The ACC is dedicated to equipping clinicians, hospitals, health systems, and other facilities and stakeholders with the tools and best practices for designing, leading, and ultimately achieving quality care. And both NCDR and ACC accreditation services are key in driving this work forward. NCDR and accreditation are under the umbrella of ACC. And while they may appear separate, they're actually pretty entwined. They're symbiotic in a way. Because in order to achieve your accreditation standards and status, you need to have that data and a continuous improvement process so that your data continues to get better and better. NCDR is the gold standard registry of quality assessment and quality improvement in the world. It really sets the standard for how we capture data in clinical care delivery that informs current care, current practice, the quality of that care, and opportunities for improvement. The registries can really help you understand how you're caring for subgroups of patients, including women and underrepresented minorities. The NCDR registry is a great platform for providing outcomes for what your hospital does providing care to cardiovascular patients. Accreditation is another element of continuous quality improvement. Accreditation is a mechanism with tried-and-true standards and procedures and protocols that help determine how well a patient can go through our systems. It's a collaborative process, and this involves taking a look at processes of care and making sure that everything is as optimized as is possible. Each accreditation or certification combines evidence-based science, quality initiatives, clinical guidelines, and best practices to help reduce variations of care. The science, all the knowledge, and the innovation that has been brought forward over many years, many decades, in fact, of experts from a multidisciplinary viewpoint, cardiology, emergency medicine, hospital medicine, administration, nursing, all there coming together to formulate these tools. There are always new devices, new therapies that we will need to understand as they are rolled out in clinical practice. The opportunities for registries to inform will never end, and we will continue to be at the cutting edge of that. I'm very excited for the future. We all bring a perspective of how to better take care of the cardiology patients. In the American College of Cardiology, their whole purpose is trying to improve the care we provide our cardiac patients. ACC's vision is a world where science, knowledge, and innovation optimize patient care, and both the NCDR suite of registries and accreditation line of products are both tools meant to advance the field of cardiology toward this ultimate goal. I think we're ready to go, guys. Good morning, everyone. So, so, so nice to see you all, and welcome to Orlando. We saw each other last in Los Angeles last year, and it's been really amazing to see how we've gotten back in person, and the participation and your ability to get out and come to this session these few days, and we're really, really happy to see you. I'm David Bonner. I've been with the college for several years, and this is Morning Conversation and Coffee with the NCDR experts, and experts mean you as well. So we have people here on the panel who actually have experience in the field as well as their experience at ACC. So welcome. Let me go backwards real quick here. Let me just introduce the panel. Starting to my right, we have Sheila Nichols from Allegheny Health Network. Sheila brings with her about, I don't know, 11 years of NCDR experience. She is a CV practice administrator, and has actually, Sheila, I don't know, you've been to every one of these meetings in the last 11 years you've been here, correct? Yes. Yeah. So we're very happy to have Sheila, and again, she's one of you. Next to Sheila, we have Kristen Young, who works at the ACC. She's a clinical quality advisor, and she also came from the seats where you're sitting, and I think about six or seven years ago, we met Kristen at one of these particular meetings, and she made that transition. So she knows where you're sitting, too, and she has kind of both sides of the picture. Next to Kristen, we have John Durroute. John has been a CV nurse for a long time. He's also been with the college and is a clinical quality consultant. So he brings a wealth of knowledge, especially in the cath PCI registry realm. And next to John is Shelly Conine, again, a wonderful person that has been a nurse for a long time and is also, you've been eight years with the college, with NCDR as a clinical quality advisor. And then our newest CQA is Yan Hong, and Yan is also somebody who came from the registry site manager abstraction world, and she has worked many, many hours in the D.C. area and has now transitioned to be on the CQA team. So a round of applause for our panelists. We have a diverse audience here, and, you know, we received feedback at our last session about what you would like to hear from us, and we had, oh, my gosh, if you can imagine all of you making comments. So what we did was went back and kind of compiled all that information. We said, how can we make this from somebody who is brand new all the way to somebody who is very, very well adapted to the registries? So can you just raise your hand for me if you've been here just within the last year? Is this your first conference? Okay. So we have incorporated a lot of things in the presentation that might help you get acclimated and learn from some of our conversation today. Anybody been here between 1 and 5 years or 2 and 5 years? We still have people there. That's good, and I'm sure there's a lot you can learn. What about over 10 years or between 5 and 10? Oh, wow. So we really have a diverse audience. So, you know, understand that we're trying to make this important and meaningful to everyone. So if there's things you know, that's fantastic, and this is not black and white. If there's things you know and, you know, maybe we don't know, you can feel free to submit questions or comments, and we'll be able to add some of this to our conversation. Our main purpose for this conversation is to collaborate with everyone in the room. So we