Learning Labs : Report from CEO Terry McGeeney

Registries

I often get asked questions about registries. Practicing physicians in many instances have limited knowledge of not only of what a registry is, but also its purpose. However, it remains an important subject. In fact, much of the discussions around Chronic Care Management and Medical Home concepts involve disease registries.

Registries serve a number of purposes. The ultimate purpose of a registry is to enable providers to take care of their patients proactively and in a population-based fashion. The day has passed when an uncontrolled diabetic is only managed when he/she presents to the office. Providers should now know who are the uncontrolled diabetics in the practice and should have a vigorous, proactive approach to managing those patients. That can only happen with a registry.

Ideally, a registry allows data to be reviewed not just by disease, but also by provider, practice or lab value. Diabetes is the disease that is often talked about when registries are considered because its issues are more concrete and well-defined, but there are many other diseases that can be considered as well. Hypertension, asthma, depression, coronary artery disease and congestive heart disease are other considerations. The true value of a registry is that diseases can be prevented not just managed.

There are really two types of registries that need to be considered: disease-based and population-based. A common example of a disease-based registry is a system for tracking diabetes that may be used for various Pay for Performance programs. It can be paper-based, electronic or some blend of the two. A high quality registry not only allows a practice to identify groups of patients by provider, disease or lab value so that a population of patients can be managed proactively, but should also provide vibrant point of care reminders so that best practice guidelines are followed and patients receive maximum care.

While managing diseases via a registry is important and will soon become expected best practice, registries create an even greater opportunity to manage wellness. Population-based registries, that include disease registries are something all practices should aspire to. The technology exists for a practice to identify its population that uses tobacco, or to target those over 50 that have not had a colonoscopy, or immunization— just to mention a few.

The concern always comes up that practicing physicians don't have enough time or money now, so how can they be asked to do more? There is no question that population-based registries to manage both disease and wellness need to have an electronic solution. Technology exists for practices that have an Electronic Health Record without a registry function to create one that does everything discussed here. From this day forward no one should purchase an Electronic Health Record without an effective registry function.

The technological capability exists— physicians just need to demand it. Disease-based registries are easier to manage and should be utilized in all practices today. Although cumbersome and somewhat time consuming, a disease registry can be totally paper-based. There are a number of software products in existence that allow data to be entered into a program allowing the population to be managed and paper forms created for the point of care service in practices that do not have an Electronic Health Record. These programs are not very expensive and after the original data is entered take very little time to update. Technology also exists to populate these software programs with external lab data.

It often comes back to the time issue in a practice. However, it is important to remember that a typical primary care provider does not have a substantial number of diabetics or any other chronic disease patients in their panel. It may be that data is being entered on less that 100 patients, but this effort will greatly impact the quality of life of those patients. Volume and time are often excuses that do not bear out under close scrutiny.

The bottom line is that Family Physicians and indeed all primary care providers need to be considered proactive and cutting edge. The marketplace is demanding population-based care that will lead to higher quality and lower cost. The technology exists to support those demands. Physicians must get on board— implementing what they can now and, when they are ready, buying Electronic Health Records that fully support population based registry functions.