may attract new patients.
- HMOs and ACOs will reduce their total expense – saving money.
- CMS will allow reimbursement $42.60 per qualified patient per month using CPT code 99490.
Creating a solid operational plan around chronic disease registries will empower your organization to help patients more reliably, reducing expenses for patients, and earning the CMS chronic disease management reimbursements. Adding quality tracking metrics to this report will also allow your group to track its progress in population management.
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If you’d like to have a conversation about how your healthcare organization benefit from chronic disease management tools, you can contact me directly through email or my LinkedIn page.