hope that it ends up that way, and we're looking forward to that conversation. One thing that I always want to point out is this is not a registry-specific session, so we will not get into details of any specific registry, what works in that registry, what doesn't work in that registry, or anything about specific sequence numbers. We just want to keep this along the lines of where we want to go with it and keeping it kind of wrapped around that whole diverse concept. Before we get started, I do want to take a moment to also point out Barb Christensen, who is actually—just stand up, Barb—Barb Christensen, who is going to be at the table. She'll be fielding questions along with Christina Cutros, if you could stand up too, Christina. Barb is our Executive Director of Registry Services. I know a lot of you have seen and heard from Barb over the course of the last several years, and then Christina is the Director of Registry Services. Together with a whole lot of other people, we're able to do the things that we do. Now, Barb and I and Christina and I have known each other for 25 years, and it's really amazing as I was thinking about that, it's like you can look around, and maybe some of your colleagues as well, you're like, wow, we've really done a long time in this field, whether it was actual nursing, whether it was actual data abstraction, and just kudos to all of you for advancing patient care in whatever form that it is, and we're really, really happy that you're here. So let me see here. If you have questions, you can submit those questions. I'm not sure I have the process to tell everyone how to submit questions. If we can get Barb's mic. No. Hello? Okay. Yeah. Hello? Okay. If you go to your app, and you go to this specific session, at the bottom of the app, you'll see something that says Q&A. Just click on that Q&A, and you'll be able to submit questions through the app. Thank you, Barb. I appreciate that. So in this first session, we're going to talk about the evolution of an abstractor, and our perception of this, right? So that doesn't mean this is something that you've experienced, but I think based upon the fact that we gathered this feedback from you, I think we're going to hopefully hit on some things that are important to you. Then we're going to also try to identify hurdles, and how to get over them, and then we're going to showcase registry value to leadership. So that's what we're going to talk about in today's session. Okay? I want to first read something to you, because it's important to me. This is an email that we got from one of you, and we get several of these emails. We do get all kinds of emails, but you know. Your staff needs recognized for their patience, kindness, knowledge, and empathy. I'm new to the registry in the last year, and I have so many annoying questions. I'm afraid to ask these questions. They take their time explaining everything to me, and they're so kind. Your staff take the time to answer all my questions, and I've learned so much about the registry I did not know. I can't thank you enough. So with that, you're not alone, and together we can work through this. So let's start here with, I'm a new abstractor, or I'm new, and I was thrown into this. And that's actual conversation we have. Kristen, why don't you lead us off? Yeah, I was going to say, as I look at these quotes, I probably could relate to maybe three whenever I was in that abstractor role. But hindsight is 20-20 for me, so being in this role, but looking at myself whenever I started out, if I could say the one thing, the one piece of advice that I could give all of you who may be that novice learner is to really build a foundation. You need to have a solid foundation, a solid understanding of processes, and maybe even like our nomenclature, our anacronyms. What does DQR mean? Just the basics that can really build upon that to make you go through that expert phase. I'm just curious to know also, as by a show of hands, who at their facility has a formal education training program whenever you have a new abstractor come on board, because that would be really enlightening for us to see. That's not a lot of hands. So three of you do. Yeah. So, yeah, and like I said, that's very relatable to me whenever I was in that role as well, because I was just thrown into it, and I didn't even know essentially where to go to even find education, or even if NCDR really had education, but coming onto this side and realizing how important education is to build the solid foundation that a novice learner needs. We're all novices, right? Whenever you first start out in anything in nursing, you didn't just get thrown into taking care of an intubated patient, right? You had to usually start off at med-surg. I don't want to digress, so I'm going to stop there, but my point is, again, just building that foundation, and now we have learned by seeing that show of hands that we really need to create good content to help you guys who don't have these standardized training programs at your facility whenever you're thrown into this. We have heard from people that they have people working in their clinical registries, and they don't have a background, any kind of clinical background. Sheila, do you have any input into that, and would it be important? That's one of our bullet points. Why is it important? Is it important? Sure. And how does that affect things? Yeah. First of all, thanks for having me on the panel today. Oh, you're welcome. Absolutely. Thank you for being here. Sure. So I started in 2012 doing the registry, and I kind of fit into the bucket of the registry was handed to me, you figure it out. When I started my role as a new position at my prior organization, I was handed the ICD registry, which is now the EPDI registry. It was six months behind. Everybody was really looking at the outcomes reports. And my first task was to catch up the data abstraction and start showing what our data looked like. And was there room for improvement, and how do we improve it? The person that had been doing it was an EP scheduler. She was not a nurse. She was doing it in between and when she had time from her scheduling responsibilities. So once I started doing