Measurement and Quality Improvement

Getting started on a diabetes registry

This document explains how to use a standardized query of your EMR to start building a diabetes registry.  It is intended for teams that do not yet have a reliable list of diabetes patients and don’t have the time or resources to start from scratch in reviewing all their patients to generate such a list.  Right now, it is also only for teams with PSS,  Accuro and OSCAR. The following steps will help your team use the query to generate a list of diabetes patients, starting from your EMR.

Step 1. Estimate how many patients you think this will affect.  Multiply the number of patients your team serves by 0.10 (the average rate of diabetes in Ontario) to get a rough idea of how many of your patients likely have diabetes.  If you still think this is a big enough group of patients for you to generate a registry for, carry on to step 2.

Step 2. Import the query into your EMR.  Right now, you can only do this if have either Telus PSS or QHR Technologies Accuro EMRs.  You will likely need the help of your QIDSS, IT staff or other person who usually works with your EMR to do this.

  • For PSS, import the PSS SRX file into your EMR. Contact Greg Mitchell for the file.
  • For Accuro, download the query “AFHTO Diabetes Frontend Search” from their publisher.
  • For OSCAR download the query and save locally to your computer.  Instructions on how to import the query into your OSCAR EMR can be found here.

We are in the process of creating similar queries for OSCAR. Contact Greg Mitchell for more information.

Step 3.  Run the query in your EMR.  Again, you might need the help of your QIDSS, IT staff or other person who usually runs queries in your EMR. Running the query will produce a list of patients with diabetes. The list will not be perfect – probably 15% of the patients identified by the query will NOT have diabetes. The query gets you STARTED in building the diabetes registry but doesn’t do the whole job for you.

Step 4. Find the patients who might not have diabetes. Review the list of patients generated by the query to separate out those patients that are clearly already coded as having diabetes. What’s left will the list of patients who MIGHT have diabetes based on other data in the EMR besides formal coding.

Step 5. Prepare your physicians to review the list  Subdivide the list of possible diabetes patients into separate, shorter lists for each physician. Work with your physicians to find out if they would prefer a list on paper or electronically and how they might like it sorted (i.e. by name or most recent visit or some other parameter).

Step 6Invite each physician to review their list of patients.  They know their patients best and can likely quickly confirm which ones do or do not have diabetes, even though that information might not be easy for others to find in the EMR.

Step 7Clean up your EMR data.  Add diabetes codes to the EMR for each patient that the physician confirms as having diabetes. This so-called “data cleaning” work is a great job for a student.  AFHTO has created a toolkit to assist members in recruiting and using students for data clean-up. Click here for the toolkit.

Step 8Re-run the query . After you have corrected the EMR, re-run the query to generate a list of patients with diabetes. This is your new diabetes patient registry. Going forward, you can run the query anytime you need to generate a list of diabetes patients.  You can use the list to invite patients to a diabetes health program, track progress with outcomes on these patients once you have started such a program or any other purpose.

This query was produced by and for QIDSS in support of all AFHTO members. If you have any questions please contact Greg Mitchell.