Saturday, January 21, 2012

Monitoring Rheumatology Conditions

Rheumatologic conditions are common, debilitating, and costly but close monitoring could help to reduce disease activity, joint damage, and improve patient functionality without involving additional costs. However, even today, relatively few organizations have systems in place that can give providers usable easy-to-access information at the point-of-care to allow for effective monitoring and support as needed.

Geisinger and the American Institutes for Research together developed a proposal for AHRQ”s “Accelerating Change and Transformation of Organizations and Networks” (ACTION) program to address the ability to monitor rheumatology conditions. The two organizations were able to secure AHRQ funding for $339.999 to develop a portion of the costs for system development and implementation as well as the total costs associated with evaluating the project.

Geisinger was very interested in developing a system to provide the information needed, as they operate three rheumatology clinics including a large clinic in Danville and two smaller clinics in State College, and Wilkes-Barre. The impetus to develop the Patient-Centric Electronic Redesign” referred to as the PACER system came from leaders in the Danville clinic. Clinic leaders wanted to investigate how to develop a parallel software-based system that could pull relevant information from multiple sources.

To begin to address the problem the system pulls data from a separate EMR and a patient touch screen questionnaire is completed at the start of each visit gives clinicians easy access to all relevant information. Clinicians are now able to systematically analyze the patient’s progress and condition right before the visit allowing them to focus scarce visit time on solving problems and provide the support needed.

Early results show that PACER has been widely adopted by physicians and has generated improvements in providing needed services, having patient symptoms reported, patients adhering to recommended care processes, and patients self reporting symptoms.

So far, data on the upfront development and implementation costs are not available. However, creating a similar system from scratch could be prohibitively expensive for many organizations, consequently, organizations wishing to adopt this system may decide to build on the existing PACER system and customize the system to the organization’s specific needs.

The system is separate from the EMR and can be used with multiple EMR systems. The program developer at Geisinger is in the process of developing mechanisms to allow PACER to be licensed for adaptation, implementation, and to be used in other settings.

For more information on the project titled “Rheumatology Clinics Leverage Technology and Redesign Care Processes to Provide Physicians Relevant Patient Information, Improving Symptoms and Adherence to Recommended Care” go to

The contact at the Geisinger Medical Center is Eric Newman M.D at and the contact at the American Institute for Research is Lauren Smeeding at