Expanding the registry universe--one EMR at a time

A new report out this week from the Institute of Medicine on surveillance of chronic conditions notes that registries can be useful for obtaining information about individuals with particular diseases or conditions. However, there's a hitch: the registry data often just reflects a portion of the population--say, with lung or cardiovascular disease or even diabetes--who receive specific treatment and who are entered into the registry.

So, what about everybody else? How about those patients who had one abnormal lab result, or who failed to continue with a treatment? Recent research from the Massachusetts eHealth Collaborative shows that there might be a better way to expand the scope of registries--while improving quality of care--thanks to electronic medical records (EMRs).

The work of the collaborative, a four-year $50 million health information technology program--and how it installed EMRs and initiated workflow redesign--is profiled this month in Health Affairs. What was found was that its provider users of EMRs were far more likely to produce various registries than the less enthusiastic EMR users.

From 2006 to 2008, the collaborative sponsored a program to implement EMRs within ambulatory medical practices and establish a health information exchange. With a grant from Blue Cross and Blue Shield of Massachusetts, the collaborative selected three Massachusetts communities (Brockton, Newburyport, and North Adams) to participate in the program. About 160 physician practices were involved with the initiative that evaluated their registry use (through surveys) in 2005 and 2009.

In their analysis, the researchers found an improved ability to generate registries based on laboratory test results and medications. No difference was found in registries based on diagnosis--in this case, diabetes and cardiovascular disease. But that most likely was due to the fact up to 89 percent of practices had already reported (probably through billing data) being able to generate diagnosis registries prior to the intervention, the researchers said.

Compared with all survey respondents in 2005, respondents in 2009 were more likely to be able to generate each registry type with expanded EMR use: 78 percent of the physicians in 2009 were able to generate a laboratory results registry, compared with 44 percent in 2005; and 83 percent in 2009 had a medication registry, compared with 33 percent in 2005.

The study was limited in several respects, the researchers noted. For instance, no control group was used, and it did not measure whether the quality of care was improved as a result of the collaborative program.

It also did not examine if differences existed in how primary-care physicians and specialists used the registries, the researchers said. Those areas remain open for further investigation.

Registries, however, are "a simple way to allow doctors to manage patients proactively," Marshall Fleurant, lead author and a general internal medicine research fellow at Harvard Pilgrim Health Care Institute, recently told the Boston Globe. "This is something they can do right from their office, rather than waiting for an outside body to do it."

The Massachusetts study also found that it was possible to put together registries that include patients that previously would have been excluded--thanks to the power of EMRs. - Janice