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P4P and Chronic Disease ManagementFrom $1Table of contentsNo headersP4P, or payment for performance, is an unproven methodology which attempts to improve outcomes by rewarding providers who are able to prove that they have performed a number of core tasks in the care of some chronic disease conditions. Until the methodology has been shown to be effective, or faulty, providers may need to track such data if they wish to receive this added remuneration. Even if you do not intend to participate in such programs, it can be useful to have a way to create views that remind you what you might wish to do in managing patients. This tutorial will take you through creating a view for managing diabetes, and applies to R212B7 and higher. The variables we need to track are:
Variables can be tracked in two different ways
We will use a popup menu to select the values, and this means the test will have to already exist in the list of normal ranges Settings/Normal Ranges. Let us create the last 3 tests as they are unlikely to exist in your default Synapse installation. On the Settings/Normal Ranges tab, enter the following values
where the title and value are both "monofilament". The Y values refer to the graph range, and since we are going to use 0 as normal, then both low and high normal range limits will be 0. Then click on the [Add] button to save this new test. Now repeat the same for foot-exam, and pedal-pulses. If you don't have a HbA1c, and LDL-c then use the following values, or those appropriate to your local units.
Now we have our baseline set of tests, we need to create the chronic view. On the Settings/Views tab use the image below to populate the table. Use the lookup icon to search for the test. If you don't have a test present, you can update the view later on.
In the image above, we have used three triggers. They refer to the first 3 characters of the code for diabetes in the Read Codes, ICD9 and ICD10 coding systems, though you will probably just use the one. Note that we have used a "Scanned" type for the "Eye Examination". This presumes that the patient will be seeing an ophthalmologist for the eye examination, and they will be reporting their findings via letter which we will be scanning in. We will therefore satisfy this test if we find the tag "retinal" in the metadata for a scanned report. If we wish to be more certain that this is the case, we can create a more unique tag such as :retinal: but then we have to make sure we add this tag in the metadata. Once you have finished as much as you can, click on the [Save Guideline] button. This view will then be loaded each tine thereafter by every client attached to your server. To show the view in action, enter the consult editor of any patient you have with diabetes, and click on the diagnosis in the Rx & Dx tab. You will probably find that you don't have any values present in the popup that appears. We, however, do as in the image below.
In the example above, we have found a scanned result with the tag "retina" present. The [Display] button on the popup will bring up the metadata for that result. We have our BP results as the result of filling in the vitals popup when this patient was last seen. The HbA1c result came in via HL7. We do need to enter the examination findings, and so we need to create a template for this that saves the data as outcome data in our numerical results table. Here's an example template that does this:
The code for this template, which is a "D" or disease specific template is as follows:
so when we use this template, we will inject the correct values into our results table which can then be picked up by the diabetes view.
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