American Urological Association (AUA) Quality Registry (AQUA) has acquired status as a Qualified Clinical Data Registry. This is an initial step toward the development of a roadmap for Maintenance of Certification credit. AQUA now collects detailed national process and outcomes data circling around urologic diseases. Software development company FIGmd is said to have partnered with AQUA to produce a program that can automate the process of figuring out data directly from the electronic medical record (EMR) to minimize the data entry burden. This move towards specialty-specific data registries has been empowered by the Medicare Access and CHIP Reauthorization Act (MACRA). This act mandates that all physicians be enrolled in 1 of 2 quality-reporting systems by 2019, namely the Merit-Based Incentive Payment System (MIPS) or an alternative payment model. A trend has been observed with majority of specialties migrating toward the MIPS option, which supports a fee-for-service model. Key components of choosing this model include quality reporting (ie. PQRS); a value-based payment modifier; an EHR incentive program and clinical practice improvement. The registry has a menu of more than 30 measures. Practices choose nine measure on which they want to report for the purposes of PQRS reporting or six measures for future MIPS reporting.
Goal
The main goal of AQUA Registry is the advancement of urologic care which is facilitated by providing physicians with the infrastructure and information they require to improve their clinical practices and patient outcomes. Quality assessment and improvement through local feedback to practices are important objectives of the program. Secondary goals include encouraging next-generation health services and clinical outcomes research and inform urology policy efforts. Participating urologists get automatic PQRS [Physician Quality Reporting System] and Meaningful Use credit. Participation may help satisfy Maintenance of Certification reporting requirements, and discussions with the American Board of Urology are ongoing toward that end.
The AQUA registry connector is integrated directly with the EMR database. Data are extracted automatically, encrypted, and transferred via a secure connection to AQUA nightly. Data are processed and incorporated into the AQUA data repository as received. You can then view your quality measure data anytime on the AQUA registry dashboard. Data collected for AQUA may be used for reporting to CMS [the Centers for Medicare & Medicaid Services] with no additional effort. This method of data collection has zero impact on physician workflow. Physicians continue to see patients and document just as they do today. As we collect the data from the EHR/EMR, we can adapt to individual usage patterns. We can process structured and unstructured data, including data in notes and text fields. Participation in AQUA also helped urologists get credit for EHR Meaningful Use in 2016 and potentially will help them get credit for Advancing Care Information for MIPS reporting as of 2017.
Action
The original way of getting a new quality measure into PQRS was extremely difficult, and you had to go through this multispecialty committee that may or may not really understand the condition for which the measure is being developed. Since AQUA, we have the latitude to develop whatever measures we believe are important. As the AUA updates its guidelines, the guidelines' working groups are helping develop new quality measures.
Data Ownership
AQUA ensures that patient-level data is never sent out to any third party. AUA maintains the AQUA database, but individual participating practices retain ownership of their data. Practice-level data are shown only with the individual practice contributing the data, which has been benchmarked against the aggregate data. The system can accommodate patient-reported outcomes. No practice will see any other individual practice's data.
Support
Each urological practice needs a physician who understands the clinical side of the business, the quality measures that are being captured, and how the practice is using its EHR to sit down and go through that process. The software for the AQUA Registry extracts data from practice weekly. While daily dashboard updates are an option. It is highly EHR based. This is the reason why participating in the registry costs less as urologists don't have to employ staff to do manual data input.
