The ACC Corner | ACC's PINNACLE Registry: Designed for Data-Driven Environments

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William J. Oetgen, MD, is chair of the ACC’s PINNACLE work group.

Healthcare reform currently is generating a great deal of debate. However, there are at least two points on which Washington legislators seem to have reached a consensus. First, providers will be subject to greater transparency and accountability. Second, once most physician practices are equipped with EHRs, the data necessary to drive such transparency and accountability will flow effortlessly across the various health networks. While the ACC accepts the first premise, those with a working knowledge of health IT recognize that the second will be much more difficult to achieve.

Given these challenges, the ACC is working to equip cardiovascular professionals and their practices with a new generation of data and quality capabilities. For example, the PINNACLE Program (formerly IC3, or Improving Continuous Cardiac Care) is designed to help cardiology practices thrive in this new data-driven environment. As a national office-based quality improvement program grounded in ACCF/AHA guidelines and performance measures, the ultimate goal of the PINNACLE Program is to translate ambulatory data into individualized clinical insight. However, participation in the program also provides cardiovascular professionals with the data resources and experience to compete effectively in a rapidly changing marketplace.

From the outset, the ACC recognized that the burden of collecting data would need to be minimized to avoid disrupting practice workflow. The PINNACLE Program has concentrated on deploying a technology platform capable of extracting and exporting relevant PINNACLE Program fields from practice-based EHR databases. Developed with Featherstone Informatics Group, this platform, called the System Integrator, is essentially a "fire-and-forget" technology, functioning with no impact on physician or administrator workflow. The degree of EHR customization determines how much practice IT staff time is required for installation and data field mapping.

Systems integration is not without its challenges. ACC technical teams have been surprised by the absence of seemingly essential data elements (like dates of procedures) and the degree of variation between ostensibly identical EHR products. Nonetheless, of the more than 200,000 patient records in the PINNACLE data warehouse contributed by more than 150 cardiologists—the vast majority have been delivered using the System Integrator.

For cardiovascular practices looking to adopt EHRs, the ACC offers several ways to streamline participation in the PINNACLE Program. First, for a turnkey, web-based EHR solution, Medical Informatics Engineering offers a variety of products—including WebChart EHR for Cardiology—that are compatible with the PINNACLE Program. Second, the college maintains relationships with most other EHR vendors and can provide guidance in the customizations required to maximize the value of the PINNACLE Program.

Once submitting data, PINNACLE Program participants receive quarterly quality improvement reports that feature a measure-by-measure accounting of the care provided to patients. Presented in both graphical and detailed formats, the reports enable physicians and practice administrators to quickly assess performance at the practice, location and individual provider level, thereby improving adherence to various quality and performance benchmarks. The college believes that it is physicians and practices like these that will be best equipped to thrive in the coming era of healthcare transparency and accountability.

Over the coming years the ACC plans to leverage the PINNACLE Program network to delivery a variety of tools, services and opportunities to CV practices and physicians. For example, the ACC is already working on real-time reporting, clinical decision support and American Board of Internal Medicine Maintenance of Certification (MOC) Part IV capabilities. PINNACLE also is a certified registry for reporting in the Centers for Medicare & Medicaid Services' Physician Quality Reporting Initiative.