Patient registries have been in use in the healthcare field for decades, beginning with the creation of the Tumor Registry almost 40 years ago. Their use has traditionally been for clinical purposes of tracking patients and providing information to support contact with those patients. Recently, however, clinical organizations have discovered the immense potential of registries to support business decisions as well. There are a number of forms that this potential can be manifested, but five business uses for the patient registry repository stand out in terms of supporting greater effectiveness, quality and efficiency in clinical organizations.
Traditional Uses for the Patient Registry
Patient registries are defined as systems used to collect, store and report on lists of patients identified with specific conditions, in order to support organized clinical care. These systems are sometimes computerized, but unfortunately are often highly manual.
Examples of registries in use today include tracking of patients with many of the priority conditions defined by the Institute of Medicine in their report Crossing the Quality Chasm (2001), such as patients identified with diabetes, asthma, hypertension, dyslipidemia, depression, etc. It makes sense to track these patients for three reasons. These groups provide the organization with the greatest concentration of their clinical efforts. They are all chronic conditions, which statistics show are trending up. Plus, since these are patients with chronic conditions, care for them requires tracking over an extended period of time.
Another category of patient registries are those used in preventative care. Common examples include childhood and adolescent immunization and mammography. This type of registry is what keeps Moms from fishing around their purses for slips of paper telling them when their children last had their shots.
Several types of organizations use patient registries for various purposes. These include primary care and specialty clinics, hospitals, health plans, pharmaceutical manufacturers and public healthcare authorities.
Traditional uses for patient registries typically fall into supporting three key clinical patient management processes:
•Population Patterns and Trends Analysis. At the population level, an organization can look at groups and sub-groups of patients to discern patterns and trends in the care of patients over time. For instance, a diabetes clinician can use the information on diagnoses and treatments across their entire population to see if, for instance, certain medications are having a positive effect on patients, or if diets are having an equally positive effect. On the preventative side, organizations can see if demographic factors, and/or healthcare access factors are affecting certain population sectors in terms of lack of immunization, etc.
•Patient Consultation Support. Registries give clinicians a timeline of the care and health condition of individual patients, making it easier to provide consultation and direction to that patient. If the patient is following the medical regimen recommended by the physician, and is showing improvement, this will show up in timelines produced from registry information.
•Patient Reminder Process Support. Studies, as well as common sense, indicate that the frequency of focused visits by the patient has a positive correlation with the health status of the patient. And this frequency of visits helps to head off more serious and costly problems for the patient. Reminder systems via phone, email, in person, etc. support this frequency and are supported by information from the patient registry. Health plans are particularly interested in this type of use of patient registries for their cost-avoidance value.
These are all important clinical uses for the patient registry. There are, however, equally important business uses for registries to support evidence-based business decision-making. In the information technology industry, this is referred to as business intelligence.
The Patient Registry in Evidence-Based Business Decision Making
Business intelligence is the commercial equivalent of evidence-based clinical decision making. One uses clinical evidence to support diagnoses to develop care plans and to evaluate outcomes for patients. In the same way, business people use financial and operational evidence to support decisions to develop plans and monitor the progress of their businesses.
Your bank uses customer intelligence to market its products and services to you. Manufacturers use production, purchasing and quality intelligence to decide what to produce and how best to produce it. Retailers use sales intelligence to decide where to locate new stores, how to staff them cost effectively and what products each should stock.
The clinical setting has financial and operational evidence to support business decisions, develop business plans and evaluate business performance as well. Some examples include the need to:
•Anticipate patient activity, what care they will need and the effect on your revenue;
•Anticipate the resources needed to provide that care, and the costs involved;
•Find ways of continuously improving the efficiency of your operations in providing care;
•Promoting your strengths in providing care for marketing purposes; and
•Supporting decisions that have a long-term, strategic impact on your organization and how resources are allocated to achieve your goals.
The difference that business intelligence makes is in the systematic consolidation of data from various sources and the organization of that data for use in making business decisions. As you can imagine, this data is comprised of millions of bits of information spread across a number of systems (e.g., encounters, labs, claims, billing, etc.). Business intelligence extracts data from these systems and brings it into a centralized, secure, historical repository, which is organized for business users to slice, dice, sort and sum it efficiently for use in making business decisions.
With the kind of organized business evidence you can obtain from your patient registry, you can support business decisions that will make your organization stronger, more effective, more efficient and provide care with ever-increasing quality. The first step is to determine which of the myriad of potential uses for your patient registry is most appropriate for your organization.
