Radiologists’ participation in data registries for benchmarking is growing. But many still need guidance on what these databases are and how to comply.
The number of radiology practices and departments looking to benchmark themselves against their peers through data registries is growing. But many still need guidance on what these databases are and how they can correctly participate.
For years, your practice or department has likely followed its own protocol for diagnostic scans, using what you felt were best practices for radiation doses, for example. According to industry experts, data registries are pathways to double-check yourself and ensure what you’re doing provides the best care to your patients.
“These registries are effective in the promotion of quality improvement changes and changes in high-quality health,” said Cynthia Moran, assistant executive director of government relations, economics, and health policy at the American College of Radiology (ACR). “The use of registries is so that people can see where they are in the performance metric.”
Although the ACR Dose Index Registry has received the most attention recently, seven additional registries exist - CT colonography, general radiology improvement, IV contrast extravasation, mammography, oncologic PET, night coverage, and quality improvement for CT scans in children. Together, these registries comprise the ACR National Radiology Data Registry (NRDR).
By providing data to a registry, you’re contributing to the body of information that will be used to craft future best practices guidelines. According to Moran, these registries also make it easy for you to compare yourself to your peers.
“If you provide data to a group or registry, you periodically get a report to see where you stand respective to your other colleagues,” she said. “If your numbers are far off from the performance of others, you can create a process to see what’s wrong and how you can do better for your patients.”
While data registries are most often lauded for improving the quality of care available to patients, they do make a more direct impact on radiology practices, said Judy Burleson, ACR’s director of quality and safety metrics.
“When quality improvement and quality reporting programs are used in combination with reimbursement mechanics, it enables payers - private or Medicare - to pay for services for their beneficiaries based on quality rather than fee-for service,” she said. “When you integrate a quality program within payment structures, you’re inserting and element of value there.”
To participate in any registry within the NRDR, your practice must complete a participation agreement. Not only does this document outline the specific registry or registries in which you want to enroll - it isn’t required that you participate in all registries - but it also mandates that you have the proper privacy protocols in place to protect the patient data you collect and submit.
There are also other rules you must follow, Burleson said.
“To be in compliance with a clinical data registry like the ACR registries or specialty society registries, practices just need to submit specific data elements in the format that’s required,” she said. “This could be problematic for some sites that must figure out the best way to get this data and from where to find it.”
Even though it can be fairly easy for you to comply with data registry requirements, there are challenges to consider. One of the biggest stumbling blocks, Burleson said, is simply finding the right data for submission and getting it into the registry.
Each practice is responsible for choosing its own process for collating the data that will be included in the registry. Staff may choose from two formats: They may either submit data from one source, such as through a PACS directly to the ACR, or they may submit via multiple sources, such as having individual CT scanners send data individually.
“Whether data comes from one system or electronic health record or one radiology information system or collected from multiple sources,” she said, “it may be a case that this could begin to be burdensome in terms of staff time.”
You may also run into some pushback from hospitals if you need their help to acquire patient information. Although clinical data registries are considered quality improvement initiatives and are, therefore, exempt from some privacy regulations and institutional board review requirements, many facilities remain wary of divulging sensitive details, she said.
There is a different challenge for Physician Quality Reporting System registries, however. These registries use incentive payments or payment adjustments to encourage providers to submit quality data. With these databases, it is incumbent upon you to make sure you’re submitting the proper CPT or ICD-9 billing codes for appropriate cases. If you send in information for cases that don’t fall under the registry’s purview, they will not count toward your reporting or performance rate. These registries are likely to alert you to this error, though, so you can correct it and avoid it in the future.
One Department’s Experience
Participation in the Dose Index Registry began in May 2011 for the University of Washington Medical Center radiology department. To lay the foundation for sending encrypted DICOM-structured dose reports from its CT scanners to the ACR, according to radiology assistant professor Kalpana M. Kanal, PhD, departmental leaders fostered collaboration between the ACR, the IT staff, PACS staff, and an on-site physicist.
Initially, the department faced difficulties, most of which arose from being an early adopter. Software installation using both new and old scanners proved challenging, as did the consistency of data transmission. Staff also had to work through implementing the exam mapping process required by the ACR, she said. The mapping process uses the Radlex Playbook from the Radiological Society of North America to standardize protocol classifications. Consequently, the department was pushed to consolidate the use of the 19 names it had for a chest CT with contrast so the registry could categorize the data more easily.
In addition, department servers initially crashed nearly every day due to data overload. The problem resolved, however, after departmental leaders learned they need only submit the CT dose and not the entire report.
Although the initial phases of registry participation were rocky, the department’s experience has been a positive one. And, the long-term benefits of the registry are clear, Kanal said.
“The ACR CT Dose Index Registry program has been very successful and is a useful tool for dose data mining,” Kanal said. “It will eventually establish national benchmarks for CT dose indices.”
The ACR’s Moran has heard similar feedback from some of the more than 1,000 facilities participating nationwide, and she recommended practices start participating as soon as possible.
“I hear stories from colleagues about patients who are concerned about radiation dose before a CT scan, and it’s very comforting to them to hear that an institution is using the technology of the dose index to continuously monitor and optimize exposure so they’re only using the radiation they need,” she said. “I think the sooner institutions get involved, the higher the worth will be for them, as well as their patients.”