Diabetes Management
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. More information can be found at the American Diabetes Association site.
Alerts
Alerts in VersaForm are controlled by protocols, which have two parts: conditions and actions. A protocol is triggered when its conditions are met, and the action is the result. When an alert is triggered, the alert appears in the patient's chart.
The conditions and actions that follow are taken from the criteria for the PQRI Quality Measures for 2009 as issued by CMS. VersaForm does not recommend medical treatment or provide medical information.
Conditions:
At least one of the ICD-9 codes in the following list is present:
250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.00, 648.01, 648.02, 648.03, 648.04
In VersaForm, these ICD-9 codes are collected together in a Problem Class named “Diabetes”. Having them collected in this way makes it unnecessary to have to key in the individual codes, perhaps repeatedly.
If lab data has been entered into your VersaForm system (either manually or electronically), the condition “HbA1c > 6.0” could be added, so that the protocol would be triggered if either of the conditions were satisfied.
In addition, if it is desired to exclude pediatric patients, the condition “Patient aged >= 18 years” might be added.
Actions:
If the conditions are satisfied, the system could provide a reminder of the standard measures for diabetes management:
- HbA1c Management and Control
- Blood Pressure Management
- Lipid Measurement
- LDL Cholesterol Level
- Urine Protein Testing
- Eye Exam
- Foot Exam
- Influenza Vaccination
- Pneumonia Vaccination
Visit Plan
Visit Plans can be printed at any time, but are conveniently printed for the day’s scheduled patients, before office hours. The visit plan for each diabetic patient will automatically include the reminders listed above.
Health Management Reports
Health Management Reports can be configured to contain the information relevant to a particular condition. These reports can be produced for an individual patient, but also for all patients in the practice who meet the conditions specified in a protocol. The report for diabetic patients would show:
- HbA1c (and date)
- Blood Pressure (and date)
- Lipids, including LDL Cholesterol Level (and date)
- Urine Protein (and date)
- Date of latest Eye Exam
- Date of latest Foot Exam
- Date of Influenza Vaccination
- Date of Pneumonia Vaccination
The ability to provide these reports is conditioned, of course, on the data having been entered in the Labs and Data section of the VersaForm patient chart. Data can be entered automatically if your lab can download it to you (most can).
Reviewing this report will give the practice an accurate indication of the management of its diabetic patients.
Patient Outreach
Reminder letters may be automatically generated for each diabetic patients whose last office visit was at least (for instance) a year ago. This is easily done by creating a second protocol like the one described above but that adds the condition that there is no CPT code for an office visit within the last year. Of course there are many CPT codes that indicate an office visit; so VersaForm has CPT code classes that are analogous to the ICD-9 classes mentioned above.
Reminder letters (indeed all mail merge letters in VersaForm) can be composed by the practice to reflect their own circumstances. VersaForm can print them or email them, and can produce a list of reminders for telephone follow-up if desired.
