ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Society of Thoracic Surgeons

The futures of registries and performance measurement are intertwined. The worldwide role of registries as tools to capture and analyze data will increase, and the parallel demand for performance measures will result in preferential use of these data because they are more credible and widely accepted than other sources and can be more fully risk adjusted. The nexus of clinical registries and performance measures will become even more important as risk-adjusted outcomes data are used for highstakes applications, such as public report cards, preferred provider networks, and reimbursement. When feasible, limitations of clinical registries, such as their data collection burden, must be mitigated by automatic extraction of some data elements from EHRs. This will be possible only for those variables for which the integrity of clinical registry content will not be compromised by automatic EHR data extraction. Similarly, the value of clinical registries, the data of which historically have been limited to short-term outcomes, will be enhanced through linkages with other data sources, such as claims data. Sources such as claims data can provide information on long-term outcomes, resource use, rehospitalizations, and reinterventions. These linkages will require methods for identifying patients across data sources. Also needed is clarification by the federal government of Common Rule and Health Insurance Portability and Accountability Act regulations, because lack of clarity in these rules sometimes dissuades providers from submitting data. By measuring and reporting registry performance to clinicians, individual sites, and integrated healthcare networks, as well as publicly reporting when appropriate, registries will be able to influence care profoundly. This will include iterative changes occurring as a result of routine, nationally benchmarked feedback reports, as well as randomized clinical trials embedded into ongoing registries, such as the TASTE (Thrombus Aspiration in ST-Elevation myocardial infarction) trial, which was performed in the Swedish Coronary Angiography and Angioplasty Registry,31,32 and the SAFE PCI for Women (Study of Access Site for Enhancement of PCI for Women) study, which used the NCDR's CathPCI Registry.Measuring and reporting registry performance data would facilitate the empirical determination of specific processimprovement strategies that result in improved patient-centered outcomes. As clinical registries cover progressively more of the healthcare landscape and are supplemented by additional data from EHRs, claims databases, and other data sources (eg, industry databases, patient-reported information from personal health records and websites [big data]), we will benefit from insights into real-world practice that have not yet been possible, ultimately improving healthcare delivery and patient outcomes.