Part 6.
Clinical Information Systems. Timely, useful information about individual patients and populations of patients with chronic conditions is a critical feature of effective programs, especially those that employ population-based approaches.
| Components | Limited support | Basic support | Good support | Full support | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Registry (list of patients with specific conditions) | … is not available. | … includes name, diagnosis, contact information, and date of last contact either on paper or in a computer database. | … allows queries to sort sub-populations by clinical priorities. | … is tied to guidelines which provide prompts and reminders about needed services. | ||||||||
| Score | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Reminders to Providers | … are not available. | … include general notification of the existence of a chronic illness, but do not describe needed services at time of encounter. | … include indications of needed service for populations of patients through periodic reporting. | … include specific information for the team about guideline adherence at the time of individual patient encounters. | ||||||||
| Score | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Feedback | … is not available or is non-specific to the team. | … is provided at infrequent intervals and is delivered impersonally. | … occurs at frequent enough intervals to monitor performance and is specific to the team's population. | … is timely, specific to the team, routine, and personally delivered by a respected opinion leader to improve team performance. | ||||||||
| Score | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Information about Relevant Subgroups of Patients Needing Services | … is not available. | … can only be obtained with special efforts or additional programming. | … can be obtained upon request but is not routinely available. | … is provided routinely to providers to help them deliver planned care. | ||||||||
| Score | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Patient Treatment Plans | … are not expected. | … are achieved through a standardized approach. | … are established collaboratively and include self-management as well as clinical goals. | … are established collaboratively and include self management as well as clinical management. Follow-up occurs and guides care at every point of service. | ||||||||
| Score | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |