Clinical Data Registry Program Needs More Effective Health IT Tools, GAO Says

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By Alex Ruoff  

Dec. 17 --The Department of Health and Human Services should improve its clinical data registries (CDR) program by developing technical standards that allow CDRs to more effectively collect data from other health information technologies, a Government Accountability Office report released Dec. 16 said.

Health IT tools, namely electronic health records, could give CDRs “substantial support in collecting and transmitting large amounts of detailed clinical data from participating physician medical records,” and improve the accuracy of the data collected by CDRs, the report said. However, CDRs are limited in what they can automatically extract from physicians' EHRs because of technical and legal barriers, the report said.

The report was titled “HHS Could Improve Medicare Quality and Efficiency Through Key Requirements and Oversight” (GAO-14-75).

To promote more effective use of health data by CDRs, the GAO said, the HHS should encourage the development of technical standards for EHRs to directly report health data to CDRs and add new clinical quality measure reporting requirements in Stage 3 of the meaningful use program.

CDRs maintain databases of health information on conditions, procedures and populations.

CDRs are expected to play a major role in at least two Centers for Medicare & Medicaid Services quality improvement programs. Under the 2014 physician payment rule, published in the Dec. 10 Federal Register, Medicare-participating doctors can report clinical quality measures for a variety of incentive programs, including the meaningful use and Physician Quality Reporting System programs, to qualified CDRs (see previous article).

The GAO also said in its report that HHS should help “ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries” by establishing a requirement for qualified CDRs to demonstrate improvement on key measures of quality and efficiency for their target populations.

CDRs Use of Health IT

The recent growth in clinician use of EHRs provides CDRs the opportunity to greatly increase the efficiency with which they extract data from EHRs by automating the process, GAO said. The proportion of office-based physicians who use an EHR grew from 51 percent in 2010 to 72 percent in 2012, the GAO said.

This increased efficiency might mean cost-savings and quality improvements for physicians as doctors would be able to spend less time reporting data to CDRs and would receive more timely feedback from CDRs on the care they are providing patients, GAO said. Clinical EHR systems in turn could provide the HHS with data on CDRs and the reports CDRs send physicians, GAO said.

Some CDRs can automatically extract data from their members' EHR systems. However, their capability to do so is limited, GAO said. The most effective method for automatic data extraction studied by GAO was capable of capturing 75 percent to 90 percent of the desired information.

Variations in the data collection and storage methods among clinical EHRs are the largest barriers for CDRs to automatically collect data from physician EHRs, the GAO said.

“Some EHR systems collect more information on some topics than others, because physicians in different specialities have different needs and interests,” GAO said.

CDRs should develop methods for converting the data in physicians' EHRs to a format that their IT systems can accept and accurately interpret, GAO said.

Meaningful Use and CDRs

The meaningful use program continues to play a “major factor” in the design of EHR systems and could be leveraged to facilitate the electronic reporting of clinical quality data to CDRs, GAO said.

Experts interviewed by GAO reported that EHR vendors design their systems in accordance with criteria from the Office of the National Coordinator for Health Information Technology's EHR certification program to ensure their customers can qualify for incentive payments under the meaningful use program.

GAO recommended the ONC include in their certification criteria standards for reporting data to CDRs.

The meaningful use program also requires health-care providers and hospitals to report on a set of clinical quality measures in order to qualify for Medicare and Medicaid incentive payments. These CQMs focus predominantly on primary care and “generally do[] not include measures relevant to CDRs, many of which focus on assessing speciality care.”

The GAO recommended including more specialty-care focused CQMs in requirements for Stage 3 of the meaningful use program, which begins in 2017.

This recommendation is likely to be heeded by the CMS as 61 percent of all health-care providers who received a Medicare incentive payment through the meaningful use program were non-primary care physicians, according to CMS data from October.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Kendra Casey Plank

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