Population-wide patient registries keep track of all patients, showing their diagnoses, lab results, past interventions, service dates, and due dates for needed preventive and chronic care. Electronic health records and practice management systems are the primary sources of this data, which is constantly updated.
Advanced Registry Software Stratifies Patients by Health Risk
Advanced registry software can generate a wide variety of reports that help providers do population health management. At the highest level, these reports can be used to stratify patients by health risk, allowing organizations to target them with interventions that fit their classification.
Dashboard-style reports can also aid medical directors in determining how well an organization is caring for subpopulations. For example, if many patients with diabetes have HbA1c values over 9, that area might require immediate attention. Similarly, medical directors can see variances among sites or individual providers and take action to reduce those differences.
Registry Reports Help Target Individual Patients with Care Gaps
Care managers and providers use registry reports to target individual patients with care gaps. After stratifying their populations, care managers can use automated messaging and other methods to reach out to patients who need to be seen; they can also send online educational materials to other patients who need to modify their health behavior. Physicians review registry reports to make sure patient care gaps are addressed during visits and to refer high-risk patients to care managers.
Registry Reports Allow Providers to Focus on All Patients
The use of these registry reports greatly reduces the manual work of monitoring and reaching out to patient populations. Care managers spend much less time keeping track of and compiling data on their high-risk patients. And physicians can have greater assurance that they’re serving all of their patients as well as possible.
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Listen to an on-demand webinar about Using Registries and Patient Outreach to Improve Quality of Care and Outcomes.