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Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology

  • Symposium: ABJS Carl T. Brighton Workshop on Health Informatics
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

Questions/purposes

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.

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Acknowledgments

We thank all of our orthopaedic surgeons and the registry staff who contribute to the success of the TJRR.

Author information

Authors and Affiliations

  1. Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, 3033 Bunker Hill Street, San Diego, CA, 92109, USA

    Elizabeth W. Paxton MA & Maria C. S. Inacio MS

  2. Department of Orthopaedics, Kaiser Permanente, Baldwin Park, CA, USA

    Monti Khatod MD

  3. Department of Orthopaedics, Kaiser Permanente, Sacramento, CA, USA

    Eric J. Yue MD

  4. Department of Orthopaedics, Kaiser Permanente, Orange County, CA, USA

    Robert S. Namba MD

Authors
  1. Elizabeth W. Paxton MA
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  2. Maria C. S. Inacio MS
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  3. Monti Khatod MD
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  4. Eric J. Yue MD
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  5. Robert S. Namba MD
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Corresponding author

Correspondence to Maria C. S. Inacio MS.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Appendices

Appendix 1. Total Joint Replacement Registry forms (hip and knee operative, preoperative, postoperative)

Appendix 2. Total Joint Replacement Registry Smartforms examples (preoperative and postoperative)

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Paxton, E.W., Inacio, M.C.S., Khatod, M. et al. Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology. Clin Orthop Relat Res 468, 2646–2663 (2010). https://doi.org/10.1007/s11999-010-1463-9

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  • DOI: https://doi.org/10.1007/s11999-010-1463-9

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