Southeast Texas Medical Associates, L.L.P.

The complexity of Diabetes Management is changing rapidly. The integration of diabetes care with hypertension, metabolic syndrome, weight management, lipids, renal disease, nerphrology, neurology, ophthalmology, podiatry and many other disciplines makes it the ideal treatment focus for electronic patient management.

Before detailing the Diabetes Master Template (the first template in the diabetes suite), we need to look at the standard of excellence for Diabetes Care which is tracked and documented by SETMA's Diabetes Suite of Templates.

The Navigation button at the bottom of this list of twelve is " Diabetes Plan"

Click on the Diabetes Plan Button, this launches the Diabetes Plan template (We will discuss the content of this template later).

In the list of Navigation Buttons at the right hand side of the Plan Template, the second button is entitled Consortium Data Set, click on that button. This will launch a pop up window titled "Diabetes Management". The Diabetes Management is a means of measuring diabetes care given by a provider. The data points are taken from the Physician Consortium for Performance Improvement. Additional functionality has been added to make it easier to provide diabetes care right rather than not at all.

The Physician Consortium for Performance Improvement

The Physician Consortium for Performance Improvement (Consortium) is a group of clinical and methodological experts convened by the AMA. The Consortium includes representatives from more than 60 national medical specialty and state medical societies, the Agency for Healthcare Research and Quality, and the Centers for Medicare and Medicaid Services.

The Consortium's vision is to fulfill the responsibility of physicians to patient care, public health, and safety by:

becoming the leading source organization for evidence-based clinical performance measures and outcomes reporting tools for physicians; and
ensuring that all components of the medical profession have a leadership role in all national forums seeking to evaluate the quality of patient care.

The Consortium's mission is to improve patient health and safety by:

identifying and developing evidence-based clinical performance measures that enhance quality of patient care and that foster accountability;
promoting the implementation of effective and relevant clinical performance improvement activities; and
advancing the science of clinical performance measurement and improvement.

The Consortium works to develop evidence-based clinical performance measures and clinical outcomes reporting tools to support physicians in quality improvement efforts.

The Consortium has published a number of disease management data sets which established quality of care measures with which physicians and other healthcare providers can measure their own performance.

The 9 data points which are automatically captured and documented by SETMA's Diabetes Suite of Templates, and, which are collected and displayed on the Consortium Data Set pop-up on the Diabetes Plan, are the quality measures for diabetes developed by the Consortium.

These 9 data points are the basis along with several other data points of SETMA's Daily Diabetes
Care Audit. These data points are:

Collected automatically
Provide a quick and easy review for the SETMA healthcare provider to evaluate his/her own Diabetes care.
Provide a quick and easy way of completing the Diabetes measures required if they were not completed.
Attention to these data points places in you line for additional reimbursement when CMS begins paying providers for performance in two years.
The Consortium material should be completed by the nursing staff and reviewed by the provider.

The Elements of the Consortium Data Set for Diabetes

Hemoglobin A1C -

The standard is that the patient has had a Hemoglobin A1C in the past three months or has one at this visit.
The date of the last Hgb A1C is displayed on this template.
If this data point is out of date, a button will appear to the right of the date box.
When you depress this button you will automatically order and charge post a Hgb A1C, making it easier to do it right than not to do it at all.

Once these elements have been checked and it only takes a few seconds, the documentation of excellence in diabetic care based on the consortium data set has been completed. In two years, when Medicare starts paying providers for performance, the completion of the Consortium Data Set will qualify you for increased reimbursement from Medicare.

SETMA also tracks the compliance of patients with Diabetes. There are 7 data points which are tracked. These data points are displayed on a pop-up which is launched by a button entitled Patient Compliance which is found on the Diabetes Plan beneath the Consortium Data Set button.

These Compliance data points must be manually documented on each visit. The compliance materials should be completed by the nursing staff. This is also part of SETMA's diabetes care audit. The data points are:

On the Diabetes Master Template It will be noted that like all SETMA templates, which are built on
NextGen's platform, they appear with the following at the top of each template:

Beneath the Top Tool Bar there are two lines of functions before getting to the main Diabetes management tool; they are:

Beneath these two lines, the Diabetes Master Template is organized into three columns; the first column has two columns within itself:

Column 1: Part A
Compliance - Nine elements are documented which are key to the proper treatment of diabetes. The date of last performance is listed at the side of each element. The nine elements are:

A quick review of these 9 elements of compliance will indicate what care is deficient in this patient and will therefore guide the provider in instructing the patient.

