insights get to know the ajrr...
TRANSCRIPT
Get to Know the AJRR BetterUse the Registry Participation Towards Your Quality Programs – a Webinar for Members of the Alliance
November 1, 2017
PATIENT-REPORTED OUTCOMES
REGISTRY
INSIGHTS
QUALITY
Today’s Speakers, Goal, and Content
Goal: Gain a better understating of
the AJRR so you can maximize your
involvement with us
• About AJRR Today
• Participant Architecture Overview
• Submitting Data to the Registry
• Registry Platform Overview
• Q&A
Lori BoukasDirector of Marketing &
Communications
Kristin ParisiCustomer Support Analyst
About AJRR
• Founded in 2009 by AAOS
• From 2015-2017 we were a stand-alone
organization
• As of last week, we are again owned by AAOS
• AJRR focuses on hip and knees; AAOS plans to
expand into all of orthopaedics
AJRR Mission and Vision
AJRR’s MISSION
To improve orthopaedic care through the
collection, analysis, and reporting of actionable
data
AJRR’s VISION
To be the National Registry for orthopaedics
through comprehensive data and technology
resulting in optimal patient outcomes
About AJRR, Cont.
• Multistakeholder governance model– Profession (Surgeons)
– Industry
– Insurers
– Hospitals
– The Public
• Longitudinal registry focused on safety, recalls,
and survivorship
• Evolved into a Registry that can assist with
quality initiatives– Level III – Patient-reported outcomes PRO (2016)
– Level II – Comorbidities and complications (2017)
Maintenance of Certification
Quality Reporting
MACRA/MIPS
Device Surveillance
• Pre- and Post-Market Studies
• Component Recalls
Reimbursement
• CMS
• Health Plans and Insurer Distinction Programs
• Employer Programs
Quality Measurement
•Hospital and Physician Level Benchmarking and Public Reporting
Evolving Roles of Registry Data
AJRR is supported by hospitals, health insurers, and
the following groups:
Supporters
OFFICIAL REGISTRY OF
AJRR History & Milestones• 2010 – started pilot program with 15 hospitals
• 2013 – reached 200 hospitals
• 2014 – received quality clinical data registry (QCDR) designation by CMS
• 2015 – achieved coverage in all 50 states
• 2015 – merged with the California Joint Replacement Registry and began a technology platform upgrade process
• 2016 – patient reported outcomes (Level III) launched
• 2017 – officially endorsed by the Ambulatory Surgery Center Association (ASCA)
• 2017 – updated Registry platform: RegistryInsightsTM
• 2017 – released LII comorbidities/complications data specs
AJRR Stats Today:
1,022 participating facilities
8,900+ surgeons
>
0
200
400
600
800
1000
1200
Jan 2012 Jan 2013 Jan 2014 Jan 2015 Jan 2016 Jan 2017 Today
Participating Facilities (Hospitals, ASCs, Practice Groups)
Current Hospital Saturation by State
73%
National Saturation 30%
62%
43%
25%
Over 1,000 Current Locations
We’ve partnered with technology vendors to
help with a seamless data submission process
for our institutions
GETTING TO KNOW AJRR’S TECHNOLOGY PLATFORM
PARTICIPANT ARCHITECTURE OVERVIEW
SUBMITTING DATA TO THE REGISTRY
REGISTRY PLATFORM OVERVIEW
What is the Registry System Platform?
LEVEL I
Patient
• Name (Last, First)
• Date of Birth
• Social Security Number
• Diagnosis (ICD-9/10)
• Gender
• Race/Ethnicity
Hospital
• Name and Address
Surgeon
• Name (National Provider Identifier)
Procedure
• Type (ICD-9/10)
• Date of Surgery
• Laterality
• Implants
LEVEL II
• Comorbidities (ICD-9/10)
• CJR Risk Variables
• Height + Weight/Body Mass Index
• Length of Stay
• American Society of Anesthesiologists Score
• Operative and Post-operative Complications
LEVEL III (Patient-reported Outcomes)
Recommended: • PROMIS-10 Global• VR-12• HOOS/KOOS, JR.Also Available: • SF-36 v1• HOOS/KOOS • Oxford Hip and Knee Scores • Knee Society Knee Scoring System• Harris Hip Score• WOMAC (Modified via HOOS and KOOS)• SF-12, EQ-5D, WOMAC (only accepting final scores)
AJRR Data Elements: What’s Inside AJRR Registry
DATA COLLECTION EVENT OVERVIEW
PRE-OPERATIVE
PROCEDURERE-
ADMISSIONPOST-
OPERATIVE
SUM
MA
RY
DA
TA
PO
INT
SA. B. C. D.
