hello everyone - A question came up today at a meeting I was attending that I thought you all might have some feedback on: (Beth - this is a follow-up on the question about when you use the EHR and when you use the CDMS in the provision of care).
We were having a conversation about organizations that are using both an EHR system as well as a CDMS tool, and how do the two actually interface with one another? At what point in the care process are they used and why? For example: Is the CDMS a better tool for reporting and the EHR a better point of care tool? Where is each one being used?
Point of care; reporting; communications to patients; population health?
Is there any point where both are used? Are both application open at the point of care? Neither?
Thoughts?
3 comments:
This is Beth's response:
Dean
Hi Jane –
While we are no longer using CDMS, here’s what I see:
Using an EMR means you can capture ALL of the population of focus without waiting for separate data entry; it is always real time. It also means the process is simple, relatively speakingJ, as documentation on the patient is your data entry. Otherwise you run the risk of data entry errors when information is transcribed either from a paper tool to CDMS or from the EMR to CDMS. Not to mention the extra steps in the process.
If you have the kind of EMR that can be modified (or is designed—although those are few and far between) to collect population data, you don’t need something like CDMS, IF—a big IF—you either have the technical skill in-house or adequate support by the EMR company to create and generate the reports you need.
A good EMR and good technical support does away with the need for CDMS or any other disease registry, and can be used for pretty much all of the purposes you would use CDMS. You can send patient letters, create reports for population management, etc. Again, technical skills are key.
While I am a clinical person rather than a technical whiz, my understanding is that any time you can eliminate an interface, that’s a good thing—so better to use an EMR only if possible.
Hope this answers your questions; if not please let me know.
Beth Greenwood, RN
Shasta CHC
I tend to agree with Beth. What we have found is that with the right technical people in place you can in essence create your own CDMS through an EHR. We actually have a specific example of this in one of our clincs. They created a separate template (completely customized which took a great deal of effort) within NextGen for Diabetes Care on a per patient basis. Basically, the database is updated twice daily so when the patient comes in everything they've had is current and everything they need is highlighted and flagged.
Beyond that of course there are aggregate reports that are created to show not only how you are doing as a whole (all clinics for their group) but how each provider is doing in handling diabetic care for their patients. It works as a kind of incentive to make sure you are getting the A1c's, lipid tests, foot, eye and dental exams etc. on the specified intervals for your patients.
CRIHB is actually taking this a step further right now and trying to incorporate something I had worked on in the past which takes the national data from IHS as a benchmark and highlighting (flagging) all the data in the report to let the providers know where they are falling short in comparison to everyone else on a regional or national level.
Make no mistake though, this takes a huge effort to produce and requires ongoing administration and maintenance. You must have the technical people working closely with the providers to make this all work.
Thanks
SMMC is currently using a CDMS (CDEMS) and EMR simultaneously. This situation is the result of the need to build up enough of a database within the EMR to allow for proper CDMS functionality. Data migration of the existing CDMS database had limitations which would not allow us to take advantage of the disease management features in eCW. The clinicians had agreed to use both systems until a critical mass of data in eCW had accrued. Both the EMR and CDMS are used at the point of care; while the CDMS is slightly better at looking at the population stats and giving alerts, the EMR has most of this functionality and adds the capability of generating letters.
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