Future role of clinical registries predicted to influence care

Clinical registries “will be able to influence care profoundly” in the future and will complement, rather than be made obsolete by, electronic health records and big data, according to a statement from the American College of Cardiology, the American Heart Association and the Society of Thoracic Surgeons.

“Registries are fundamental to health care quality and improvement,” Deepak L. Bhatt, MD, MPH, FACC, FAHA, executive director of intervention cardiovascular programs at Brigham and Women’s Hospital, professor of medicine at Harvard Medical School, chief medical editor of Cardiology Today’s Intervention and chair of the committee that wrote the statement, said in a press release. “Registries can support the development, implementation and evaluation of performance measures as tools for improving patient care and communicating meaningful information to patients regarding quality.”

Deepak L. Bhatt

According to the statement, “Despite the growth of [electronic health records] and [electronic health record]-derived databases, clinical registries will continue to play an increasingly important role in measuring health care outcomes, appropriateness of care and disparities in the delivery of care, and will serve as the basis for clinical and comparative-effectiveness research. [Electronic health record] data have important limitations with regard to key [CV] data elements. For example, contraindications to therapy and other critical data elements may not be captured in discrete and hence analyzable fields.”

In the future, some degree of integration of electronic health record (EHR) data sources, administrative data sources and registry data is likely to occur, the authors wrote.

Bhatt and colleagues suggested that professional societies be mindful of barriers to creation of new registries, including the need for dedicated full-time staff and software vendors and reliance on data warehouses and analytical centers. In addition, costs may exceed revenues in the early stages of a registry when participation is low, so “societies must be willing to view these early losses as an investment in the future,” according to the statement.

The authors also called for increased efforts to standardize data element definitions across different registries and to implement universal data quality standards.

Although the capabilities of EHRs to automatically extract data are appealing, “extraction from EHRs of many of the more detailed elements in clinical registries will require the personnel administering these two data sources to work collaboratively on structured data element definitions or to blend electronic data abstraction with manual abstraction of non-extractable concepts,” according to the statement. “It will be essential to ensure that these data elements are collected with EHRs with the same rigorous attention to detail as displayed by clinical registries.”

Bhatt and colleagues also noted that “because hospitals may be reluctant to implement new registries in a time of aggressive cost containment, the role of registries in clinical care improvement and the subsequent financial benefit should be emphasized.” The statement called for more financial and direct support from payers for registries and those who participate in them.

Registries also play a strong role in performance measure development because the data can show “where contemporary patterns of care are not consistent with evidence-based recommendations,” the authors wrote. Another benefit is the ability to quantify differences in care and outcomes by subgroup.

In the future, registries will need to “adapt to collect patient-centric performance measures” and link to claims databases and other sources to track longer-term outcomes, Bhatt and colleagues wrote.

Clinical registries will also affect care via “iterative changes occurring as a result of routine, nationally benchmarked feedback reports, as well as randomized clinical trials embedded into ongoing registries” such as TASTE and SAFE PCI for Women, they concluded. – by Erik Swain

References:

Bhatt DL, et al. Ann Thorac Surg. 2015;doi:10.1016/j.athoracsur.2015.07.078.

Bhatt DL, et al. Circ Cardiovasc Qual Outcomes. 2015;doi:10.1161/HCQ.0000000000000013.

Bhatt DL, et al. J Am Coll Cardiol. 2015;doi:10.1016/j.jacc.2015.07.010.

Disclosures: Bhatt reports consulting for Bristol-Myers Squibb/Pfizer, Eli Lilly and Novartis, and serving on a data safety monitoring board for Duke Clinical Research Institute, which has numerous grants and contracts sponsored by industry. See the full statement for relevant financial disclosures of the other authors and reviewers.