As part of its ongoing commitment to improving the quality of care for patients with urologic disease, the AUA recently announced it is developing the AUA AQUA Registry.
The AQUA Registry will be the only specialty-wide, urologic disease focused registry in the United States and will be designed to measure and report health care quality and patient outcomes. Through the aggregation and organization of both clinician- and patient-reported data on diagnostic and therapeutic interventions, clinical and patient-reported outcomes and resource utilization, AQUA will provide the urologic community with a definitive resource for informing and advancing urology within the United States.
Starting with prostate cancer, the AQUA Registry will gradually expand to include other urological conditions.
AQUA Registry can be a powerful tool for urologists to observe the course of disease; understand variations in treatment and outcomes; examine factors that influence prognosis and quality of life; describe care patterns, including appropriateness of care and disparities in delivery of case; assess effectiveness; monitor safety and harm; measure quality of care; and compare themselves with their peers."
Dr. Gopal H. Badlani, AUA Secretary
The AUA AQUA Registry is being developed under a sophisticated information technology infrastructure and will be implemented in a phased manner over the next three years in terms of number of participating practices, scope and functionality.
Phase one (design and testing) of the Registry is underway and began January 2014. Work during this phase will focus on data validation and quality, measures validation, and EHR integration success.
Phase two (pilot phase), is scheduled to begin July 2014, with the launch of a fully operational AQUA Registry scheduled for July 2015.
Phase 1 – Design, build, test (beta)
Phase 2 – Pilot
Launch – Regular operation
Once the beta development and testing phase is complete and the pilot phase begins, participating sites will begin contributing data on an ongoing basis in order to create a robust, longitudinal registry for quality improvement and research purposes.
Participation criteria will expand during each phase, and AUA will make announcements as we open the Registry for wider participation, so please monitor the AUAnet.org website and AUA publications for new information.
For further information on how to participate, please email your name, practice name and contact information to aqua@AUAnet.org.
To participate in the AQUA Registry, your urology practice must:
Prostate Cancer Care Provider
AQUA is the first specialty-wide urologic registry at a national level, designed to provide data to help identify trends in the diagnosis and treatment of urologic conditions. As such, AQUA will initially focus on prostate cancer, as it is one of the most common conditions treated in the field of urology. It will then gradually expand to include other urological conditions.
As a requirement for participation, practices must currently be using and EHR system. For those using an EHR system, the Registry is designed to fit seamlessly into your clinical practice workflow and will minimize time spent on data entry and produce cleaner data through EHR data integration.
AUA chose this course of action as most Medicare reimbursement eligible providers are moving to comply with the Centers for Medicare & Medicaid Services (CMS) Meaningful Use criteria by January 2015, which is the timeframe the AQUA Registry will open for wider participation.
Business Associate/Data Use and Registry Participation Agreement
When a practice decides to participate in the Registry, it will be required to sign a Business Associate/Data Use Agreement and Registry Participation Agreement. The Agreements mostly addresses HIPAA requirements for the collection of de-identified patient data as well as outline what the AUA agrees to provide and what the participating practice agrees to provide.
Benefits of participating in the AQUA Registry include:
Physician reimbursement support
As health care in the United States continues its rapid transition to a value-based system in which providers are paid based on treatment results, quality of care, efficiency and patient satisfaction, the AQUA Registry will provide a means for providers to track these parameters.
AQUA will apply to meet CMS requirements for Physician Quality Reporting System (PQRS) and Qualified Clinical Data Registry (QCDR) reporting starting in 2016. Use of the registry under PQRS and QCDR will avoid negative financial reimbursement from CMS.
PQRS was introduced by CMS to evaluate patient outcomes and quality of care. PQRS registries, and now QCDRs introduced as of January 2014, are considered key vehicles to automate the reporting of data to qualify for Medicare reimbursement. Private payers are also moving to collect these quality measures to evaluate agreements with providers.
National benchmarks for diagnosis and treatment
To date, there is no specialty-wide urologic disease registry at the national level. Facility- and region-specific prostate cancer registries exist at the University of California, San Francisco (the Cancer of the Prostate Strategic Urologic Research Endeavor, aka CaPSURE), and the University of Michigan (the Michigan Urological Surgery Improvement Collaborative, aka MUSIC). Experience and expertise gained within the urology community from the development of these registries, combined with disease expertise of AUA leaders in prostate cancer, will inform the design of the national registry at the AUA.
Cross-specialty practice pattern and outcome comparison
With participation from urology practices nationwide, data from the AQUA Registry will be used to generate regular feedback reports summarizing local practice patterns and treatment outcomes, and to compare a practice's own patterns with those of a number of others across the nation. The reports could also be used to identify process-of-care variables that may correlate with key patient outcomes.