it, and kind of the data dictionary was my Bible. We didn't have the resources that you guys have now. So Denise Pond and I, for those of you that know Denise Pond, who's now retired, will probably be friends forever because I called her so much when I was a new abstractor. But one of the things that we realized and why the clinical aspect is important, the scheduler that was doing it, she was doing a really great job. And she taught me what she could to hand it off. But from my clinical background, I recognize that SOTA law was listed as anti-arrhythmic. But we know that it has, if you're a clinical staff or you have, you know, if you're a nurse, you know that that also has beta blocker properties. So I asked, can that be taken as the beta blocker? Yes, it could. So she was missing all of those beta blockers, which we know is an executive metric. And the other thing was defibrillation. When they were doing DFTs in the lab, they were putting the patient into V-fib and defibrillating them to test the defibrillator. She was counting that as defibrillation, as cardiac arrest and defibrillation, well, as V-fib. So just those kinds of things is where the clinical aspect is very helpful. And I don't want to say that if you don't have it, you can't do it, because I'm sure there are people in this room that don't. I'm just saying that it's more difficult to learn. So ask questions. If you're not sure, ask a clinical individual. And Google, your friend. Google is your friend through the whole. Sorry, John. That's okay. Yeah, no, I wanted to build on what Sheila was just saying. So I mean, it's understood that there's a variety of experience in the room, some clinical, some non-clinical. It's a bit more of a challenge, of course, if you don't have that clinical experience being a nurse. But it's certainly achievable. And for those that have the clinical nursing experience or healthcare experience, you may not have the procedural area experience. And if it's a procedure-based registry that you're supporting, I think that especially – well, this is for the folks that are actually working in the hospital and not remotely – there's a real big opportunity there to feed off of the staff that work in these procedural areas every day. I mean, they are such experts in what they do. And so you can learn a ton. And I think that most of them would be really happy to go ahead and share their knowledge and their experience with you to go ahead and help you in your role. I know working in the cath lab, I enjoyed any time I had an opportunity to teach anybody anything. And especially if I knew it was for the purpose of quality improvement, yeah, go ahead, pick my brain. I want to share this. In my past experience, I transitioned from clinical to data abstracting. It definitely helped me. We all know how important door-to-balloon is. So I was a cath lab staff. I need to document this. In registry, I'm like, oh, this is why there's measures, there's things, there's standards. So it does help to understand the purpose and connect the dot with the clinical experience. Yeah, let me ask you a question, if you don't mind. So when you transitioned from being in the hospital, in the registries, and then you came to NCDR, did you realize the resources? Did you see a difference? You had been in the field for so long. Did you know we had the resources and things that were there to help people? At the time, and my big resources, I have a great mentor, and it really helped me. And I don't think we have the same resource then and compared today. We have the QI Learning Center. We have some with the staff here studying the QI Learning Center. We have case scenarios back then we didn't have. And we also have these registrars review the questions. It helps. And I think, you know, if I know that back then, maybe we'll have code of some case more accurate versus that I was my guessing. It definitely helped. But just to point out, for all of those of you who raised your hand, who are in this for less than one year, please give yourself some grace. Yeah, it's, you know, it's definitely a hard thing. And I always tell people, when we start a new person on our team, it takes a significant amount of time. And we do it seven days a week, or five days a week, seven hours a day, something like that. We have long lunch hours. We work on Saturdays. Anyway, we work eight days a week. And it takes us a long time to learn everything. So then I always sit back and I think, oh my gosh, so, you know, somebody who is just new to an abstract reposition, who was maybe even pulled from another department, and they're like, this is what you're going to do now. You know, I cringe when I think, like, what resources do you have? Who's teaching you what? And you know, because at the end of the day, you're still responsible for the data results at your facility. So we definitely empathize and we're always open for different ways to tap into what you might think we could do better to help educate, to help streamline things for you. Like I said, we don't know all the answers, but we're definitely open ears and willing to work together. Yeah. I'm not sure if all of you noticed the trend, but we're really trying to put our education also in one place. So if you've noticed this, I see some heads nodding, our QII Learning Center. So we're trying to direct you there for all, like, our case scenarios have moved there. Even our, like, whenever we do a registry upgrade or a small update, we try to get those new videos out related to what has changed because update, upgrade means we're changing, right? We're growing. So things aren't going to stay the same. So we have to get that new information to get a quick turnaround on, you know, updated abstraction out there. But also, Kristen, we have accreditation pipeline now in our QII Learning Center. We also have the annual conference. We have the quality summit pipeline. So you can see the presentations if you missed them from last year. And I think we're keeping a rolling copy of those. We have a non-CE pathway. We have a CE pathway. We try to renew our presentations to help those of you who need CE credit. There's a lot of benefits to going there, but we also