Health Maintenance and the Diabetes Registry

You may be aware that quarterly diabetes registry reports were recently sent to all BMP adult primary practice managers and medical directors. Admittedly, we are still working out some of the core and composite calculation quirks that are used for global and group assessments. Assuredly, the demographic and lab details are accurate and clearly defined in the tables. What is lacking, however, are many of the features that are used to assess quality and, ultimately, pay-for-performance. These include:

• date of last diabetic retinal exam
• date of last comprehensive diabetic foot exam
• date of pneumococcal and influenza vaccines

The first two of these need to be manually entered into the health maintenance tool. Depending on the work design of a particular practice setting, this might be done by the MA upon patient's arrival to the office, by practice associate (PA) when a letter comes from the ophthalmologist/optometrist, or the physician upon review during chart review or during an office visit. My personal preference has been to enter the data during the patient visit as I spend time reviewing the health maintenance profile. Depending on where the retinal exam letter is buried, the entry of these two data items takes considerably less than a minute.

The vaccinations are, or at least should be, fed into the health maintenance tool as a consequence of the procedure being documented by the MA/RN. In other words, if you see a red mark in the HM tool, then the patient likely needs the vaccine.

It may be the case, however, that a patient received a vaccine at another site, e.g. VA, CVS, senior center. If another member of the staff has not entered that information, this can be done by entering into the immunization profile and attributing the procedure to "Historical Data" with an approximate date. If this profile is unfamiliar territory, I'd recommend asking your staff to enter this data when vital signs and other such information is entered.

The bottom line is that your engagement with the Health Maintenance tool will help make the registry reports, and thus quality & P4P measures, accurate and meaningful. I'd be glad to give more detailed instruction for those who are not comfortable with manual data entry.