SER Next-generation Dashboards

Deployment Date: December 2024

The next generation of SER dashboards has launched. The new dashboards improve:

• Aesthetics and usability
  • Navigation tabs are now available at the top of the page for easier access
    • Toggle between tabs to follow the episode of care
  • Removed "National-Level" tabs for each episode of care
  • Integrated into Authorized User and Surgeon Authorized User dashboards for ease and efficiency
• Access to data
  • Data drill downs are available with a right click for graphs displaying rates to show record-level data submitted by the site
  • New tables to the left of graphs were added to show numerators of each procedure or diagnosis type
• Improved accuracy
  • Updated calculations and measures for precise reporting
  • Standardized Metrics: Seamless comparison of national and institutional data for better insights
• Benchmarking, trends, and analysis
  • Five new filters were added
    • Institution Type: Allows filtering data based on the type of institution (e.g., Academic, Community, or Specialty)
    • Bed Count: Enables users to filter by institution size using the total number of hospital beds
    • Teaching Status: Provides the ability to filter by whether an instition is designated as a teaching hospital
    • Race: Adds functionality to filter data based on patient race categories for more detailed demographic analysis
    • Payer Status: Allows filtering based on insurance or payer types (e.g., Private, Medicare, Medicaid, or Self-Pay)
  • Insitution type characteristics were acquired from the AHA Survey Database

Removal of Rotator Cuff Repair Revision Visual in SER

Deployment Date: December 2024

The "Rotator Cuff Repair Revision" visual was removed from the SER Next-generation Dashboards to align with the Registry's updated terminology. A replacement "reoperation" visual is not present but is planned for inclusion in a future update.

SER Mean Charlson Comorbidity Index Card Updates

Deployment Date: December 2024

The "Mean Charlson Comorbidity Index (CCI)" card was removed from the "Procedures" dashboard tab in SER due to the lack of available data. Pipeline issues on the "Post Discharge" dashboard tab were resolved and the "Mean CCI" card in that location now accurately reflects the full data set.

Linked 90-Day Readmission Rate by Diagnosis Visual Updates in AJRR and SER

Deployment Date: December 2024

The "Linked 90-Day Readmission Rate by Diagnosis" visual received updates in AJRR and SER. The visual now displays "National" and "Institutional" comparison bars for Authorized Users. "National," "Institutional," and "Your Data" comparison bars are visible to Surgeon Authorized Users to provide multiple comparative perspectives.

The layout has been adjusted for clarity, ensuring easy interpretation of the data comparisons. The values in the visual are accurate and aligned with the latest data.

National Comparison Bars in ASR and AJRR Dashboard Visuals

Deployment Date: December 2024

"National" comparison bars were added to specific dashboard visuals in ASR and AJRR. The bars reflect the latest available benchmark data and provide more context for the metrics. Authorized Users and Surgeon Authorized Users will both be able to see the new "National" comparison bars.

ASR visuals with new "National" comparison bars:

• "Procedures" tab: "Comorbidities Present on Readmission"
• "Post Discharge" tab: "Comorbidities Present on Readmission"

AJRR visuals with new "National" comparison bars:

• "Procedures" tab: "Comorbidities Present for Your Institution(s)"
• "Post Discharge" tab: "Linked 90-Day Readmission Rate by Diagnosis for Your System," "Comorbidities Present on Readmission for Your Institution(s)"

Revision and Post-operative Visuals Update in AJRR and SER

Deployment Date: December 2024

Revision-related visuals in AJRR and SER were updated to enhance clarity and consistency. Key updates include:

• Expanded Revision Coverage: Visuals now include both procedures and post-operative cases
• Updated Denominators: All revision visuals use all index procedures as the denominator
• Enhanced Documentation: Clearer titles and explanations for visuals are provided
• "All Time" View: The view removes the previous 90-day limit, allowing full historical revision data
• Procedure Type Filtering: Filters now apply to revisions by specific procedure types, such as "hip hemiarthroplasty"

Visuals Reordering in the AJRR Dashboard

Deployment Date: December 2024

The visuals within the AJRR dashboard were reordered to improve the logical flow and enhance user experience. The updated layout ensures that related data visuals are grouped for better interpretability and accessibility.