understand it's not how you're going to learn everything, right? We also understand that it's going to be an interdisciplinary functionality that's going to help you learn everything. So just hang in there with it. I want to add to that real quick because you guys are all here, for those of you that are new, you might not know the impact of networking quite yet. But another way to learn, because we saw that not a lot of you have a formal registry training, maybe you were lucky enough for the person that was doing it to hand it off to you. But if not, reach out to each other. Look at that shared resources because this is one of the areas that I've noticed the most people are so willing to share their processes. Someone might not be able to implement it the same way as you because their resources are different, their buy-in is different, but you're gonna get ideas that you can use. And there's also a list of the participants that are willing to share their contact information. If they're willing to share their contact information, they're likely willing to share their processes. I know I am. And just to add on, so she's speaking of our participant resource sharing. That's where many of you have submitted processes or projects that have worked for you in your facility and you're willing to share it. So for those of you who are not familiar, participant resource sharing as well as the participant directory is also within the private side of NCDR and it is valuable. And for those of you who have not submitted one, we would love to have your process or project. Well, it's just about helping each other, right? Yeah, it is about helping each other. But in that vein, Shelly, and I'm sorry if I just cut you off. I do apologize for that. But in that vein, we do have a lot of you who have participated and submitted abstracts. So please make sure you work your way down. Watch the presentations, the on-stage presentations from your colleagues and see some of the practices they have put into action using the data and the processes that they're implementing too. Absolutely. Sheila, you had experience about, you know, when you first started, you know, maybe you were only one abstractor in a facility and you experienced a lot of burnout or you had to kind of protect yourself from burnout. So in this age of getting back to a new reality that's post-COVID, and I don't even feel like we even need to say that anymore, but a lot of work has shifted to people being isolated. A lot of work has shifted outside of like departmental cohesiveness in the hospital. If you're just kind of there and you have all these cases and you feel understaffed, what kind of experiences do you have? And maybe do you have some feedback for people based on your experience? Yeah, when I took over that ICD registry and it was way behind, I had to abstract literally 600 cases or over 600 cases back to back to back to back to get us caught up so that you're really looking at more real-time information so that you know where to focus. One, that's how I became an expert because the more you do, the more expert you're going to be because you're going to ask questions. But two, I was feeling if I have to abstract one more case, I just I can't do this. It was so much, but once I did get it caught up and I started looking into the metrics and the drill down and learning why the patients were outliers and and looking at the companion guide, the metric companion guide, and learning the inclusion exclusion, and I could speak to it, oh that piqued my interest. That's why I'm here 11 years later still doing it because that's where one, you understand the importance of what you're doing and how it truly is impacting patient care. A lot of us, myself, I've left the bedside, went back, left the bedside, went back, and I had to recognize you're still impacting patients at a higher level and many more patients. So get involved with more than even if you are not the person that's responsible for the reporting piece. Look at those documents and understand why you're collecting the data. It makes what you do so much more impactful. Can anyone identify with what Sheila is talking about? Yeah, so there's several of you and I know everyone's experience is different based on the size of your departments and the workload that's being put out, whether you use third-party contractors for data abstraction, there's a lot of different factors to things. But you know, I think the biggest thing here is, and we have on one of our bullets is, you know, maintain organized communication, whether you're by yourself or you're in a team. I think communication is so, so important to all of our jobs and making sure that your boundaries are in place. You know, like if you're gonna have a lot of a huge workload, I mean, there has to be some level of setting boundaries to make sure that you're being supported. And that might mean you need to kind of step out of the box sometimes and think about it, or give us a call and say, what are other people doing? And maybe we can help walk through or connect you with one of your peers. Yeah, I wanted to just add to that, David. I think when you're talking about the burnout that Sheila was speaking to, inevitably, because so much of the job is dependent on documentation, on good thorough documentation, you're looking to the physician primarily, usually conceived, you know, but there's opportunity there to kind of build on my last comment to use the procedural staff who actually are collecting, they can collect some of that information. So the physicians are probably gonna have their own way of documenting, you know, they basically have been trained and have been working in a certain capacity their entire careers. And, you know, some might be more likely to maybe augment their practice to go ahead and kind of help you out a little bit to give you the documentation that you need, and others may be a little bit more resistant. But a lot of that, a lot of those variables, a lot of those data points are collected literally during the procedure. So I think that there's really an opportunity there to go ahead and speak with the staff directly and say, hey, this is the kind of information