Registries: Clinical Perspective

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

2. 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

3. 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

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

5. … but different EHR 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 • 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

6. Meaningful Use Use information to transform Improved population health Improve access to information Enhanced access and continuity Data utilized to improve delivery and outcomes Data utilized to improve delivery and outcomes Patient self management Patient engaged, community resources Utilize technology to gather information Care coordination 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 Privacy & security protections Privacy & security protections Privacy & security protections PCMHs 3-Part Aim ACOs Stage 3 MU Stage 1 MU Stage 2 MU

7. 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 outcomes Emphasizing volumes Applying appropriate levels of care at the right place Maximizing the use of resources & assets Offering care at sites convenient to patients Offering care at centralized facilities 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

8. 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.

9. 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

10. Data Quality

11. Registry Uses Research

12. Patient tracking and outcomes Think Patient Centered Medical Home

13. Research RCT Efficacy and safety in a small population with a restricted study protocol GAP 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.

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

15. Quality Improvement Tools – Examples

16. Trends

17. Gaps

18. Examples of QI Registries and QI Tools 18

19. 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/ChronicDiseaseRegistryReview.pdf