Rheumatologists practicing in the current healthcare environment are experiencing unprecedented information flow, data management issues, and a rise in quality designations and pay-for-performance incentive programs. There is increasing pressure on rheumatologists to document or capture treatment concordance with guideline recommendations and best practices and to monitor gaps in care and patient outcomes. Unfortunately, some quality programs are not considered clinically meaningful, and even those that are often bring administrative burdens related to reporting, data aggregation, and analysis.
Electronic systems provide the opportunity for rheumatology practices to systematically store patient information in a way that can be easily accessed, filtered, and analyzed. Local systems that store patient data may be comprehensive electronic health records (EHRs) or more limited specific data storage applications called electronic patient registries (or chronic disease management systems). Either way, well-designed systems can provide the data that reveal opportunities for improvement in care delivery, clinical and administrative processes, outcomes, and patient satisfaction.
What Do I Do With All This Data?
The healthcare system is brimming with patient information. For the average rheumatology practice, the challenge lies in knowing how to successfully aggregate information from different sources, organize and store the information, and process it in a way that yields useful and actionable knowledge. Electronic patient registry systems can help your practice manage information in a structured, effective, and efficient way; they can also identify areas for improvement.
An electronic patient registry is a computer application that gathers, stores, and processes large amounts of disease-specific individual and population-based health information. The application effectively extracts and transforms those data into actionable knowledge that supports care management, outreach, quality improvement, and outcome research.
An electronic registry supports organized care management by:
- Generating patient-specific reports on services performed;
- Generating condition-specific care prompts and recommendations;
- Offering outreach support that identifies patients who have missed appointments, are due for services, or who are not reaching care goals; and
- Promoting the timely availability of evidence-based health information to meet patients’ specific needs and support sound clinical decision making.
A good electronic registry will generate patient population-level reports for your practice and stratify them as needed. These reports can be run and tracked over time to provide performance feedback to care teams.
Using an Electronic Registry
When fully integrated into practice operations, an electronic registry system will allow for complete utilization of one of the practice’s most valuable assets: patient data. A successfully implemented registry system will also give your practice the ability to take the reins in performing analyses for strategic decision making. Your practice will be empowered to stay one step ahead of the ever-changing healthcare environment, especially as it relates to patient safety and reimbursement issues.
A registry can be used as a stand-alone application supporting care in a paper office environment, as a stand-alone application aligned with an EHR system, or as an integrated component of your EHR system. The electronic registry should not be confused with an EHR system because a registry only manages specific information relevant to a selected patient population or condition. In contrast, an EHR system collects and stores comprehensive medical and billing records. It is also important to note that, unlike the EHR system, the registry does not represent a legal documentation of care. Essentially, the registry serves as a computer application facilitating secondary use of patient health information.
Some EHR systems currently provide a patient registry or population management module as part of the integrated solution; however, it is far more common that large health organizations and practices use a complementary system or spend a great deal of time and money working with the EHR vendor to customize a solution. This is most often the case for specialties like rheumatology. Most EHR vendors do not have qualified support staff to develop and maintain these systems in a way that provides a complete solution.
Finding the best registry solution for your practice can be a challenge. Some EHR purchasers have worked closely with EHR vendors to customize their systems to offer some of the needed functionality. However, EHR customization is time intensive and requires significant technical experience.
The Importance of Aggregating Data and Benchmarking
Practice- and institution-specific registries have several important limitations when they are used for quality-monitoring purposes.
- Conducting consistent and thorough analyses is challenging. Good quality metrics use carefully specified numerators, denominators, and exclusions to ensure valid and reliable data reports.
- The sample size for any individual physician or practice may be too small to draw meaningful conclusions.
- Results of analyses may be difficult to interpret in the absence of national comparative or benchmarking data.
These limitations of local registries can largely be overcome by contributing data to multi-institutional or national registries. These larger efforts have the resources to conduct data analysis and quality reporting to provide comparative and benchmarking data that give context to a practice’s own data, and to aggregate data to achieve sample sizes that allow for valid conclusions regarding care processes and patient outcomes.
240 of Your Colleagues Submitted for PQRI Using the RCR—Did You?
Did you know that you can use the RCR to satisfy the PQRI requirements necessary to receive bonus incentive payments for registry reporting, rather than employing the claims-based reporting that users have found so onerous in past years? To learn more about the RCR, visit www.rheumatology.org/practice, or e-mail Itara Barnes at [email protected].
The ACR Working For You
The ACR is committed to helping you and your practice find an electronic registry system that will support population management and quality improvement while meeting increasing reporting demands for external quality and pay-for-performance programs. To provide for these activities, the ACR has developed the Rheumatology Clinical Registry (RCR), an electronic registry system designed to help you organize and maximize information. The RCR was developed by rheumatologists to meet the specific requirements of and support the unique needs of ACR members.
The RCR launched in the spring of 2009. The first release allowed users to enter and store patient data using direct upload or manual data entry via ACR-developed patient registration and encounter forms. The current version of the RCR supports documentation and reporting for the Centers for Medicare and Medicaid Services Physician Quality Reporting Initiative (PQRI) and American Board of Medicine maintenance of certification, provides practice/provider benchmarking reports, and helps support the practice of evidence-based medicine at the point of care. A portal for direct patient data entry into the RCR is in development and is expected to go live in the coming months.
The RCR provides a single system to support local registry/disease management functions, as well as data aggregation, analysis, and reporting in a national program. As the ACR moves forward in the development process, the RCR is being designed to seamlessly extract key data to provide you with an easy-to-use tool that works in parallel with your existing systems and fulfills local needs.
The ACR is also working to develop rheumatology-specific data standards that focus on the capture, storage, and extraction of information in electronic systems to address interoperability needs as they exist now. This effort relates to the analysis of static data, with an eye toward the future and real-time technologies.
Be Part of the Evolution
In order to make the RCR a tool that meets the needs of its users, the ACR looks to its members for guidance on next steps. Are you a current RCR user? If so, the ACR’s registry, quality, and healthcare informatics department wants to hear from you about your experience and how we can make the tool more useful for you. We’d also like your ideas about future development of the RCR, including functionality that will streamline patient/population care management and quality efforts in your practice. Please send your comments and suggestions to Itara Barnes at [email protected].