Key Updates:

• Procedure Data Placement: The "Procedure Type" and "Your Post Discharge Procedures" charts are now prominently displayed at the top to prioritize key procedural data insights
• Revision Rate and Diagnosis: The "Your 90-Day Linked Revision Rate by Diagnosis" chart is strategically placed below the procedural data, providing a clear transition to revision insights

American Joint Replacement Registry Quality Improvement Scorecards

Deployment Date: Q3 2024

AJRR participants gained access to the Quality Improvement Scorecard on the Institution and Surgeon Dashboards in RegistryInsights. The Scorecard enhances transparency, allowing participants to track performance, benchmark against national standards, and support practice improvements.

What's New?

• Scorecard Dashboard Tab: Track key metrics, including:
  • Unplanned 90-day readmission/admission rate
  • 90-day composite complication rate
  • Preoperative patient-reported outcome measures (PROMs) completion rate (90-0 days pre-op)
  • Postoperative 1-year PROMs completion rate (300-425 days post-op)
  • Pre AND postoperative 1-year PROMs completion rate (90-0 days pre-op AND 300-425 days post-op)
    • Aligns with the Centers for Medicare & Medicaid Services (CMS) Inpatient Quality Reporting (IQR) Total Hip Arthroplasty (THA) / Total Knee Arthroplasty (TKA) Patient-reported Outcomes Performance Measure (PRO-PM) and Joint Commission 1-year PROMs requirements
• Measure Details: Measure definitions and coding lists can be found within the "2024 Scorecard Measure Specifications & Code Lists" document in the "Dashboard Guides" section of "Tools & Resources" on RegistryInsights.

For more details, see the "July 2024 Registry Release Notes" in "Tools & Resources" on RegistryInsights.

View the "August 2024 Release Notes" for information on functionality updates that were made in August 2024.

The Scorecard tooltips were updated in December 2024 to provide clearer explanations of metrics. The improved tooltip content includes numerator, denominator, and benchmark comparisons for transparency and better understanding.

Coming Soon

• Risk-Adjusted Revision Rate: A new, risk-adjusted measure to provide a deeper look into revision rates
• Quarterly PDF Summaries: Regular summaries to provide snapshots of your key metrics with links to the full dashboard

To ensure all your site's users receive the quarterly PDF summary emails, please confirm your users are current in the "Role Management" section under "Administration" on RegistryInsights.

Tools & Resources Enhancements

Deployment Date: July 2024

The "Tools & Resources" section of RegistryInsights has been updated to improve the organization of instructional documents. In addition to new sections categorized by document type, supplemental information is available when hovering over each document.

For additional information on the updated "Tools & Resources" section, please view a recording of a recent office hours session that offered a preview of the new layout before it launched.

Secure File Transfer Protocol Updates

Deployment Date: June 2024

AAOS enhanced the security of secure file transfer protocol (SFTP) transmissions on June 17, 2024, by adhering to industry best practices and aligning with the National Institute for Standards and Technology (NIST)'s standards. These standards provide guidance on the use of cryptographically secure protocols and ciphers.

These changes applied to all AAOS registries. The updates do not affect uploads via the HTTPS website, only uploads via SFTP client software are affected.

Please share the "Registry SFTP Requirements for Compatibility" document with your site's IT department to ensure continued communications with the AAOS Registry SFTP service after June 17, 2024. The document can be found in the "Data Submission Tools" section of "Tools & Resources."

Registry Quality Collaboration with the Blue Cross Blue Shield Association

Deployment Date: Q2 2024

The AAOS announced that it is collaborating with the Blue Cross Blue Shield Association (BCBSA) to allow quality outcomes data from the AJRR and ASR to be evaluated for current and prospective Blue Distinction® Centers.

AJRR and ASR accept the data that meet the five required quality measures for Blue Distinction Centers, and sites can submit via the Registry Program or the BCBSA Provider Survey for the 2025 Designation Evaluation. New dashboard visuals for the five measures are available in the Performance Measures tab of RegistryInsights, and a performance report for BCBSA metrics launched in May. The report received updates in August to improve the functionality and user experience.

Read more about the collaboration here. View the "June 2024 Release Notes" on RegistryInsights for more information on the dashboard visuals and performance report.

