Registries: Clinical Perspective

J. Marc Overhage, MD, PhD, FACP, FACMI Chief Medical Informatics Officer Siemens Health Services

www.amia.org

Definitions

• EHR: “An electronic record of health-related information on an individual that conforms to nationally recognized standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization” • Focused on the care of individuals, with the purpose of collecting, sharing, and using health information for the benefit of that individual

www.amia.org

Definitions

• Registry: “An organized system that uses observational study methods to collect uniform clinical and other data to evaluate outcomes for a population defined by a particular disease, condition, or exposure, that serves one or more predetermined scientific, clinical or policy purpose” • Focused on a population and designed to fulfill specific purposes

www.amia.org

Alike ..

word processing

Word processing Documents that don’t require calculations Fancy documents Flyers Resume

spreadsheet

Tables Cell Calculations Changing fonts, colors, shading, etc Word processing Spread sheets Financial formulas Database inserts Macros Timesheets Graphs

www.amia.org

… but different

EHR

General, multi-purpose A complete record of patient clinical encounter Billing Computers not pencils One patient at a time Rules based diagnosis Provider tool Decision support Patient care alerts Supports team care Integrates with other systems Automates workflow Reports Patient Education

Registry

Single purpose - PHM Focus on data and outcomes Group care (disease or preventive care management) In-reach/Out-reach Proactive Care Improved efficiency through population health Regulated Outcome reporting

www.amia.org

Meaningful

Stage 1 MU Use Improve access to information Utilize technology to gather information Care coordination Basic EHR functionality, structured data Privacy & security protections Patient informed Structured data utilized Privacy & security protections Stage 2 MU Data utilized to improve delivery and outcomes Patient self management Care coordination Evidenced based medicine Registries for disease management Privacy & security protections Use information to transform Improved population health Enhanced access and continuity Data utilized to improve delivery and outcomes Patient engaged, community resources Patient centered care coordination Team based care, case management Registries to manage patient populations Privacy & security protections PCMHs 3-Part Aim ACOs Stage 3 MU www.amia.org

A Significant Shift in the Healthcare Business Model is Underway

Individual care providers Collaborative teams of providers Treating individuals when they get sick Keeping groups of people healthy Emphasizing volumes Maximizing the use of resources & assets Offering care at centralized facilities Treating all patients the same Avoiding the sickest chronic patients Being responsible for those who seek our services Best efforts Emphasizing outcomes Applying appropriate levels of care at the right place Offering care at sites convenient to patients Customizing healthcare for each patients Creating venues to provide special chronic care services Being responsible for the needs of the community High reliability organizations www.amia.org

Key Technology Components Will Be Required

• • • • • • • • An electronic health record that spans the continuum of care A revenue cycle and contracts management application that spans the continuum of care Care management systems that span the continuum for individuals and populations Rules engine, workflow engine, and intelligent displays of data that enables intelligent processes across the continuum , defined by best practices Sophisticated business intelligence and analytics Systems that enable interoperability between closely affiliated providers Technologies that support the engagement of patients Services that enable maximum leverage of health care IT investment

Our vision is focused around key technology components that are crucial to support accountable care. www.amia.org

Interoperability

• • “The ability of any EHR to exchange valid and useful information with any registry on behalf of any willing provider at any time in a manner that improves the efficiency of registry participation for the provider and patient and does not require significant customization to the EHR or the registry system” Any EHR should be able to exchange data with any registry, and any registry should be able to exchange data with any EHR

www.amia.org

Data Quality

CIS Training Interpretation & Coding CIS Limitations Collection Procedures Data Quality Leadership

www.amia.org

Registry Uses

Surveillance Patient Tracking and Outcomes Measurement

Benefits of CIS Integration and Standardized Data

Available Tools for Providers / Staff Public Health / Program Planning Quality Improvement Initiatives

www.amia.org

Patient tracking and outcomes

www.amia.org

Research

Efficacy and safety in a small population with a restricted study protocol RCT

Patient Population

Real world information to make health care decisions for large populations within defined budgets Real World Data Garrison et al

Value Health.

2007;10(5):326-35.

www.amia.org

Quality Improvement Initiatives



Assembles data needed for reporting



Monitors status relative to a program



Provides insight on gaps



Submits data

www.amia.org

Quality Improvement Tools – Examples

Major Goal

Care delivery and coordination Population measurement

QI Tool Description

Patient lists Automated notifications Population level standardized reports Lists of patients with a particular condition who may be due for an exam, procedure, etc.

Prompts provider or patient when an exam or other action is needed.

Decision support tools Provide recommendations for care for an individual patient using evidence-based guidelines.

Provides an analysis of population-level compliance with QI measures or other summaries (e.g., patient outcomes across the population) Benchmarking reports Compares population-level data for various types of providers.

Population level dashboards Provides snapshot look at QI progress and areas for continued improvement.

www.amia.org

Trends

www.amia.org

Gaps

www.amia.org

Examples of QI Registries and QI Tools

Registry

AHA Get With The Guidelines

Disease/Condition Area

Heart failure Stroke MaineHealth Clinical Improvement Registry Diabetes National Comprehensive Cancer Network (NCCN) Cancer

Functionalities Implemented

           Decision support (guidelines) Communication tools Patient education materials Real-time quality reports with benchmarks Transmission to 3 rd parties Patient care ‘gap’ reports Decision support Transmission to 3 rd parties Patient care ‘gap’ reports Center level reports Education materials 18

www.amia.org

Examples of Clinical Registry Software

• CDEMS: Chronic Disease Electronic Management System

http://www.cdems.com/

• For an excellent review of 16 registry products by the California HealthCare Foundation, try this:

http://www.chcf.org/documents/chronicdisease/C hronicDiseaseRegistryReview.pdf

www.amia.org