that we need to collect. And then it also makes it a little bit easier on the physician, and so that you don't have to go ahead and track people down necessarily, because I think that that must have something to do with some of the burnout is just getting kind of thrown up your hands, like when you just don't have what you want, or you don't have a good explanation or understanding of what the person, the physician is trying to to actually convey. Yeah, and let me ask you, you had a lot of experience, and you had a very successful department. And, you know, what did you do to, you know, communicate, make sure people are engaged? Did you share with the entire team? Do you have people that are included in seeing results, that type of thing? How do you engage people? I try to talk to the physicians and then my leaders to figure out where the best way they want to see the results, especially for the medical directors. If they are, like, saying, give me an email, give me the pictures. I review the dashboard and give them the pictures of their week. Every week they get something. I make common conclusions that we stayed good, or like there's something we need to address. So it gets their attention. That's the way they want to communicate. And also I feel like it's incorporated some certain elements through the care process is the best way to decrease some burden. I don't know if you all had experience, you know, knowing that capture the Timmy flow after PCI. It is a hard element. If the physician didn't document it right away, you would not know. So we worked in the cath lab and, you know what, let's ask the doctor right then and then. It's documented. It's there. It's easier for you to abstract. So that's how you decrease your burdens, you know, makes life a little easier for both sides. So and getting more accurate the data. I think that's really a way to do it. I think people like being included, you know, people that are actually helping you with the data, wherever that is, you know, they like being included. And when somebody feels like they have a stake in it, then they actually go the next level and try to help. Kristen or Sheila, you know, the drill-down information, you were mentioning earlier, Sheila, that once you actually got to a certain advanced point in your evolution, that really energized you, right? And, you know, so when you sit down to review the drill-down information, you know, did you experience any kind of like blocks? Like what does that even mean or how did how did you become engaged in that? Right. So one of the things when you're doing drill-down, you're looking at your outliers, you're looking at the reasons why. I think every one of us could probably say that, you know, medication is a low-hanging fruit. Easy win. Go for medication first because a lot of times it's related to documentation. So if you can recognize that there potentially is a contraindication and reach out to the provider to have that record amended, that's an easy win. And, you know, winning is like a snowball. So anything that you could do to build up to those more involved metrics are going to help you get buy-in for your drill-down. The other thing, I guess, two things that I would add. One is be as timely as you can. I know sometimes it's difficult. I think NCDR's done a really good job at drilling in our heads. Submit often. What is it? Submit early, submit often. I say that in my sleep. Yeah. But you know what? No one listens. No, people are doing it. Some of y'all listen. I think everyone's doing it at this point. But do that so that you're within that 30-day window, if at all possible, so that you could have that documentation improved. I know we dove into going into metric results and things, but I just want to back up the conversation just a little bit because you really need to understand the metric first. And you really need to know, well not know, but at least know the location of your resources to understand those metrics. And that would be your Outcomes Report Companion Guide, which every registry has underneath the resources page. There's a lot of information in there in regards to the metric, the numerator, why is this patient falling into your numerator? Do you even want the patient to follow in your numerator? Maybe you do, maybe you don't. It depends on what that metric is reporting out, a positive or possibly a negative outcome. You have your denominators in there so you know who's making up the population. And then you have your exclusions and your exceptions so you know who's being removed for whatever reason. The other two things that are in there, which I think are hidden gems, is a lot of, we get a lot of questions regarding, you're getting pushback from your physicians on the results. This patient shouldn't be here. Why are we looking at this? Things like that. We've heard this type of feedback before. And we have two little columns in each companion guide. One is our clinical rationale. And that kind of, sometimes whenever I was in your studios I used to just copy and paste that. Here's why. It came from this resource document. We didn't just pluck it out of the sky, right? It's coming from actual scientific clinical practice guidelines, expert consensus documents, and that's where our metrics essentially are built from. So there's some really good tidbits of information whenever you get challenging admin or challenging physicians. Whenever you're looking at your metrics and they want to know the why, you have to speak to that. And that is a great point, Kristen, because we do have a very successful science team that works very collaboratively with all of us. And they do sometimes, when there are questions, sometimes we even go to them and say, now what is the meaning behind this? And we just want to make sure that we're giving you the right rationale for things. But everything is very deliberate. And the fact that it's documented, I'm not sure everyone always knows that some of this information is available at your fingertips if you go into some of our companion guides. But the rationales are there. There's a lot of information. So, you know, as you're navigating around learning or you're teaching somebody