PRO Portal Updates

Deployment Date: May 2024

The Patient-reported Outcome (PRO) Portal was updated to improve the functionality and user experience for Registry participants. These updates included:

• New PRO Portal menu
• Additional Patient Lookup fields
• Kiosk Mode updates
• Responsive mobile design
• Clear, Save, and Submit functionalities were added
• All survey questions display in a single screen
• New survey completion emails

Learn about these enhancements in the "May 2024 Release Notes" in the "Tools & Resources" section of RegistryInsights.

PROMIS Global Update to v1.2

Deployment Date: May 2024

We have updated the PROMIS Global responses to v1.2 of the assessment. Sites submitting on the 2024v1 AJRR PROMs file must update responses to have the assessment accurately scored for any submissions after May 9. No action is required for PRO Portal users, as the PRO Portal was updated automatically.

Please see information on the PROMIS Global v1.2 in the "May 2024 Release Notes" on RegistryInsights.

Shoulder & Elbow Registry Data Specifications Updates

Deployment Date: Q2 2024

We have updated the Trigger Codes and Concomitant Codes tabs in the SER Data Specifications to support data extraction clarity. In the procedure file, at least one trigger code needs to be submitted per patient case and a concomitant code should not be submitted without a trigger code. View the new SER Data Specification versions in "Tools & Resources" on RegistryInsights.

Resources for the CMS IQR THA/TKA PRO-PM

Deployment Date: Q1 2024

The CMS IQR THA/TKA PRO-PM mandated that pre- and postoperative data must be captured for procedures performed from July 1, 2024 - June 30, 2025. The AJRR offers an IQR PROMs Performance Report for tracking PROMs completion and scores for the required data elements. The report is formatted for direct submission to CMS, or you can opt in to have the AJRR submit the data to CMS on behalf of your site.

Click here for more information on how to use the AJRR to support your site with the CMS IQR THA/TKA PRO-PM.

The Next Generation of RegistryInsights Dashboards

Registries Impacted: AJRR, SER, and ASR

Deployment Date: AJRR - November 2023; ASR - February 2024; and SER - Spring 2024

The next generation of RegistryInsights dashboards will improve:

• Access to data

  • Data drill downs are available for graphs displaying rates to show record-level data submitted by the site

• Benchmarking, trends, and analysis

  • Five new filters were added

  • Institution Type characters were acquired from the AHA Database

• Aesthetics and usability

  • Navigation tabs are now available at the top of the page for easier access

    • Easily toggle between tabs to follow the episode of care

  • Removed National-Level tabs for each episode of care

    • Integrated into Authorized User and Surgeon User dashboards for ease and efficiency

• Actionable quality improvement measures

  • The Performance Measures Tab now includes data for sites supporting Quality Payment Programs

    • QCDR Measures, e.g. Postoperative Ambulation (Hip)

    • MIPS CQMs, e.g., CQM 376

  • Data automatically populate in the Measures

  • Data in the Performance Tab populates for four programs regardless of site participation

This information can be found in documents available in the Tools & Resources section of RegistryInsights.

New Epic SmartForm Version and Dashboard Enhancements for the Musculoskeletal Tumor Registry

Registries Impacted: MsTR

Deployment Date: Fall 2023

The new MsTR SmartForm version enables surgeons to input exclusive data concerning their sarcoma patients at the point of care, which cannot be readily extracted from the EHR automatically. The new version is accessible through a turbocharger package available for download from the Epic community library, allowing for facilitated implementation into the surgeon's clinical workflow.

Several dashboard enhancements were introduced for MsTR in 2023. These enhancements expand the existing MsTR dashboards to include visual representations of data elements captured beyond the initial baseline visit where patients are assigned their histological diagnosis of sarcoma. The new graphs provide information on recurrent follow-up encounters such as complications, recurrence, and additional OR visits, offering a more comprehensive and perpetual view of sarcoma care over time.

New Epic SmartForm Version for the American Spine Registry

Registry Impacted: ASR

Deployment Date: Fall 2023

The ASR, a collaborative effort between the American Association of Neurological Surgeons and AAOS, also received a new Epic ASR SmartForm version. Similar to the new MsTR SmartForm version, it is accessible through a turbocharger package. The new ASR SmartForm version allows surgeons to input spine data that cannot be extracted from the EHR automatically.