Level III Data
Level II
Level II Data
Level II Data
Level III Data
▪ HOOS, JR. /
KOOS, JR.
▪ VR-12 OR
PROMIS-10
▪ CMS CJR Risk
Questions*See other accepted
▪ Procedure
Information
▪ Presenting
complications
that result in re-
admission within
90 days of the
actual procedure
date▪ Presenting co-
morbidities
▪ Present on
Admission
(Yes/No)
Level I
▪ Presenting
complications
noted during
post-operative
follow-ups within
90 days of the
actual procedure
date (that do not
result in re-
admission)
▪ HOOS, JR. /
KOOS, JR.
▪ VR-12 OR
PROMIS-10
▪ Questions
*See other accepted
• Procedure Layout- Use this file layout for
submission of Level I procedural data and
Level II Co-Morbidities and Complications that
occur during the procedure/during inpatient stay
• PROMs Layout-Use this file layout for submission
of Level III data; NOTE – for institutions using
the AJRR platform to collect PRO data, you do
not need to submit data to the Registry
• Post-Op Complications Layout-Use this file for
submission of Level II complications that occur
post discharge and within 90 days of the actual
procedure date
File Layout Options
Data Elements Requested
REVISED CURRENT
Level I 23 26
Level II 5 0
Level III 177 50
Demographic 29 15
Revised Data Specifications: Change ‘Snap Shot’
FILE LAYOUT WALKTHROUGH
File Layout & Unique Identifiers
• Unique Account Number
- assigned by AJRR
- eliminates shared NPI issue
- data assigned to procedure location
• File layout is updated to a ‘column’ vs. ‘row’ format
- For procedure and diagnosis codes, up to 10 codes
per patient/case record are supported
- For components, up to 20 per patient/case record
are supported
LEVEL I • Additional/modified data elements:
• Triggering code lists for ICD-10, ICD-9 (for
retrospective) and CPT (for outpatient)
- ‘Discharge Disposition Code’
- ‘Length of Stay’
- ‘BMI’
- ‘Height’
- ‘Weight’
- ‘Surgical Approach’
- ‘Surgical Technique’
- ‘Periarticular Injection’
- ‘Anesthesia Type’
- ‘Date of Admission’,
- ‘Date of Discharge’
LEVEL II• Comorbidities present on admission or
identified during the procedure and/or
inpatient stay
• Complications that occur during the
procedure and/or during the inpatient stay
• Post-operative complications occurring
within 90 days of the initial procedure are also
requested (re-admission)
• Triggering codes for related ICD-10-CM (and
ICD-9-CM for retrospective submission)
Institution may choose to extract and submit all codes for the
patient/procedure and AJRR will complete the trigger code
mapping
LEVEL III
• Patient Reported Outcome (PRO) responses
for the Centers for Medicare & Medicaid’s
(CMS) Comprehensive Care for Joint
Replacement (CJR) model mandated
instruments are now included
• Responses for CJR Patient Risk Questions (3)
now included
• Question responses for the full HOOS/KOOS
instruments are now included
• Bi-lateral procedures should be submitted as
2 cases (i.e. separate patient/case records)
• For REMOVAL procedures, the
REPLACEMENT procedure should be included
as a secondary procedure for the same
patient/case record
• Component Manufacturer list expanded for
your reference
Accurate component information is critical to
realizing our mission!
Additional Notes
REGISTRY PLATFORM OVERVIEW
PLATFORM SOLUTION OVERVIEW
PLATFORM FEATURE/FUNCTION OVERVIEW
PLATFORM ROLES & PERMISSIONS OVERVIEW
Provide access to data submitted and uploaded to the Registry via the
following tools:
a. User Interface: Search & View Patient Demographics and Case
Information
b. Pre-Defined Queries: Search &View Patient and Case Information
c. AJRR Dashboards: Search and View National Benchmarks
System Purpose
The Registry platform supports TWO primary use cases:
Provide the ability to administer pre and post-operative PROM
Assessment surveys to patients
a. Create Clinician/Surgeon Accounts
b. Create Patient/Case Pre-Registration Records (for the purpose of
administering Pre-Operative PROMs)
c. Facilitate PRO Data Collection & Storage
i. Patient Kiosk
ii. Paper or Phone Collection w/Administrative Data Entry
d. Review Patient/Case PRO Status and Trigger Reminders
e. View Patient/Case PRO Results
1.
