SAN DIEGO—Officials for the American Academy of Otolaryngology Academy-Head and Neck Surgery (AAO-HNS) trumpeted the arrival of the organization’s clinical data registry, Regent, saying that the data it provides will make it easier for otolaryngologists to comply with new regulations, help deliver more powerful research, help physicians keep up with certification and licensing, and put otolaryngologists at the helm in defining the quality of their care.
At the same time, officials emphasized that the registry will only be as strong as the amount and quality of data that is put into it.
Nuts and Bolts
Regent began regular operations in September 2016 after a pilot period that involved 21 academic sites and practices. Its technical aspect is being run by Illinois-based health IT company FIGmd, which also handles other clinical data registries, including those of the American College of Cardiology and the American Academy of Ophthalmology.
The Regent website (entnet.org/regent) includes a sign-up portal with a payment module, new contracts, and a simple procedure for signing up, executing a contract, and verifying membership. The cost is $295 per year in addition to a $250 application fee.
Jim Denneny, MD, CEO of the AAO-HNS, said he expects the registry to have wide appeal. “We were looking at ways to provide the tools for people practicing in all venues, whether you’re academic, small practice, private practice, large practice,” he said.
Above all else, he hopes the data in the registry will help the Academy and its members define what it means to deliver quality healthcare, which is crucial in the new payment landscape of medicine in the United States. “One main goal is to be the definers of quality for our specialty, rather than to have insurance dictate it,” said Dr. Denneny. “With the data and information we can get from a registry, we can actually influence that greatly.”
The goal of the registry is to function with little to no additional work from otolaryngology practices. The preferred method of data collection is for the registry to pull it straight from providers’ electronic health records.
The registry will also allow for easy assessment of a center’s performance. “If you are not meeting standards, it’ll be very easy … to see within national standards what you need to do better on,” Dr. Denneny said. “It’s always been hard to categorize results and compare yourself by just reading an article here or there … but [the registry] is really valuable in that.”
The registry will be a constantly developing entity, with new measures added as they are needed. The Academy has also formed clinical advisory committees in seven subspecialties to consider the need for new measures. These committees are made up of experts from Academy committees, specialty societies, and stakeholder groups and are chaired by a Regent executive committee member who has a five-year term, said Lisa Ishii, MD, a member of the Regent executive committee and associate professor of otolaryngology-head and neck surgery at Johns Hopkins in Baltimore.
New measures for Regent will be developed in much the same way that new clinical practice guidelines are currently developed by the Academy. A development group will consider a request for a new measure from the clinical advisory committee and then will have the option to put together a panel to develop that measure.
Dr. Ishii said that clinical data registries will become even more critical going forward. “It is assumed that the future of safe surgery is for surgical subspecialties to be reporting the data through clinical data registries,” she said. “It is assumed that to participate as a safe surgeon in a house of surgery you will have some relation to a clinical data registry.”
Regent will store clinical data such as patient demographics, implants, procedures, and performance measures, but not administrative billing data, said Dr. Ishii. This will make the registry a powerful tool for research, she added, pointing to the Society for Thoracic Surgeons, which has had a clinical data registry since the 1980s. “They publish more than 100 research papers using data from their registry every single year,” she said. “So that’s how they’re defining their practice.”
Tim Parr, the vice president of technology for FIGmd, touched on the many changes in information technology that have allowed registries such as Regent to take shape. Registries have evolved from manual entry to automated systems and from providing limited data to the availability of complete clinical records for large numbers of patients.
The process of adding data to the registry is not time consuming for users. Once Regent participants enter data into their electronic health records, just as they do now, they have nothing more to do. “This passive data collection and central data analysis enables us to do much more than we could have in the past,” said Parr. He added that the registry will be nimble enough to adapt to new regulatory requirements that might be imposed down the line.
One main goal of the registry is to be the definers of quality for our specialty, rather than to have insurance dictate it. With the data and information we can get from a registry we can actually influence that greatly. —Jim Denneny, MD
Louise Eddy, MS, an audiologist and executive director of Texas Ear, Nose and Throat Specialists in Houston, said the process of joining the registry was “incredibly simple.” You sign up, sign the agreement, and take part in a kick-off meeting by phone; Regent then sends the requirements on how to connect to the system, she said. Everything after that is handled by Regent.
Eddy said that compliance with new reporting requirements, such as the Merit-Based Incentive Payment System (MIPS), is a key reason to sign up for the registry. “As the administrator of a large group, or if I was the practice manager of a one-physician office, being ready to report quality measures under MIPS is the most important thing in my life right now, because it changes everything,” she said. “The quality mandates that are being added bring a level of complexity and tedium to the practice of medicine that is literally staggering. I find myself coming to work some days thinking, ‘Can I talk about quality one more moment?’”
She urged otolaryngologists to join the registry sooner rather than later. “The sooner we all get started, the broader and deeper the database will be. The database is only as good as what is put into it,” she said. “We can determine the future of the definition of quality clinical improvement and outcomes by providing this invaluable insight into how physicians really practice, boots on the ground, in the real world.”
Thomas R. Collins is a freelance medical writer based in Florida.