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Data-Driven Diabetes Care Gets Smarter

Elyas Bakhtiari, for HealthLeaders Media, December 13, 2010
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Building a network
Smita Bakhai, MD, MPH, has spent the past year or so exploring how technology can improve the quality of diabetes care as part of a project for the NCQA Diabetes Recognition Program, which certifies providers of evidence-based diabetes care. As medical director for the outpatient internal medicine clinic at Erie County Medical Center in Buffalo, NY, more than half of her patient population is diabetic and has risk factors, such as high blood pressure, for related complications.

For providers, Bakhai says, one of the primary benefits of a robust HIT network is better communication—with both patients and other providers. Free-flowing information allows physicians to better track the slew of referrals to specialists and various tests required for a typical diabetic patient over a lifetime. It also makes it easier to follow up with a patient after a discharge or diagnosis, monitor the disease over time, improve patient self-management, and even jump on early detection. The result, hopefully, is reduced readmission rates and ED visits from heart attack, stroke, and other complications of diabetes.

Erie County Medical Center, which has about 550 inpatient beds and 40 outpatient clinics, is one of nine hospitals working to establish that level of connectivity between physicians through HEALTHeLINK, a regional health information exchange in western New York that includes physicians, hospitals, and payers. About 90% of lab results and 75% of radiology tests already flow through the exchange, and the participants are working to build better two-way communication between primary care physician and specialist EHRs, says Dan Porreca, the executive director of HEALTHeLINK.

"When you think about the care for a diabetic patient, coordination of care is a critical element to efficient treatment. You have a team of physicians that need to be in sync with the primary care physician in order to make sure the patient is getting the most efficient, effective care," he says.

To make that happen, HEALTHeLINK network recently received a $16.1 million Beacon award from HHS to improve quality and reduce costs related to diabetes care. The funding comes with requirements to measure 31 outcomes and goals of a 5% reduction in ED visits, hospitalizations for ambulatory care, and 30-day readmission rates.


Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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1 comments on "Data-Driven Diabetes Care Gets Smarter"


Matt Adamson (12/16/2010 at 1:16 PM)
I concur with the information and opinions provided in this article and appreciate the statements around the importance of care coordination. With the advent of healthcare technology and the patient-centered medical home (PCMH), the days of paper files, illegible handwriting, missing lab work and unfilled prescriptions are truly coming to a close. Technology has the ability to enable a true collaboration and sharing of information among healthcare's many stakeholders, including the patient, which is key to tackling diabetes. To be able to electronically connect with the health plan and other resources would allow providers a multi-directional data exchange so he or she can communicate with pharmacists, labs, nutritionists, specialists and other entities in the healthcare spectrum, creating a virtual medical home environment. We, at MEDecision, believe that the improvements in analytics technology is the clincher to the success of the virtual medical home approach and to optimizing health outcomes. It will enable the care coordinator to [INVALID] and use a digital 360-degree view of the patient and to analyze factors such as gaps in care, diet, exercise and medication adherence. This more inclusive view of a patient's healthcare needs will enable optimal interventions and more focused plans of care, regardless of whether the patient is receiving care inside or outside of the provider's office. Matt Adamson,vice president of medical home initiatives for MEDecision, a leading provider of collaborative healthcare management solutions