2.
Manual data entry of detailed Patient/Case Records
- The Registry user interface is NOT designed to function as an
EMR/EHR
- Your detailed actual patient/case data must be extracted from
your source systems and submitted to the Registry via the defined
data submission process and the most current Registry data
specifications
System Purpose (cont’d)
What is OUT OF SCOPE of Registry platform usage:
X1.
Home Page Overview(Features & Functions Summary)
*System Alerts may appear below the yellow navigation bar to indicate system issues or planned downtime
PLATFORM ROLES & PERMISSIONS OVERVIEW
Module role
Module role
Clinician/ Surgeon
User
Clinician/ Surgeon
User
Clinician/ Surgeon
User
One Registry
Authorized User License
One PROMs Site
AdministratorLicense
Clinician/ Surgeon
User
Clinician/ Surgeon
User
Clinician/ Surgeon
User
Patient Kiosk
Access
Patient Kiosk
Access
Patient Kiosk
Access
AJRR Base Subscription Includes…
The PROMs Site
Admin can create
multiple
Clinician/Surgeon
roles which have
access to launch the
Patient Kiosk
RE
GIS
TR
Y S
YST
EM
R
OL
ES
PROMs Site Administrator
Role
Surgeon /Clinician Role
Registry Authorized User
Role
RE
GIS
TR
Y S
YST
EM
R
OL
ES
What Type of Access is Granted?This user role provides access to ALL data (Level I, II & III) submitted to
the Registry on behalf of the subscribing institution(s) via the Registry system
platform. This includes access to view reports and the national
dashboards to view benchmark reports. A signed Authorized User form is
required to name the individual user and the associated institution(s) for
which they are authorized to access and view data.
This user role provides access to the Registry system platform for the
purposes of enabling a subscribing institution(s) to use the Registry system
platform for PRO DATA COLLECTION. [Note: this role is NOT needed if the
institution is using another technology product or other process for PRO data
collection and are submitting data to the Registry via the SFTP file upload
process]. This role will allow the user to create multiple Surgeon/Clinician
users to support the PRO data collection process using the Registry system
platform. A signed PRO Onboarding form is required to establish the institution
profile and the individual user that will be assigned the PROM Administrator role;
this form also indicates all of the associated institution(s) for which they are
authorized to manage and administer PRO data collection.
This user role provides access to create patient records and access the
survey management functions of the Registry system platform to facilitate
dissemination of PROMs instruments and view associated responses and/or
status of assessment assignment, progress and/or completion. The PROMs
Administrator will create these roles and assign the data creation/access
permissions for specific institution(s).
Access Overview
Data/Permissions Framework
PART 2: KEY SYSTEM CONCEPTS
ACCESS & SECURITY
REGISTRYINSIGHTS FRAMEWORK
REPORTS & DASHBOARDS
PATIENT REPORTED OUTCOMES
MULTI-FACTOR AUTHENTICATION
• Two-step verification
• Security feature providing additional account
protection
• Relies on 2 forms of authentication
• Something you know = password
• Something you have with you = phone or device
• Even if malicious hacker gets password they
don't have access to your phone
TECHNICAL REQUIREMENTS
• SUPPORTED BROWSERS
– MICROSOFT INTERNET EXPLORER 11.0 AND
HIGHER
– MICROSOFT EDGE – CURRENT VERSION
– CHROME – CURRENT VERSION
– FIREFOX – CURRENT VERSION
• MOBILE/DEVICE RESPONSIVE
The RegistryInsights platform is comprised of multiple WEB
APPLICATIONS; You need an active Internet connection and your
account information to access RegistryInsights
YOUR PROFILE
PRO PROFILE
The configuration settings selected by your institution for:
• Quality of Life forms
• Disease Specific forms
• Other forms
• Interval Settings
• Distribution Settings
The NATIONAL profiles (for National Benchmarking)
include:
• Quality of Life forms: PROMIS-10 OR VR-12
• Disease Specific forms: HOOS, Jr. / KOOS, Jr.