new on your team, please make sure you're using the resource documents. Not everybody learns that way and we get it. You know, it's a lot of reading and if you're not familiar with the terminologies and things like that, it makes it a little difficult. That's why we try to do things in different formats. And also sharing it with who it needs to go to. I know we're talking about a lot of, you know, physician feedback and possibly admin feedback. But, you know, the people on the ground doing the work and that are kind of the hidden resources as well. So, for instance, whenever I did chest pain in my registry, I sent my feedback on my metrics that may have touched the ED to my ED nurse manager or my ED medical director. I sent it to my cath lab staff. I sent it to my CCU because we had a STEMI nurse who responded to every STEMI at that time. And then all the way up to discharge, you know, my patients went to a unit called the PCCU. So, I would share all my discharge metrics, which is usually medications, with that group of people. So, don't forget about them. Don't forget about them. Yeah, I could just agree more about this, share this information and the impacts. Everybody wants better care, right? And with this information shared with them, some of just a little reminder, even on a regular basis, that will help. You know, it is overwhelming when they take care of the patient at the bedside. And with this little reminder, working with results and what is really required, there's one metric in the chest pain in my registries about our doctor. There's a lot of, you know, hints for, oh, this patient's diabetic or this, you know. So, this is a reminder to the practitioner at the front. It helps them. I really feel like they feel like, ah, okay, I'm here with them. I'm not just here to tell them da-da-da. No, there's a reason behind to help them, to be on the same boat with us. One of my least favorite words is silo. But these quotes are somewhat taken directly from some of our feedback. You don't see them? Okay, well, so I feel isolated and lack confidence. I can't keep staff, which impacts my continuity. I don't think I said that word right. Continuity. Okay, every once in a while, I have a little blip. Actually, more than every once in a while. There's no community at my facility. We're not talking to each other. We don't share ideas between registries. Sometimes there's a total lack of bench strength. Does this sound familiar to anybody? If so, raise your hand. And if not, then that would be great. Yeah, so some of you feel that way. Some of you don't. The mass majority of you feel like you do have or have tackled silos. Is that right? For the most part, you're talking between registries. You're sharing practices. So if one person is working in the chest pain of my registry, another person is working within the cath PCI registry, you're talking to each other for the most part. I think that that's really important. Now, just because registries don't necessarily share, and some of them often do share, a lot of the same data elements, data definitions, target values. But even if they don't share a lot of them, there's still best practices that can be utilized from one registry to another. Standardization creates efficiency. So if this one person has a great way of going through the documentation, and just has a good process and a good system in place, and is able to go ahead and get things done efficiently, and you've come upon, hey, I've got a great way of doing this. Let me go ahead and share this. Another thing is, just to speak to our last bullet point on here, this is total lack of support and backup bench strength. Internally at NCDR, and I give David a lot of credit for setting up the program like this, is that this clinical quality advisor team typically supports more than one registry. So we're cross-trained, and it's absolutely necessary based on just being able to provide support when you have somebody who's out, and also having someone to bounce ideas off of. So I would say, you know, and I know time is, it's easy for me to sit here and just say, do this, do this, do this. I know time is not necessarily an infinite resource, but when there is opportunity to kind of cross-train, I think that's a really, really beneficial thing, and it also makes it so that if you want to take a vacation, and you come back from said vacation, that you're not completely underwater trying to, you know, surface for a breath. Yeah, I work with the team. I have a great mentor. We are in the same office, and we bounce it with each other, with ideas. Come to, like, for instance, Sheila mentioned. We'll come back to you, Yen. So we, so it sounds like that's not a huge issue, like interdepartmental. See, I'm gonna go down this road now again, where I can't talk. So what about silos and hurdles with your physicians? Are we seeing a lot of that? Raise your hand if so. So that's a little more so. We're still feeling that there are some kind of disconnects between, and I'm gonna guess, them documenting the data that you need, the elements that you need. So let's just talk about, you know, again, going, and if you don't have resources, create some resources, or tap into the participant resource sharing, like Shelly said, and see what other people have done. Create a sheet that's specific to one particular procedure, and have them code things into that, or have the staff that's working with them code things into that to maybe bridge that gap. And then I think another thing is hurdles within CDR. I mean, let's, we're not gonna hide our head under the cabbage leaves here. So, you know, we do hear sometimes that, you know, it's sometimes difficult. You know, we have a team here, and if, imagine if you all picked up at the, picked up the phone at the same time and called us. We obviously, if there were six of us, can't answer your calls directly. So I know sometimes you see that as a hurdle. We do the best we can at turning around our questions and answering things as quickly as we can in the order received. We're always trying to look, and we definitely pay attention to your feedback when you give it to us about what we could do better, understanding that