T&ORegistries

John Timperley    FRCS (Ed)  DPhil (Oxon)

UK Orthopaedic RegistersExisting:•National Joint Register (NJR)

– Hip arthroplasty– Knee arthroplasty– Shoulder/elbow arthroplasty

•National Hip Fracture Database (NHFD)•Trauma Audit and Research Network (TARN)•Non Arthroplasty Hip Register (NAHR)•British Spine Register (BASS)•Knee ligament Register (BASK)•Paediatric Register (BSCOS)•Hand surgery (BSSH Audit Website)•Foot and Ankle surgery index•Trauma Register (OTS)In planning•?Knee osteotomy Register (BASK)•?Soft tissue shoulder register•?Computer assisted surgery (CAOS)

Orthopaedic Registries in UK

• It could become the normal culture that all orthopaedic procedures are automatically entered onto a Registry

• There must be collaboration between Registries

• They can be a vehicle for multi-centre RCTs• The BOA can co-ordinate between Specialist

Societies and Registries

Registry UmbellaWhere are we?:

Two meetings of Specialist Societies:Chateau Imnpney (Droitwich) 23/10/2012London 4/7/2013

Two UK Emerging Orthopaedic Registry SessionsManchester 2012Birmingham 2013

Proposed a BOA Umbrella organisation:BOA ExecBOA CouncilBoard of Specialist Societies

ScopingRegistry Umbrella

– Facilitates National Representation of Profession in strength– EMPOWERMENT of the Profession

Issues in common– Consent/Caldicott issues– Governance– Policies (e.g.data access)– Database structure and duplication of data– Functionality– Validation of data– Interpretation and release of data

Opportunities– Strategic planning– Develop initiatives to improve compliance

• Through CGRs, NICE, Revalidation, – Integration with care.data initiative (upload to HSCIC)– Collaboration with PHIN

ScopingRegistry Umbrella

Existing models:NJRNHFDTARN

Managed by HQIPGovernance – NJR Steering CommitteeFinance – levy on implants

NHFD funding comes from HQIP (NHS England), administered by the RCPCEEU. Governance is determined by the RCP in line with their HQIP contract

Funded by contributing hospitals. Non-for-profit.Supports staff at Manchester University (Hope Hospital)“Advised by CQC”

ScopingRegistry Umbrella

Explore relationship with:HQIPRCS Eng. Clinical Effectiveness UnitPHIN

etc.

Role of HQIP:•National Clinical Audits inc. Patient Outcome Programmes•Quality Accounts Reports from all Health Providers•NCA Quality Assessment

Various roles in national audits:Lead Unit (Manages and holds Contract)Subcontracts workAnalyses data

Typically three bodies for each Registry:

Project TeamClinicians, methodologist, Managers

Clinical Reference GroupAll stakeholders

Project BoardHolds and oversees delivery of Contract

HES to CES

2014 Report: - Requires PMIs to inform patients that they will be able to obtain quality information on consultants and hospitals from the website of the insuring organisation.- Information about hospitals and consultants will be addressed via a single remedy: PHIN (Private Healthcare Information Network)- PHIN will be expanded and made more independent in terms of governance and funding. It will be jointly funded by private hospital operators and PMIs - PHIN will become the main resource for clinical outcomes and quality and the information will have to be in a prescribed content and format

CollaborationFunding?

Scope: •Individual Registries. Define and record:

– Governance structures– Functionality– Database structure– Coding (ICD, OPCS)– Mechanisms for validation of data– Policies regarding

• data requests • access for research• Interpretation and release of data

– Funding streams•Structure and function of BOA Umbrella organisation

– Structure of the organisation – Define Default Registry Model including governance and general policies– Discussion with FOI office– Define Umbrella database structure and function

• Interface with Registries (e.g. Amplitude integrated architecture)• Data sharing

– co-ordinate collaborations– co-ordinate national studies – funding/support– Promotion of data collection culture (JTO, Congress)– Contact with NHSE and lobbying

•Data governance/Caldicott issues •Outlier status identification and management (HQUIP process gudelines)•Compliance levers

– Use of CRGs, NICE, Revalidation, PBR •Collaborations

– HQIP– PHIN– care.data initiative (share data with HSCIC)– ISAR (ISOR)

•Umbrella Funding streams

Proposal:BOA Quality Orthopaedic

Outcomes Committee (QOC)Chair

BOA Exec. Member – Colin Howie – President Elect BOAManager – Julia TruslerRegistry representatives from Specialist Societies (BHS, BASK, BASS, BSCOS, BOFAS, BESS, CAOS, OTS, BSSH) Patient representativeBy invitation:

established Registries (NJR, TARN, NHFD)Software experts (e.g. Amplitude)HQIP

BOA Brighton 2014Emerging Registries session - Agenda:Co-Chairs: John Timperley, Colin Howie. 1. Overview, Structure and function of BOA Umbrella organisation          John Timperley (10’)2. The established Registry Models           NHFD – Rob Wakeman (10’),

TARN – Maralyn Woodford (10’)NJR – Keith Tucker (10’)

3. Collaborations          HQIP (Yvonne Silove) (10’)          PHIN (Matt James, CEO) (10’)