Data will be housed in a secure, protected server and in compliance with all applicable regulations. It is of AUA's utmost priority to maintain confidentiality of patient information.
Participation in the Registry during the initial years is free. Any fee introduced in the future would be communicated in advance through the AUA and may be used to cover individual user access to the information system or mapping to EHR data fields.
If you are interested in participating and have not been contacted by the AUA directly please email your name, practice name and contact information to aqua@AUAnet.org.
The AUA Quality (AQUA) Registry
An AUA Board-Approved Initiative
Collecting Meaningful Data to Bridge the Knowledge Gaps around Urology
The AQUA Registry
As part of its ongoing commitment to improving the quality of care for patients with urologic disease, the AUA is developing the AUA Quality (AQUA) Registry. This is the first specialty-wide urologic registry at a national level, designed to measure and report healthcare quality and patient outcomes. It will also provide data to identify patterns, trends and outcomes in the diagnosis and treatment of prostate cancer. The AQUA Registry's clinical focus will be on the longitudinal follow-up of patients with newly diagnosed prostate cancer and include a personalized portal for patients to report self-perceived outcomes on their quality of life.
Quality Care through Comparative Evidence
Initially focusing on prostate cancer and then expanding to other urologic conditions, the AQUA Registry will, for the first time, enable urologists to review their practice patterns and outcomes in comparison with their peers. Starting in 2015, the AQUA Registry will provide urology practitioners with patient outcomes and healthcare quality metrics specific to prostate cancer using data gathered from physician and practice levels as well as patient reports. The AQUA registry will then gradually expand to include other urological conditions.
A Physician-Friendly System
The AQUA Registry is designed to be physician-friendly. With little data entry burden to physician offices staff, clinical and patient data will be extracted, transformed and loaded into the AQUA Registry from the practice sites' electronic health record system.
How AQUA Registry Data Will Be Used
National and comparative data generated by the AQUA Registry will support guideline-informed physician practice, and evidence-based patient decision support mechanisms. It will provide participating urologists feedback regarding their individual- and/or practice-level performance on a range of process and outcome quality measures, benchmarked against their peers at national and regional levels. For physicians, these data will help them meet both the Centers for Medicare and Medicaid Services' Physician Quality Reporting System (PQRS) reporting and potentially regional and national certification requirements. For government policy-makers, the AQUA Registry will provide further understanding around patient safety, costs of care and system effectiveness.
Why Urologists Should Support the AQUA Registry
The healthcare environment is transitioning from volume-based to value-based payment for care. The AQUA Registry will ensure that urologists, rather than other parties, are identifying what works best and for whom.
Identifiable information collected by the AQUA Registry will be stored in a secured area, and only participant sites can see their performance with benchmarking comparisons of national or regional statistics.
The AQUA Registry is being developed under a sophisticated information technology infrastructure and will be implemented in a phased-in manner over the next two years in terms of the number of participating practices, scope and functionality. The initial design and testing phase began at February 2014 with the participation of 10 sites. The pilot phase is expected to begin summer 2014. Through the aggregation and organization of both clinician- and patient-reported data on diagnostic and therapeutic interventions, clinical and quality of life outcomes and resource utilization, the AQUA Registry will provide the urologic community with a definitive resource for informing and advancing urology.
What are the goals of the AQUA Registry?
The AQUA Registry's goal is to advance urologic care by providing physicians with the essential infrastructure and information they need to improve their clinical practices and patient outcomes. Initially, the registry will focus on prostate cancer; later, it will expand to other urological conditions.
Is this Registry nationwide?
Yes, the AQUA Registry is the only national, specialty-wide clinical data registry of urologic conditions in the United States.
How many sites are participating?
We will enroll 30 practice sites by the end of 2014, at least 50 by mid-2015, and at least 100 by the end of 2016. The Registry's long-term goal is to include every urologic practice in the United States.
How do I join the AQUA Registry?
Please contact AQUA@AUAnet.org or call toll free 1-855-898-AQUA (2782).
Are you collecting data on newly diagnosed or established prostate cancer patients?
We are collecting data on newly diagnosed patients.
Will this be a prospective or retrospective process?
Patients will be followed prospectively from time of diagnosis. We may validate the data extraction process by examining retrospective data, but it will not be reported in any quality metrics.
Are you collecting identifiable data?
Yes, we need identifiable data to comply with the Centers for Medicare and Medicaid Services' (CMS) Physician Quality Reporting System (PQRS) requirements and to link with SEER and other repositories in the future. Identifiable information collected by the AQUA Registry is stored on a secure, HIPAA-compliant server with robust backup. Participant sites will only have access to their performance data, which will be benchmarked against comparison data aggregated at the national or regional level.
