ACC: PINNACLE Registry aims to improve outpatient cardiac care

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ATLANTA - Originally piloted two years ago as the Improving Continuous Cardiac Care IC 3 registry, the recently rebranded PINNACLE registry is the first and only ambulatory registry for cardiovascular conditions in this country, noted William Oetgen, MD, clinical associate professor of medicine at Georgetown University, at the 59th annual American College of Cardiology (ACC) annual conference on March 16.

The session, “Preparing your practice for quality-based payment: an ACC roadmap to success,” featured multiple speakers who discussed the variety of clinical decision tools that are available through the PINNACLE Network, including the PINNACLE registry, a subset of the network.

Oetgen explained that the registry collects information from EHRs on six common cardiovascular conditions, including coronary artery disease (CAD), congestive heart failure, atrial fibrillation, hypertension and diabetes. “The software reaches into the health records to extract the data that is of interest to the PINNACLE registry and automatically send the report to the data warehouse at ACC,” he said.

The registry and performance measures are based on ACC and AHA guidelines. “We designed the registry so that it requires minimal data collection and delivers maximum clinical value on about 29 performance measures and we also offer compatibility with several commercial EHRs,” noted Oetgen. “Our goal is to provide easy-to-interpret benchmark reports on a regular basis to the practices.”

In terms of what PINNACLE has accomplished, Oetgen said that by the end of 2009, there were 34 practices submitting data, from about 112 sites. There were approximately 482,420 patient records in the ACC data warehouse at the time, and Oetgen noted that the number is now north of 600,000 records. In addition, the registry successfully submitted Physician Quality Reporting Initiative (PQRI) submissions to the Centers for Medicare & Medicaid Services (CMS) for 156 practices.

When the program first began, Oetgen said that it became clear very quickly that the ACC was not going to be able to get appropriate cooperation from the EHR vendors to collect and report data on an automatic basis. “We think that the larger vendors are interested in collecting these data themselves and selling it back to physicians, so they actually represent competition to us. With PINNACLE's integrative solution, however, we have overcome that to a large extent,” he explained.

The first finding report looked at multiple CAD measures. "Based on the records, we found that they were reasonably well collected, with a variable inherence rate for particular performances measures. Blood pressure assessment was present 93 percent of the time; platelet therapy at 90 percent; beta blockers post-MI 85 percent; drug-eluding stents 60 percent; appropriate use of cardiac rehabilitation 17 percent and screening for diabetes at 13 percent.

While the system may not have collected the data perfectly, these preliminary findings show there is “evidence for improvement,” he noted.

Why should practices consider getting involved in PINNACLE? Oetgen explained that the service provides data for quality improvement in the outpatient practice, an interest that he believes is a current priority for cardiologists.

Another benefit is that the registry provides benchmark data reports on a quarterly basis. However, Oetgen noted that as of now, these reports may not be often enough to be of use to physicians looking to improve the quality of their practice. “Hopefully in a couple of months, we will be able to provide very rapid, real-time reports concerning a physician’s practice,” he said. In addition, the registry covers all of the major cardiovascular disease entities.

Lastly, noted Oetgen, “the price is right,” as the cost is covered by the ACC and free to practices. “Once the system is implanted, the data goes automatically,” he explained. “The program is hassle free.”