Data Element Quality and Coverage Dashboard

Registries Impacted: AJRR and SER

Deployment Date: AJRR - August 2023; SER Levels 1 and 2 - November 2023; SER Levels 3 and 4 - February 2024

AJRR and SER participants can now utilize the Data Element Quality and Coverage Dashboards to help improve completeness, inform outcome analysis, and enhance the overall quality of Registry Program data.

There are three different file layouts for three different episodes of care:

• Procedure - intended to capture the primary or index procedure
• Post-op - created to capture complications that occur within 90 days of index surgery (both surgery-based and not)
• Patient-reported outcome measures (PROMs) - several different PROMs are collected at multiple intervals (pre-op and post-op)

We identified four levels of data submission quality for these three episodes of care for the Data Element Quality and Coverage Dashboard.

These levels are:

• Level 1 – Minimum Data Set
  
  The Minimum Data Set is the minimum number of elements that are utilized to identify a procedure with basic information on the patient, performing surgeon, and procedure details. The visuals in this level will help your site know why data may not be populating on your dashboards.
  
  
  • Required for a submission to be accepted
  • Includes fields such as Patient First and Last Name, DOB, Surgeon NPI, and procedure and diagnosis codes
    
    
• Level 2 – Enhanced Data Set
  
  The Enhanced Data Set includes research-relevant data elements. Reporting is not required. However, it is needed for recognition as an enhanced reporting site.
   
  • Enhanced reporting sites will be recognized in the AJRR and SER Annual Reports and the recognition may be required for centers of excellence designation or credit for the American Board of Orthopaedic Surgery (ABOS) Maintenance of Certification
  • Includes fields such as BMI, anesthesia type, surgical technique and approach, and robotic use
    
    
• Level 3 – PROMs
  
  PROMs data reflect the patient’s perspective on the outcome of surgery, and in conjunction with other clinical measures can provide a fuller picture of the impact of care.
  
  
  • Includes accepted general health scores and joint specific scores
  • There will be additional recognition for sites consistently submitting PROMs
    
    
• Level 4 - Remaining Elements
  
  The Remaining Elements encompass any data elements not included in the other levels.

For Level 1 data elements, completenesses display as green if your site’s data for that field is entered in the acceptable format, or red if it doesn’t meet that requirement. The dashboards also show your site’s data quality progress over time. As for the other levels (2, 3, and 4), the completeness displays as green if it’s above the national benchmark and orange if it’s below the national benchmark.

An AJRR Data Element Quality and Coverage Dashboard quick reference guide, full user guide, and FAQs document are available in the Tools & Resources section of RegistryInsights.

Surgeon Dashboard Integration with the AAOS Website

Registries Impacted: AJRR, FTR, MsTR, SER, and ASR

Deployment Date: August 2023

AAOS members no longer need to log in to RegistryInsights separately – they can view case-level data submitted to the Registry by logging into their MyAAOS Customer Account on the AAOS website.

We implemented this dashboard integration to improve the registry data that will inform practice change and drive outcomes. AAOS members are only able to log into their dashboards if their site sets up an account for them in the Registry platform. Ask your site’s Registry Authorized User to create a Surgeon Authorized User account for each of your site’s surgeons or reach out to RegistrySupport@aaos.org to identify your site’s Authorized User. This document details how to set up a Surgeon Authorized User account.

Click here for a guide on how to access the Surgeon Dashboards from the AAOS website.

File Encryption for Every Registry Report Download

Registries Impacted: AJRR, FTR, MsTR, SER, and ASR

Deployment Date: August 2023

We updated RegistryInsights to improve the security and encryption process of the exportable reports. Any file or report containing PHI is protected and requires a user password going forward.

All RegistryInsights reports now require a personalized password to be accessed. You will need to visit the new “RegistryInsights Report Password” section in the platform and copy your password to open downloaded Excel files.

If you have any questions about the file encryption process, please view the guide in the Tools & Resources section of RegistryInsights or reach out to the Registry Support team at RegistrySupport@aaos.org.