According to Kathleen, the Diabetes Collaborative is even on Washington Governor The Diabetes Objective Research Project (DORP) is currently aggregating 60,000 …
CDEMS User Support Newsletter
November 16, 2005 Kent, WA
Meeting Highlights
Twenty CDEMS users attended the CDEMS User Support Meeting in Kent, WA on
November 16, 2005 Participants were: Bev Roder Tammie Bigelow
Physicians of SW Washington, Cathy Irby, Jim Strawn, Shari Peterson, Jean
Gambrielle, Kelly LaRue Northwest Physicians Network, Judy Tomassene
Seattle Indian Health Board, Francisco Arias Erica Long SeaMar
Community Health Center - Seattle, Shonnie Evans Yeshi Zelleke Country
Doctor Community Health Centers, Cassandra Beard Shari Giomo St
Peters Family Medicine, Colette Rush The Polyclinic, Crystal OBrien,
Anita Christiansen, Linda Pelland Snoqualmie Tribe North Bend Family
Clinic, Sue Barwick Mason General Hospital, Barb Flock Rockwood
Clinic, along with Kathleen Clark Jeanne Harmon WA DOH, and Dusty
Knobel Jackie Gianunzio CDEMS Support
User Presentation: Spread of the Planned Care Initiative at NPN
Cathy Irby, QI Initiatives Manager at Northwest Physicians Network NPN
lead a panel discussion about the NPN experience in spreading the CDEMS
registry to over 100 independent providers in South King and Pierce
Counties Panel members also included:
Jean Gambrielle Credentialing,
Kelly LaRue, RN, Shari Peterson, RN, and Jim Strawn, IT The NPN
PowerPoint slide presentation is available to all on the Newsletter page
at wwwcdemscom
CDEMS is a tool that NPN has provided it members to offer support beyond
the normal activities of a clinic office Cathy reviewed some of the
benefits of using the registry more control for providers and staff in
knowing how patients are doing, increased job satisfaction, empowerment,
reduced faxes for prescription renewal, better patient care and
emphasized that building registry confidence has taken some time Its
not something that starts quickly It takes awhile to get to the point to
where you really believe in it It can take up to six months before a
clinic begins to see the benefits of registry work so its critical to be
able to sustain the registry during that initial six month period
Eventually the number of patients that can be seen increases as time is
saved through use of the progress note checklist Cathy summarized some
key first steps in initiating spread:
Establish flow of information and responsibilities within the office;
identify and re-examine roles of how the
flowsheet is used and who
records updates Cathy shared Roles buttons that were used in
training to lay out roles for everyone involved in areas of the
registry form The exercise demonstrated the flow through an office
and helped people know who was playing a role that might be swapped or
shared with someone else
Get providers to understand the power of the information in the
registry early This important concept has prompted NPN to bump
training about queries and summary reports to the forefront of the
registry implementation process
Organize care around appointments and planned visits; reduce triage
phone calls for med refills by implementing a meds by appointment
policy
Lessons Learned:
Make it simple and practical
Get everyone involved As Bev Roder Physicians of Southwest
Washington says, Many hands make light work
Get people using lists and reports early
Include a patient education component - teach patients what to expect
during a visit This is an active and ongoing idea
Staff meetings are important to keep communication flowing and
maintain contact
and interest about the project
Make users more independent - mentoring vs support
How to make time for Data entry? Cathy Irby says, Take time to make
time It will save provider time later
Participants discussed the big issue of standardization versus
customization of registry forms Francisco Arias shared that
standardization of the progress note among five Sea Mar Community Health
Center sites has been driven largely by the Collaborative and has worked
well
Users also discussed other ideas for sustaining changing and for applying
different models that work for different populations While planned visits
are more difficult in the community health care setting, patients without
insurance can be included in quarterly diabetes training sessions as
suggested by Linda Pelland of the Snoqualmie Tribe North Bend Family
Clinic At SeaMar Community Health Centers, free diabetes education and
preventive services are offered through internal programs such as REACH,
and the CDEMS registry is used to identify patients eligible for
alternative assistance on Asthma Day and Diabetes Day Judy Tomassene
of the Seattle Indian Health Board reiterated that having the CDEMS
sheet
in the chart encourages providers to start working on Diabetes issues
whenever the patient is seen even if the visit is unplanned or not a