Vital Signs - In two columns 12 aspects of the patient's vital signs, body habitus and metabolism are documented, including:

By clicking on "return," you will be taken back to the Diabetes Master Template.

Column I Part B
At the beginning of Part B of the first column are 9 hyperlinks which take you to other tools needed for optimal diabetes care; they are:

Beneath these hyperlinks are 5 additional functions related to Diabetes Care; they are:

This displays the Most Recent Labs and the date the test was done. The button entitled "Check for
New Labs" when depressed will search for any newer labs than the ones displayed. The lab tests which are displayed are:

This column is entitled Navigation and presents SETMA's Navigation Bar for the Diabetes Suite of
Templates.

The first function is the choice between the Diabetes templates the General Templates.

If the check box beside the General is clicked, the following General Templates from the Master GP Suite of Templates will be displayed:

If the check box beside Diabetes is checked, the Diabetes Suite of Templates will be displayed. There are 15 functions here; they are:

From Top to Bottom, the Diabetes Plan Template is organized into three sections. Top Section:

When the New Subq Insulin Dose is completed at the bottom of the screen and the "save" button" is depressed, the following information about the patient's insulin is automatically generated. This prints on the follow-up note which you will give to the patient.

General Measures -- This launches a pop-up with the ability to order:
1. Home glucose monitoring
2. Exercise
3. Reduce Weight
4. Follow ADA Diet

Any of these that are checked will print on the chart follow-up note which you will give to the patient.

Help - this launches a pop-up entitled "Strategies for Achieving Glycemic Control in Type 2 Diabetes"

The Middle Section contains:

Laboratory and Procedures - it is possible to charge post these studies from the Diabetes Plan Template. The process is simple:
1. Add the diagnosis to the Assessment box below
2. Check the boxes by the tests you wish to order
3. Click the "Submit Labs" box in the bottom section of this template.
4. BMP
5. C-Peptide
6. EKG
7. Flu Shot
8. Fructosamine
9. Hepatic Profile
10. Magnesium
11. Microalbumin
12. Pneumovax
13. Spot AC Ratio
14. TSH
15. Venipuncture
Note: The date on which the above were last done is noted in the date box to the right of each test or procedure.

Management Strategies
1. Change Self-monitoring of Glucose to (SMBG) - there is a box with a pick list which allows the following choices: QD, QID, QOD, BID.
2. Phone Glucose data into our office in 7 days - there is a check box to activate this so that it prints on the follow-up note.
3. Refer to Eye Specialist - when the box next to this function is checked, it automatically places Dr. Asad Abbas' name there. In the next line is the referral template can be accessed by double clicking in the space to complete the eye referral.
4. Follow-up visit - patients with diabetes ought to be seen at a minimum of three times a year.

Medications - check boxes are present which allows you to document instructions to:
1. Continue present insulin and metformin etc.
2. Continue Aspirin
3. Start Aspirin 325 mg
4. Begin, Increase Decrease

NOTE: For more information on using the Medication Module, Click Here

The bottom section of the template contains:

Assessment, including
1. Three boxes for diagnoses; the top box only has Diabetes ICD-9 codes attached.
2. Chronic Conditions - a button which launches the patient's chronic condition
3. Submit Labs - a button which submits the lab requests to the lab and the charges to charge posting.
4. EM Coding

New SQ Insulin Dose
1. Import Current - this moves the insulin dosing which is displayed on the Master Diabetes Template to the Plan Template
2. Save - once any changes are made, this button saves the new insulin dosing and places it in the basal and meal categories at the top of the Diabetes Plan Template.
3. Sliding Scale - this allows a sliding scale to be selected based on the patient's insulin sensitivity.

Printable Provider Education Materials on:
1. Comparison of human insulins
2. Conditions - Glycemic Control
3. Drugs - Glucose Levels
4. Basal/Bolus Insulins
5. Incretins
6. Byetta
7. Actions Byetta

The last action is to create the Diabetes Follow-up Note and to give it to the patient and then to create the Diabetes Chart Note.