Framework for Making Systems Changes

Information Systems

When making a systems change, one of the first areas any practice will want to review is its information system. A reliable and effective information system is one of the most important tools a practice can use to provide timely, proactive care for patients.^1,2 A patient registry enables a practice to track its diabetes population and proactively organize and plan care. When a thorough information system is in place, the health care professional will be able to identify patients at critical break points and obtain reports based on projected plans for follow-up and feedback. The system also can create a report on aspects of a defined patient population and provide graphical summaries that help health care professionals project needs, analyze possible cause-effect relationship, and plan interventions.

The technology for electronic medical records is rapidly expanding with more and more options becoming available - from server-based to web-based registries - making paper-based products, for the most part, cumbersome and obsolete. Current software makes it is possible to assign "fields" to each patient so the patient can be identified based on due dates for follow-up, testing, exams, reminders, and general follow up. When the database is structured appropriately, reports can be run when desired for all patients with diabetes who are in particular stage of treatment such as recent diagnosis, high-risk for vision complications, experiencing vascular complications, or satisfactory maintenance. Those patients then can receive the appropriate intervention, whether it is a phone call, post card reminder, or scheduling an exam or visit. Providing patients with reminders and ongoing support is important facet of patient centered care. An information system can make this one-on-one interaction between the health care professional and patient automatic and easily integrated into the practice routine.

An information system that is networked or resides on a password-protected, secure Internet IP address also can help different members of the patient's team access information, such as test results and the long-term management plan. This sharing of information can make team decision-making more effective and efficient. As technology progresses and software customized for health care continues to be developed, health care professionals and office staff will be able to integrate evidence-based decision making into more and more aspects of patient care. Interactive systems into which patients input daily blood glucose values, blood pressure readings, or food selections also are possibilities that allow the clinciain or educator to monitor a patient's progress electronically from a remote location, provide education, answer questions, renew prescriptions, etc. Patient education materials and behavioral assessment tools can be integrated into the system. Personal health records enable patients to take responsibility for their own health, contribute to the record, and enable continuity of care when health care providers change over time. (See Resources for a list of tools.)

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