Surgeons from the Johns Hopkins School of Medicine have published a study in the Journal of Healthcare Quality saying that the state of registries in the US is tantamount to the “Wild West” and that most clinical registries are not set up to make the information they collect useful to patients, physicians and policy makers.
Clinical registries were established to give us the means to learn what works best in terms of health services and disease treatments by compiling outcomes from thousands of hospitals. Currently, there are 153 U.S. clinical registries; on average, each registry tracks 1,160,000 patients across more than 1,600 hospitals.
We don’t doubt the study’s conclusions that there is much room for improvement, but clearly some registries are having a substantial impact. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) says that participating hospitals “have the opportunity to prevent 25-500 complications, save 12-36 lives, and reduce costs by millions of dollars.” The 20-year old cystic fibrosis registry has been credited with prolonging survival by almost 2 decades. And CMS has included Public Health and Clinical Data Registry Reporting as part of its Proposed Stage 3 rule for Meaningful Use of EHRs.
1. Huge effort put into up front approval for devices/procedures
“Instead of focusing on outcomes, we have a huge upfront effort to approve a new device or a new medication. Once they’re released, nobody’s tracking anything. You have no idea how people are doing with a new medication or a new knee joint.”
2. Lack of incentives dampens investment in tracking outcomes
“Hospitals are not malicious, but there’s no incentive for them, from a business stand point, to chase down their outcomes and measure their performance for internal quality improvement.” (We bet we will see this change with increased dependence on quality measures for reimbursement for Medicare, up to 50% by 2018.)
3. Extreme variation between registries in terms of quality of their data
“The biggest surprise was that [among the 153 registries we identified] there is tremendous variation among the different medical specialties. And the other big surprise was that only 18 percent had any form of auditing to verify their data. Now, on Wall Street we would never accept an 18 percent auditing rate when companies report their earnings.”
4. It’s time to get serious about measurement
“If we’re going to get serious about reining in healthcare inflation, we have to get serious about measuring our performance in health care. Everybody agrees about that. The actual work of measuring patient outcomes is what’s missing.”
There is great potential for learning what works and what doesn’t from the data that is being tracked in registries. That’s why QPID is providing software that will help providers populate registries more easily and completely than current methods.
For more information on how QPID is solving this problem read about the Q-Folio solution.
On April 28 we were proud to host a webinar featuring Dr. Robert Wachter, father of the “hospitalist” movement and recently named the nation’s #1 most influential physician by Modern Healthcare.
QPID Health Chief Medical Officer Dr. Mike Zalis moderated as Dr. Wachter provided insights from his new book: The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age. Among the topics discussed was how technology has profoundly changed not only clinical work but also the relationships among healthcare professionals as well as between patients and doctors.
3 key takeaways from the webinar:
1. Beware the “Irony of Automation”:
One repeated theme was the “irony of automation,” which states that as technology gets better, the role of humans becomes more important, not less. Dr. Wachter noted that as health IT becomes more prominent, we must be careful to strike a balance between depending on technology and using our judgment, experience, and training.
2. Healthcare IT should learn from the airline industry:
According to Dr. Wachter, the user-centered concepts employed at companies like Boeing should be applied in healthcare IT. Burdening clinical users with taxing documentation requirements to support billing, malpractice, and quality measures is one symptom of lack of user-centered design. Dr. Wachter & Dr. Zalis shared a vision of the note that captures the human narrative and can be mined for “big data” insights in the way that lab values and other structured information can be leveraged.
3. We have all the tools; it’s a matter of using them:
Dr. Wachter believes we currently possess the necessary tools for improving patient outcomes and the way we approach patient care. Developing these solutions is not the issue. Overcoming political, social, and personal hurdles is the challenge. “The technology we need to make outcomes happen is available. But the challenge is now getting people to rethink how things work.”
Thank you Drs. Wachter and Zalis for your time and your thoughtful, perceptive answers. We hope that the insights gleaned from our webinar will continue to drive the industry towards a more efficient, safe, and bright future.