Diabetes visit
Quotes of the Day
Everything is a process and never
done
Talking is not teaching; listening
is not learning
- Dusty Knobel, CDEMS Programmer Developer
DPCP Chat: Sustaining Change Initiative
Kathleen Clark, Washington Diabetes Prevention and Control Program, updated
the group on Collaborative and registry-related activities at the State
level
The Washington State Collaborative WSC is a system change and
quality improvement program Over 100 organizations have gone
through four Washington State Collaboratives According to Kathleen,
the Diabetes Collaborative is even on Washington Governor Christine
Gregoires radar Weve hit the big time Medicaid folks are
taking more of an interest in the Collaborative work and are looking
at the possibility of pay-for-performance incentives
for
Collaborative organizations that can demonstrate outcomes and
improvements in health care
The fifth WSC begins Learning Session 1 on Feb 13-14, 2006 with
tracks for Diabetes and Cardiovascular Prevention Enrollment for
WSC-5 is required by December 15, 2005 and scholarships are
available Visit the Washington State Collaborative web site
wwwqualishealthorg/wsc for more information
The Diabetes Objective Research Project DORP is currently
aggregating 60,000 CDEMS diabetes records to see how were really
doing with patient care in WA
The Sustaining Change Initiative is an 18-month structured program
providing ongoing support of the planned care model after the conclusion of
the Collaborative The Initiative assists organizations who have been
through the WA State Collaborative to sustain and spread planned care by
providing tools and interactive experiences that build skills, confidence,
competencies and infrastructure to improve the care of all patients
Kathleen explained the difference between sustaining change and
spreading Sustaining change is keeping the registry up, adding new
patients, keeping teams
active and motivated at each site; Spreading is
moving to new conditions, sites, and prevention Spread actually helps
sustain change
Suggestions for a framework to continue and perpetuate change:
1 Sustain change in your corner of the world by updating job
descriptions to include the planned care model and registry work,
introducing planned care model during new employee orientation,
documenting changes made and procedures
2 Work in all components quadrants of the planned care model
3 Whatever makes it easier will sustain it, eg lab interfaces,
service interface from health care plans, quarterly cleanup of
registry
4 Build in time to work on your B list - things beyond crisis mode
5 Communicate with others about what youre doing; use your social
network to sustain changes
6 Engage senior leaders in your project Help senior leaders with
concrete activities they are responsible for eg have senior leader
drop in on a discussion of the planned care model to show support,
personalize understanding of the model with a connection to senior
leaders life, schedule time with senior leaders
7 Have providers
spread to other providers by mentoring peers
Barriers:
Lack of senior lead engagement If you are an earlier adopter, you
can go pretty far If senior leaders are not brought along — like a
rubber band — you can only stretch so far
Clinical information systems
Lack of response to train others in use of the Planned Care Model
Jeanne Harmon, also with the Diabetes Prevention and Control Program,
shared a story about a small clinic in eastern Washington where a CDEMS
registry tracking 50 Diabetes patients spread the registry to monitor 200
patients with bronchiolitis and asthma Providers and nurses there were
unaware of the rich data available in the registry, and Jeanne met with
them to enhance their understanding of the full capability of the registry
- the power of information
Dusty Celebration
Dustys closing thoughts were a last pitch for the SQL Server version of
CDEMS He reiterated the benefits of CDEMSSQL that include tighter
security protections to satisfy HIPAA requirements and increased protection
against massive data loss through a transaction rollback feature Dusty
shared his excitement over a Michigan installation of CDEMSSQL that
was
accomplished in just 30 minutes
Dusty Knobel, CDEMS programmer and developer, officially retires from
public service on December 1 so the User Meeting concluded with a special
farewell luncheon Everyone enjoyed a slideshow of Dustys on the job
memories and shared stories and sentiments in appreciation of his registry
work and respectful, supportive style of assisting non-technical users
Thanks to all who attended to share in the celebration of Dustys work
Tammie Bigelow, won the Japanese Family tile door prize for this meeting
Congratulations, Tammie, with thanks for supporting and spreading the
registry to providers in southwest Washington
Source:cdems.com