we know we're not perfect, and we know that, we know that sometimes it's frustrating for you because you may be setting at your chart, you may be putting something in, and you need the answer right then, and you don't want to wait three days for it. We just have to try to meet in the middle somewhere and continue to work on it, is all I would say for that. Sheila, did you have any questions about that, or opinions about it? No, I think I would just add for the rationale that Kristen was talking about, share it with your physicians. The new, you know, AUC documents, the new evidence-based criteria documents, because I feel, I know myself, I assumed they knew all this. There's a physician, these are their peer organizations, they know, and I remember I brought up the new appropriate use criteria when stable ischemic heart disease AUC came out to one of the physicians, and the physician said, there's a new AUC? I said, yeah, and he said, will you send it to me? And I kind of was like, are you quizzing me? Are you teasing me? I was really thrown off, and he was very serious. He wasn't aware, because at the organization I worked at, it was large, and you know, a lot of physicians, they have their areas of focus, and if it isn't maybe research, or specifically this, they're not looking at that and following that constantly, because think of how busy they are. I can't even imagine, it baffles me how they even have families, you know, for how much we see them in the hospital. So don't assume that they know, and share it, and if they did know, thanks, knew that, great. They already knew that, but I would just say don't assume that they know. And they also can have, we'll plug here, the ACC app, which has all of those updated guidelines at their fingertips, so that they aren't blindsided in hearing it from you. It can be coming from the app and they can be accessing it at the point of care with their patients as well. So again, a lot of useful tools available to you and your teams. Does anybody know about the ACC app with the guidelines and do you have that accessible in case somebody would need that? Do you all use it? I don't see any hands. One, I saw one. Okay, well that's a fantastic point to bring in then. So everyone needs to download the ACC app. They need to be familiar with the fact that there's guideline information in that and if for some reason you're ever questioned by your physician, maybe they don't know it either. There's apps specifically for AUC. Your physician or you can put in specific patient criteria and it will tell you what the AUC recommendation or indication is. Yeah. So go wait while you download. And actually Kristen brought this up because we're always trying to think of new ways to help but she brought this up that we could put some kind of a resource place on our website that would allow you to just do like one-stop shopping and it would take you where you need to go because we realize right now, if you want something, you have to go here. If you want something else, you have to go here. You don't know how they're connected and we're working on all of that slowly but to have something where you're actually aware of what's available to you in terms of the apps and that type of thing, I think that that is a great suggestion and a pathway that we'll try to be visiting in the near future. Yeah. Trying to think of what other things we get in regards to hurdles. So I think since COVID, we've learned a lot of things. You know, we're not all in those centralized spaces or even in the same office. My experience in being part of my team was that at the time I was in the CCU at a desk and then my cath PCI abstractor was in the cath lab. I don't even, I don't even think I remember where my ICD abstractor was now that I think about it but that could just be a brain farts, my apologies. But what my point is, is that we weren't like in this centralized location where I can just be like, hey, Sheila. So I probably did rely more on NCDR assistance as well. But that just speaks to now going to COVID, now we're all not, I shouldn't say we are all, but some of us are working from home, we're remote and you may have that feeling of being disconnected and that lack of standardization. And I think actually I'm gonna put Sheila on the spot with this one because she's no longer centralized or you are just not on the. I am now, yeah. But we actually, here I'll give a little plug. The leadership track tomorrow, myself and a colleague are doing a presentation on staying connected when working from anywhere. And my team is a centralized team but we are all remote and we don't even live in the same states. I live in Ohio and my health network, Allegheny Health Network's in Pennsylvania. I have staff in Oklahoma, Pennsylvania, Florida. So whereas Heather who will be doing the other look at it, she's within a hospital system, but she, I'll say manages. She, let me think. She manages through influence I think is how she words it because she may not be the manager but she's the team that says we're not centralized. I'm not even their manager but we need consistency within our health system. So two very different views to help from that standpoint. I think to this slide, I would say, we talk about champions, be the champion. If there isn't standardization, reach out to the other individuals that maybe are in other registries. Create that standardization. And a lot of times approaching it from a how do you do it opens that door versus maybe telling them how you do it and then it becomes a conversation. As far as, I'll just add one more thing. No, no, no, please. As far as including the appropriate stakeholders, this makes me think of we did an improvement project as a poster last year for cardiac rehab referral. And we did the drill down, we talked about drill down. We looked at the patients that were falling out. What was the commonality of it? It was that it's not the interventionist that's discharging these patients that know they should be put on it. It's APPs or hospitalist residence fellows if you're at a educational tertiary hospital. And so once we identified that, we said, can we present, can we have 10 minutes of your meeting for