As of Jan. 15, New York City's Department of Health (DOH) had instituted a Diabetes Surveillance program called the "A1c Registry." This is a mandatory reporting of all Hemoglobin A1c (HbA1c) test results taken in the city's five boroughs and reported electronically to the DOH.
It's been reported that the DOH wants to reduce the financial costs of diabetes to the city, and DOH Commissioner Tom Frieden, M.D., has said that diabetes costs the city $5 billion.
Will the information gathering lead to a reduction in the incidence or prevalence of diabetes? That's doubtful. Will the information gathering lead to interventions that will reduce the costly co-morbidities (amputation, ESRD, hypertension, etc.)? That's to be determined, but for now, a letter will be sent to the patient's provider when the HbA1c test result is above a given range, and the patient will also get a letter with DOH recommendations. Also, a ranking of each provider's patients, by HbA1c, will be sent to the providers.
Will these interventions reduce the costs of diabetes in New York City?
Again, that remains to be seen. But this program provides some insight into what should be asked about an organization's healthcare informatics infrastructure; that should be a matter for everyone's concern in this era of spiraling costs and reimbursement pressures.
Here are three questions you should ask when implementing a healthcare informatics system, or if you are working with an established system:
These three questions, if asked on an ongoing basis, should support your organization's mission and provide metrics that can help you manage in this increasingly complex, and costly, world of healthcare. New York City is trying to reduce its costs of diabetes — what will you do?
Steven Lazarus, MBA, MPH is a New York-based consultant, specializing in healthcare informatics, finance, and quality improvement. (firstname.lastname@example.org)
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