Do the patients in my practice need to provide informed consent to participate in the AQUA Registry?
No, patients do not need to provide informed consent, as the registry is considered part of quality improvement.
Is the AQUA Registry IRB approved?
Yes, an independent institutional review board (IRB) oversees the AQUA Registry. The IRB waiver is available upon request. The IRB will be modified in the future to include the patient-reported outcome portion of the registry, once it is developed.
What are the outcomes and measures?
Will you provide me with templates so I know which data needs to be entered?
Yes, we have templates that you can use or modify. We expect the templates will greatly facilitate the data reporting process.
How will you pull the information that is related to the diagnosis but entered by another provider?
FIGMD pulls patient data based on the National Provider Identifier (NPI) number of AQUA's participating providers. If a patient sees two or more urologists who participate in AQUA, FIGMD will extract all of the diagnostic and treatments information from each urologist's EMR. FIGMD is currently working on a patient matching process so that it can detect and link diagnostic and treatment data from the same patients visiting multiple practices.
What are the benefits of joining the Registry?
Participant sites enjoy many benefits:
How are outcomes reported?
Sites will access real-time data summaries using a secure login. Sites will receive individual reports and be able to benchmark their performance against regional and national peers.
What is the cost to participate?
As part of its efforts to help members promote quality care, AUA will cover the costs of the registry until 2016. Any fee that may be introduced in the future would cover individual user access to the information system.
Is this Registry eligible for certifications and reimbursements?
In 2016, the AQUA Registry will apply to meet the Centers for Medicare & Medicaid Services' (CMS) requirements for a Physician Quality Reporting System (PQRS) and Qualified Clinical Data Registry (QCDR). CMS reporting would start later that year. In the future, AUA anticipates that members who participate in AQUA will also receive Maintenance of Certification (MOC) credits from the American Board of Urology.
How involved does the practice manager have to be in AQUA?
The practice manager will need to participate in at least two to three calls with FIGMD and/or AQUA Registry staff to review reports until the mapping process is validated and complete.
Will a nurse or physician from AQUA help review reports?
Dr. Matthew Cooperberg is the AQUA Registry's physician advisor and provides clinical expertise and insight into data collection and reporting.
Can I use my own BAA?
Frequently Asked Questions about FIGMD, the AQUA Registry Vendor
What other groups or specialties does FIGMD, AQUA Registry's software vendor, work with?
What is the standard integration method used by FIGMD?
FIGMD uses the data-pull model. In this scenario, FIGMD fully manages the reporting process, with minimal impact to the practice. The vendor installs software on the local practice's server, which queries the EMR's backend database and extracts relevant clinical data. This software runs passively in the background, typically during off-hours, and does not affect clinical workflows or EMR performance.
What is/are the other method(s) that can be used to retrieve data?
FIGMD uses the data-push scenario when the software installation is not possible. In this situation, the practice IT staff sends the Registry a file each month containing all of the required data.
How long will it take for the first initial data extraction to be completed after mapping?
Initially, it takes two to three weeks to collect the data. After data is collected, FIGMD reviews it with the practice and makes any necessary mapping adjustments.
Does the Registry require real-time access?
The Registry does not require real-time access. The data pull runs early in the morning (between midnight – 6 a.m.) so it does not inconvenience the participating sites.
How are outcomes reported?
Sites will access real-time data summaries using a secure log-in. Sites will receive individual reports and be able to benchmark their performance against regional and national peers.
What other resources are needed?
Minimal time is required; local practice IT burden is estimated to be 30-40 minutes for software installation. FIGMD works directly with each practice's IT department to complete the mapping integration process. No ongoing maintenance or effort from local clinicians or support staff is required.
Where is the extracted information stored?
The Registry data is stored on Amazon Cloud, a secure, protected server that has been evaluated at the "moderate" level for Federal government systems. A full list of Amazon's security measures, including a white paper on Amazon's security processes, can be found on the Amazon Web Services (AWS) website. AWS complies with all applicable HIPAA regulations. AUA's utmost priority is to maintain the confidentiality of patient information.
Who will work with the practice to rectify any issues with the system?
FIGMD works directly with the practice and monitors the system. If it detects a problem, FIGMD will immediately notify the practice.
Which EMRs does FIGMD work with?
The software works with more than 60 EMR systems and can be adapted to any system with a backend database.
Will the AQUA Registry work with Epic?
Yes. AUA has several test sites with Epic EMR software.
What happens if the EMR software changes to another vendor?
FIGMD will re-adapt to the new EMR.
The following is a general outline of the steps we follow for the AQUA System Integration (SI) Process. This process will take anywhere from 4-6 weeks, depending on the availability of staff at the practice and timely responses:
System Integration Process