Ensuring the safety and quality of total joint replacement: The American joint replacement registry (AJRR)

Background: Over 750,000 total joint replacements (TJR) are performed in the United States annually. With exponential increases expected in TJR, attention must be paid to implant failure, periprosthetic joint infection, and associated expenditures. The goal of the AJRR is to foster a national center for data collection and research on TJR with societal benefits including reduced morbidity and mortality; improved patient safety, quality of care and medical decision-making; reduced spending; and advances in orthopaedic science. Objective: A pilot project was conducted to evaluate the feasibility of a multi-stakeholder national TJR registry. Methods: In 2010-2011, AJRR conducted a pilot project with a nationally representative sample of hospitals. The goal was to: a) collect Level I (procedural and demographic) data; b) assess privacy, legal and Institutional Review Board issues; c) review data submission procedures and data quality; and d) make recommendations for selection of a technology solution for the production phase of a national registry. Results: Data on 6,003 procedures were collected from 8 hospitals. Level I results were comparable to findings from other TJR registries. Challenges regarding the data submission process included: a) mandatory submission of Protected Health Information; b) varied electronic medical record (EMR) systems; c) errors associated with manual data entry; d) database security including HIPAA and HITECH compliance; and e) higher priority tasks to be completed prior to data submission. Since concluding the pilot project, AJRR has enrolled 121 hospitals. Our Level I national registry went live in June, 2012 and now contains data on over 34,000 TJR procedures. Discussion: During the pilot project, AJRR encountered varied departmental review processes at each site. As such, the AJRR recognized the need for a configurable, dynamic technology solution and cooperation from EMR vendors. The AJRR also identified the advantage of using Enterprise systems for extracting data sets representing multi-hospital systems.