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

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

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

Alike.. word processing spreadsheet Word processing Documents that don’t require calculations Fancy documents Flyers Resume Spread sheets Financial formulas Database inserts Macros Timesheets Graphs Tables Cell Calculations Changing fonts, colors, shading, etc Word processing

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

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

A Significant Shift in the Healthcare Business Model is Underway Being responsible for those who seek our services Avoiding the sickest chronic patients Treating all patients the same Offering care at centralized facilities Maximizing the use of resources & assets Emphasizing volumes Treating individuals when they get sick Individual care providers Best efforts Being responsible for the needs of the community Keeping groups of people healthy 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 Collaborative teams of providers High reliability organizations

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.

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

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

Registry Uses Benefits of CIS Integration and Standardized Data Patient Tracking and Outcomes Measurement Available Tools for Providers / Staff Quality Improvement Initiatives Public Health / Program Planning Surveillance Research

Patient tracking and outcomes Think Patient Centered Medical Home

Research Garrison et al Value Health. 2007;10(5): RCT Efficacy and safety in a small population with a restricted study protocol Real world information to make health care decisions for large populations within defined budgets Patient Population GAP Real World Data

Quality Improvement Initiatives  Assembles data needed for reporting  Monitors status relative to a program  Provides insight on gaps  Submits data

Major GoalQI ToolDescription Care delivery and coordination Patient listsLists of patients with a particular condition who may be due for an exam, procedure, etc. Automated notifications Prompts provider or patient when an exam or other action is needed. Decision support toolsProvide recommendations for care for an individual patient using evidence-based guidelines. Population measurement Population level standardized reports Provides an analysis of population-level compliance with QI measures or other summaries (e.g., patient outcomes across the population) Benchmarking reportsCompares population-level data for various types of providers. Population level dashboards Provides snapshot look at QI progress and areas for continued improvement. Quality Improvement Tools – Examples

Trends

Gaps

RegistryDisease/Condition Area Functionalities Implemented AHA Get With The Guidelines Heart failure Stroke  Decision support (guidelines)  Communication tools  Patient education materials  Real-time quality reports with benchmarks  Transmission to 3 rd parties MaineHealth Clinical Improvement Registry Diabetes  Patient care ‘gap’ reports  Decision support  Transmission to 3 rd parties National Comprehensive Cancer Network (NCCN) Cancer  Patient care ‘gap’ reports  Center level reports  Education materials Examples of QI Registries and QI Tools 18

Examples of Clinical Registry Software CDEMS: Chronic Disease Electronic Management System For an excellent review of 16 registry products by the California HealthCare Foundation, try this: hronicDiseaseRegistryReview.pdf