1. VIEWPOINT
Beating Diabetes
What could New York City’s new program mean for you in the long run?
by Steven Lazarus
Steven Lazarus
VIEWPOINT
As of Jan. 15, New York
City’s Department of
Health (DOH) had institut-
ed a Diabetes Surveillance
program called the “A1c
Registry.” This is a manda-
tory reporting of all He-
moglobin A1c (HbA1c) test
results taken in the city’s five
boroughs and reported elec-
tronically 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 pro-
vides 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 imple-
menting a healthcare informatics system, or if you are
working with an established system:
Why have a healthcare informatics system?
Is it just “because it’s there,” or because everyone else is
doing it, or because your board decided it’s time, or it’s for
some academic reason? Is there a defined strategy behind
your healthcare informatics program? These are not triv-
ial issues. Developing and maintaining a healthcare infor-
matics system, department, division etc. can be a costly,
time consuming, and beneficial, or wasteful allocation of
resources. Don’t do it unless you know why you’re getting
into it. New York City’s DOH has a goal behind the A1c
Registry — to reduce its costs associated with diabetes.
What is your organization’s goal for its healthcare infor-
matics infrastructure?
What outcomes does your organization desire from a
healthcare informatics system?
Is it cost savings, improved patient outcomes, reduction
of provider errors? Does your organization have a clearly
established set of outcomes to be achieved via healthcare
informatics? New York City’s DOH has a stated goal, as
above, but the reductions in diabetes comorbid conditions
is, in theory, the driver of the stated goal of bringing the
costs of diabetes down.
Are you analyzing the data?
One of the issues I have with the A1c Registry program
is that there has been no discussion of what will be done
with the HbA1c data when it’s gathered. It’s one thing
to send a letter in response to a number, and/or dump a
stream of patient test results into the providers’ mailboxes.
It’s quite another to look at the biostatistics of a given
population to determine if the interventions are producing
the desired outcomes, at what time, and for how many pa-
tients. There is no sense in developing a healthcare infor-
matics infrastructure if the data just sits in a warehouse.
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 com-
plex, 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 consul-
tant, specializing in healthcare informatics, finance, and
quality improvement. (slazarus@type1advisors.com)
There is no sense in developing a healthcare
informatics infrastructure if the data just
sits in a warehouse.
70 September 2006 Healthcare Informatics www.healthcare-informatics.com