More on Health Maintenance

Another sometimes problematic health maintenance issue is the time frame for each of the preventive measures. I am in complete agreement that the current HM tool is painfully inflexible in that one cannot change the time frame in the event of an (often common) exception. For example, if a patient has a history of colon adenomas, the timing of the next exam may be anywhere between 1 and 5 years, depending on pathology and physician judgment. While the colonoscopy can be documented in the Procedure Profile, the date of the next expected colonoscopy cannot be altered in the Health Maintenance tool.

The following is the list of time frame defaults for preventive measures. They are based on the guidelines I alluded to in my first post last month. I don't doubt that a couple of these are debatable, and not just for special populations. For example, bone density tests are often performed every 2 years depending on age and clinical judgment.

Mammogram: every 365 days
Cervical cancer screening: every 365 days
Bone density testing: every 5 years (1825 days)
Prostate DRE: every 365 days
PSA: every 365 days
Colorectal screening: if postponed, then 365 days; colonoscopy - every 10 years; flex sig - every 5 years; stool occult blood - every 365 days
Chlamydia screening: every 365 days
Tobacco exposure: every 365 days
Influenza vaccine: every 365 days
Pneumococcal vaccine: once
Tetanus booster: every 10 years
Zostavax: once

In the same way that a red mark can drive us crazy, so too can the inflexibility of the time frame. Keep in mind that the HM tool was built both to meet the minimal standards of care for all patients and to maximize opportunities for quality measures performance. In this way, the tool is really an aid; it can help facilitate best practice. Ultimately, though, it is the physician, and not the guideline, that provides the exemplary care our patients expect of us.

I do have some good news: by the end of 2009, CIS will undergo another upgrade (that is, in addition to the Enhanced View upgrade to be rolled out across Baystate Health on March 24). In the later upgrade, there will be a number of significant improvements to already extant tools as well as the introduction of new and quite excellent tools (more on that later). One major improvement that I have seen demo'd is of the Health Maintenance tool. This new design will include the customizability we are all wanting for...