Registries Clinical Perspective J Marc Overhage MD Ph

Registries: Clinical Perspective J. Marc Overhage, MD, Ph. D, 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 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 www. amia. org

Meaningful Use information to transform Improved population health Improve access to information Enhanced access and continuity Data utilized to improve delivery and outcomes Patient self management Patient engaged, community resources Care coordination Patient centered care coordination Patient informed Evidenced based medicine Team based care, case management Basic EHR functionality, structured data Structured data utilized Registries for disease management Registries to manage patient populations Privacy & security protections Stage 2 MU PCMHs 3 -Part Aim ACOs Stage 3 MU Utilize technology to gather information Stage 1 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 Emphasizing outcomes Maximizing the use of resources & assets Applying appropriate levels of care at the right place Offering care at centralized facilities Offering care at sites convenient to patients Treating all patients the same Customizing healthcare for each patients Avoiding the sickest chronic patients Creating venues to provide special chronic care services Being responsible for those who seek our services Being responsible for the needs of the community Best efforts 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 Interpretation & Coding CIS Limitations CIS Training Collection Procedures Data Quality Leadership www. amia. org

Registry Uses Patient Tracking and Outcomes Measurem ent Surveillanc e Benefits of CIS Integration and Standardized Data Public Health / Program Planning Available Tools for Providers / Staff Research Quality Improveme nt Initiatives www. amia. org

Patient tracking and outcomes ed er nt Ce nt tie Pa nk hi T e om l. H ica ed M www. amia. org

Research Efficacy and safety in a small population with a restricted study protocol GAP Real world information to make health care decisions for large populations within defined budgets Garrison et al Value Health. 2007; 10(5): 326 -35. RCT Patient Population Real World Data 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 QI Tool Description Care delivery and coordination Patient lists Lists 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 tools Provide recommendations for care for an individual patient using evidence-based guidelines. Population level measurement standardized reports 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 Maine. Health Clinical Diabetes Improvement Registry 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 Health. Care Foundation, try this: http: //www. chcf. org/documents/chronicdisease/C hronic. Disease. Registry. Review. pdf www. amia. org