Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), and Dr. Ralph Brindis, the incoming president of the American College of Cardiology (ACC), recently endorsed two different kinds of electronic disease registries. Both can contribute to healthcare quality improvement, but in different ways.
Clancy made her remarks at a hearing held by the National Committee on Vital and Health Statistics to gather information about the definition of "meaningful use" of EHRs. This definition is the key to deciding whether or not CMS should provide financial incentives to particular physicians who have acquired EHRs. It's believed that physicians will be required to show that they use their EHRs to prescribe electronically, exchange data with other providers, and report quality data. But HHS Secretary Kathleen Sebelius must determine what meaningful use is.
Clancy said that physicians who want to obtain government funds should prepare themselves by using registries to gather data on how they treat chronic conditions. She suggested that they work with their vendors to set up such registries. The kind of registries she's talking about contain actionable data on visits, tests, lab results, and medications for patients with particular conditions, and they can be set up to remind physicians and/or patients when follow-up tests and services are due. Such registries are most often used by primary care physicians, although some specialists also use them.
The kind of registry to which Brindis was referring is used to assemble data from hospitals and physician groups on particular conditions or procedures. The collected longitudinal data generates benchmarks that physicians can compare their own process and outcomes data to. The American College of Cardiology maintains several registries, and orthopedic surgeons contributed to a joint replacement registry for several years. (A new joint replacement registry appears to be on hold because of malpractice liability concerns.) This type of database can help surgeons evaluate the outcomes of procedures and the reliability of devices. But it's not designed to assist physicians in keeping track of the care provided to individual patients.
Up to now, few ambulatory EHR vendors have developed robust registries of the actionable kind. But some commercial registry programs are available, and there are also services that provide web-based registries based on data from practice management systems and EHRs. So far, it has been next to impossible for small practices to do this on their own, so the main users of registries are large group practices. But an increasing number of physician-hospital organizations and IPAs are providing registries for their member practices, partly to capture pay for performance rewards.
There's no doubt that the use of registries could help doctors deliver better care, with or without EHRs. If the new HHS Secretary includes them as one way to meet the definition of meaningful EHR use, more physicians would use registries, and patients would benefit. But to get the full benefit of registries, they should be combined in communitywide databases that show everything that has been done for patients with particular chronic diseases and which services they need.