She has created templates for all the things she needs to check and do for patients with complex conditions like diabetes. Her templates easily insert into clinic notes on TouchWorks, an electronic medical records system. The templates help her overcome the problem of “so many patients and so little time, with so much to do,” she said in an interview.
A short time ago, Dr. Ilias, an internal medicine resident at Barnes-Jewish Hospital, St. Louis, was asked by her Wohl Clinic supervisor, Dr. Charles Lieu, to take part in a pilot study being done by the National Committee for Quality Assurance. For the study, she submitted cases for the Diabetes Practice Improvement Module and her performance in caring for diabetic patients was evaluated.
She was dismayed to learn that her patient care fell short of the 80% mark established for the module, meaning that she had neglected something that was being used as a marker for quality care for more than 20% of her patients.
Most of the time, it was not that she actually neglected to perform a test or ask a question of a patient; it was that her documentation was incomplete. Nevertheless, Dr. Ilias was determined to do better.
She created templates that include complete quality measures that should be reviewed and documented at clinic visits for various medical conditions. One is for diabetes management. Another is for coronary disease. A third and fourth are for osteoporosis and health maintenance.
She also has some “mini-templates,” such as one for monitoring patients on hyperthyroidism medication.
Because they are electronic, she can insert the checklists right into the patient's record. That means “it is very easy to just throw in the numbers,” she said. “I feel like I am missing fewer things.”
Her diabetes template contains five sections, with the optimal goal value for each section listed underneath that particular heading. The section headings are glycemic control, blood pressure, lipids, antiplatelet therapy, and smoking status.
She also uses the TouchWorks system to send herself reminders to follow up on patients at appropriate intervals and ensure that their medical conditions are optimally managed.
“With these measures, patients are now presenting with better control over medical conditions, increased dedication to weight loss and physical fitness, and more complete and comprehensive health maintenance care,” Dr. Ilias said.