Five Key Business Uses for the Patient Registry Repository
For the past four years I have interviewed more than 200 executives, physicians, clinicians, managers, researchers, informaticians, and analysts in my work on business intelligence strategy and patient registry development projects. These people work in clinical practice networks, hospitals, health plans, specialty clinics, government agencies, research labs and a host of other settings. From these interviews and a fairly extensive review of the literature as it relates to applying business intelligence to patient registries, I have cataloged several potential business uses for this specialized type of repository. From these, I and the organizations I work with have found five uses that offer significant, positive, long-lasting effects on the clinical organization. They are described below.
Revenue Prediction. People from other countries express puzzlement over the nature of the $1.7 trillion healthcare industry in the United States, since it combines business and the public good. This tension between “mission vs. money” is one that practitioners in our healthcare industry carry with them to work every day. Nevertheless, healthcare is a business, and as such, the clinical organization needs to use the information it has to run its operations effectively. This begins with revenue. Your revenue comes from caring for patients. Having solid, historical information on patients and the sources of revenue from them (e.g., self-pay, insurance), allows you to predict with greater accuracy what that revenue will be in the future, and make wiser decisions regarding staffing, supplies, facilities and operations. In addition, you can find, prioritize and correct problems in receiving revenue, such as insurance denial, which for many organizations detracts from the primary clinical activities that they should and want to be devoting attention to.
Cost Prediction. In the same way that predicting revenue is a valuable use of patient registry information, so is predicting cost information. By looking at trends and patterns in patient volumes and patient segments (e.g., demographic factors, chronic vs. well-care activities, etc.), the clinical organization can make better decisions that efficiently apply resources to where they are most needed. Examples include make-up of staff, justification for specialized equipment and/or supplies, etc. Plus, you can find and eliminate costs that are no longer justified based on shifts in your patient population.
Efficiency Improvement Backup. Continuous improvement of the processes occurring in your clinical settings is essential to survival and success in the healthcare industry, just as it is in other industries such as manufacturing, financial services, retail, etc. Since quality, effectiveness and efficiency in healthcare has come into the spotlight over the past decade, it seems as if every participant in the industry (employers, payers, patients, government officials, etc.) is demanding evidence of improvement. Information, or business evidence on the patients you serve, the care activities you provide (and those you don’t), is necessary to find and correct inefficiencies, and to support reporting of your efficiency to these other participants in the field. Your patient registry is a rich source of this information, and it is in your best interest to make use of this information to better your operations proactively, instead of passively responding to demand for this information.
Marketing Support. Whereas efficiency is the stick when it comes to improving healthcare, evidence-supported marketing is the carrot. Sophisticated patient registries are often used for marketing purposes by a number of the beacons of the clinical healthcare industry. Key forms of marketing clinical effectiveness include awards such as accreditation by organizations like the National Committee for Quality Assurance (NCQA), promotion of differentiating organizational capabilities such as prowess in a clinical specialty (e.g. superior heart specialists), service superiority (“be seen by a doctor in 33 minutes or visit is free”), etc. In addition, marketing of your abilities can extend beyond your four walls to the effect you have on patients themselves in terms of increased patient functionality, increased feeling of overall wellness, reduced workplace absenteeism, etc. These claims are possible with a well-designed and well-managed patient registry repository.
Strategic Priorities Guidance. Finally, and perhaps most important is the effect that knowledge of your patient population trends and patterns available from your patient registry can have on your strategic organizational planning. Decisions such as concentration of your “product lines,” justification of new specialties and/or facilities, new markets, etc. can be supported with patient registry data, and have a long-range impact on your organization. For example, one organization might find from registry data that its population is getting older and suffering from chronic conditions such as diabetes. This organization can make conscious decisions to focus on this area of concentration. Another organization may be in an environment with wide economic swings, and find this showing up as stress and depression in its patient population. Knowing this helps justify support for additional resources to serve these patients.
A Better Way to Manage Your Patient Registry
The clinical uses for a patient registry are well known. Business uses for this information provide a way to support those clinical uses, and to multiply their effectiveness many times. Each day we are finding ourselves in the healthcare field with more demand for information on the business side of the house. This will only intensify. We need to make use of all of the information and intelligence we have, our business evidence, to meet this rising demand. Patient registries, especially those using the wealth of clinical, financial, demographic and other information we already own, are essential to the success of our clinical organizations.
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