• Other forms: CMS Risk Questions
• Interval Settings: Pre-Operative and 1 YR
• Distribution Settings: Pre-Operative –Clinical; Post
Operative -Email
SUPPORTED FORMSID
AJRR Form
Category
Site
Specific Form Instrument Full Name Specification Note #of Items
1Quality of Life
Form N/A SF36
Medical Outcomes Study 36-Item Short
Form Health Survey36
2.1Disease-Specific
Form Knee KSS (Pre-Op) Knee Society Knee Scoring System
Contains Surgeon Reported
Questions as well as patient44
2.2Disease-Specific
Form Knee KSS (Post-Op) Knee Society Knee Scoring System 44
3Disease-Specific
Form Hip Harris Hip Score Harris Hip Score
Contains Surgeon Reported
Questions as well as patient8
4Disease-Specific
Form Hip HOOS
Hip Disability and Osteoarthritis
Outcome Score 42
5Disease-Specific
Form Knee KOOS
Knee Injury and Osteoarthritis Outcome
Score42
6Quality of Life
Form N/A VR-12 Veterans Rand 12 Item Health Survey 12
7Quality of Life
Form N/A PROMIS-10 Global
Patient Reported Outcome Measure
Information System - Global Health
Short Form
10
8Disease-Specific
Form Hip HOOS, JR
Hip Disability and Osteoarthritis
Outcome Score (HOOS), JR.6
9Disease-Specific
Form Knee KOOS, JR
Knee Injury and Osteoarthritis Outcome
Score (KOOS), JR. 7
10Disease-Specific
Form Hip Oxford Hip Oxford Hip Score 12
11Disease-Specific
Form Knee Oxford Knee Oxford Knee Score 12
12 Other N/A UCLA University of California at Los Angeles
Physical Activity Question 1
13.1 Other Hip CMS Questions CJR Required Risk Questions One of the 3 questions is joint
specific3
13.2 Other Knee CMS Questions CJR Required Risk Questions One of the 3 questions is joint
specific3
14 Other N/A CollaboRATEBlueShield Pre-authorization Program
(California Only) 3
PROMS Data Flow
Manual registration
of patient
demographic &
case information
Batch registration
of patient
demographic &
case information
via file upload
process
Institutions may select
from 2 configuration
options:
1. System will auto-
email assessments
to a patient upon
registration
2. Email may be
manually sent via
the system
interface
Other option:
Clinician may enter
responses on
behalf of the
patient via the
system interface
The Actual
Procedure date
must be uploaded
to the Registry to
trigger the post-
operative
assessment options
If record cannot be
matched, institution
will be contacted to
assist with error
resolution
Institutions may select
from 2 configuration
options:
1. System will auto-
email assessments
to a patient based
upon the
institution’s
frequency interval
configuration
settings
2. Email may be
manually sent via
the system interface
Other option:
Clinician may enter
responses on
behalf of the
patient via the
system interface
Data Access OptionsThe Registry System platform offers 2 primary access points for
viewing data submitted and uploaded to the Registry:
1 2ReportsNational
Dashboards
Pre-defined
PATIENT/CASE level
data
Exportable to Excel for
additional analysis
Pre-defined
AGGREGATE level data
Filters available for
benchmark analysis
A report is a real-time retrieval of pre-defined data elements from the
Registry database. Each report addresses a specific subject such as:
“Show me a listing of all patients submitted to the Registry that have
had a hip procedure”
“Show me a listing of each procedure submitted to the Registry with
the associated component information”
A dashboard is defined as a visual display of key information or metrics for “at
a glance” monitoring to support the analysis of data and to provide
actionable insights to improve or optimize performance. The Registry system
dashboards provide aggregate, de-identified views into the data at varying
levels of categories and access described in the subsequent sections. The
data is refreshed regularly as new data is submitted and uploaded to the Registry.
REPORT
DASHBOARD
Report vs. Dashboard
What’s on the Horizon
• 2017 AAHKS Annual Meeting– November 2-5 at the Hilton Anatole in Dallas, TX
• 2017 Annual Report Released– November 3, 2017
• User Group Network (Unet) Conference Call– December 14
• Unet In-person Meeting– March 2018
• Stay Up-to-Date– Join our Social Media sites for the latest news
– Join our Unet Forum and connect with other AJRR users
– Specific webinars on data submission and PROM use
Q&A
Thank You!Your Day-to-Day Support
Maria Gomes Kristin Parisi Stephanie Palaguachi
Customer Support Analysts
Jerry ManningBusiness Development Representative