Kaiser Permanente National Total Joint Replacement Registry: aligning operations with information technology.
BACKGROUND
A Total Joint Replacement Registry was developed in a large community-based practice to track implant utilization, monitor revisions and complications, identify patients during recalls and advisories, and provide feedback on clinical practices.


OBJECTIVE
We describe the development, implementation, and integration of this Total Joint Replacement Registry, highlighting critical steps in aligning information technology and operations.


METHODS
The primary Total Joint Replacement Registry data source consists of standardized electronic health record forms developed by consensus. The Total Joint Replacement Registry forms are integrated into the clinical workflow (preoperative, intraoperative, and postoperative) and produce a standardized progress note for electronic health record documentation. Secondary data are extracted from other electronic data sources using standard terminologies (ie, ICD-9 codes) to supplement the Total Joint Replacement Registry forms. Electronic screening algorithms are applied to identify complications, in combination with chart review validation and quality control mechanisms.


RESULTS
Three hundred fifty surgeons voluntarily contribute to the registry with 90% participation. The registry has been used for implant recalls and advisories, contract decision making, and identification of patients at risk for revisions (eg, younger patients having total knee arthroplasty). Tracking of overall survival of implants influenced clinical practice, with feedback resulting in the reduction of the number of unicompartmental and uncemented knee arthroplasties performed, usage of femoral head sizes < 28 mm, and the number of minimally invasive surgical procedures performed.


CONCLUSIONS
The Total Joint Replacement Registry has effectively aligned operations with information technology and leveraged that to enhance our ability to respond to recalls and advisories as well as improve quality of care, cost-effectiveness, and create research opportunities.
Paxton
Elizabeth W
EW
Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, 3033 Bunker Hill Street, San Diego, CA 92109, USA.
Inacio
Maria C S
MC
Khatod
Monti
M
Yue
Eric J
EJ
Namba
Robert S
RS
D000465:Algorithms; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000706:statistics & numerical data; D057225:Data Mining; D019033:Delivery of Health Care, Integrated; D057286:Electronic Health Records; D006279:Health Maintenance Organizations; D006302:Health Services Research; D006801:Humans; D057052:Medical Device Recalls; D008490:Medical Informatics; D010043:Outcome and Process Assessment, Health Care; D016730:Program Development; D012042:Registries; D012086:Reoperation; D018511:Systems Integration; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States