your APPs for the person that was in charge of the hospitalist residence and fellows? And we spent 10 minutes going through a brief presentation of why they have to have cardiac rehab referral. And driving home the point, it has to be before their discharge or upon discharge. Not after, because a lot of them were doing it, but it was at that seven-day follow-up. So that was our process improvement so you can be the champion to pull in the proper stakeholders. And Sheila, you had mentioned that you were all in office too at one time and now your whole team is scattered across the country. I know with the launch a few years ago of our third-party abstractors for data entry. I know it's Shelly Pifer here. Shelly, oh, hey, Shelly. You've gotten used to not meeting your coworkers face-to-face. Did anyone meet here today for the first time and you've worked together? So there are people, isn't that fun? So yeah, it's really fun. So we're gonna make an assumption here based on what you're saying that that has really been ironed out and it's smooth. Any issues, Shelly? No, it's all good. So, okay, fantastic. It's good to see you too, by the way. Yeah, and that's new to hospital systems, but they're starting to embrace it. So it's made a big difference. Yeah. So talk, write, collaborate, communicate. I think the hurdles are something that we don't wanna get hung up on here too much, but we definitely wanna address and acknowledge that there are hurdles inherent to the data registries and that's just how it is. And so again, as long as we communicate with each other, keep our pathways open when there's something that we're not really aware of or you have questions about, let's just focus on helping each other through this. Now, let's turn our attention to the patient and bringing and showing registry value to leadership. And I think, Sheila, we might look to you for this too, because this is part of your daily everything, right? Sure, yeah. Constantly trying to defend our positions. I hate to say that, but it is true. Because if you're not talking to the appropriate leadership, they don't understand what you're doing and the importance. They may be related to a specific code or something that we're, yes, we're going through records, but they're not associating that critical thinking piece that goes with it. So when we have to bring the value of the registry to them and what we do, we are talking that this data goes into future research. We see the research study publications on a daily basis. So we want and need the data to be accurate. That supports the education piece, what we do, critical thinking, that that's part of it. Once you talk to your physicians or you're talking about your metrics, you talk about how hard is it to capture our cath indication or versus our PCI indication and those areas that are gray. So explaining that, a key thing, share the data collection form with your physicians because they may only be hearing about seeing the outcomes report or the key things you're honing in on. If you let them know that you have access to all those data elements, all of a sudden it brings this different life to the registry because they can start asking you for specifics and you can start providing those. That's a whole different area. So you've done the hard work. You've done the data abstraction. You've assessed the drill down to know that your data is accurate and correct. Now you need to showcase it. And public reporting is a great way to showcase what you've done in your facility, process improvements that you may have initiated. When you publicly report, you're being transparent with the community in which you serve. And trust me, we all Google things, including the patient community that we serve. So it's really important to be transparent. But in addition to publicly reporting and all the wonderful things that goes along with that, you know, it just recently came out about a month ago, September 13th, I think, the US News and World Report reported the top American hospitals. I think I've said that title correctly. At any rate, you get credit for publicly reporting. I think it's like a 3% credit when you publicly report. That you get credit for that. So it'll just bump your facility up a little bit higher in that category as well. Kristen, I wonder if you could talk a little bit about what you can do with your NCDR registry data that is showcasing that to the leadership. Are there different things you can do with the data that would just kind of be a little bit different or out of the box showcasing? You're like putting me on the spot, David. Okay, then she will. No, I'm kidding, I'll go. So I think that whenever it comes to talking to leadership and presenting the value of registry is, one, it's going in that you were there for the patient. What we're doing is all about the patient. Your patient is not coming in for their cath procedure and wanting to bleed, right? Your patient is not coming in for their outpatient tabor and worst case scenario expiring. And I don't wanna be negative, Nancy, but these are like the outcomes that you're looking and you're trying to prevent these things when you can decrease the risk of these things happening. So metrics, but you also have access to customizing your own data. We do have, and third party vendors also have this embedded in their tool, the data extracts. So you can run customized reports. So if your facility wants to look at something that maybe we're just not looking at yet in our executive summary or our patient detail lines, you have the capability to customize the report. And then if it's something that you can't even find in our extracts, you can also, or cause the extract can just be, I mean, it's an Excel heavy, what's the word here I'm looking for? Product. So, you know, if you're not, if you're not. Savvy with Excel. Oh my gosh, thank you. Savvy with Excel. So it's not just me. Good Lord. Anyway, Savvy with Excel. We have another team and actually that's where John is going to, where he could do like custom analysis of your NCDR data. I think Yen might have an example of what she's used that for, don't you? Oh, do share. I don't know why Yen can't be heard. Microphone. Okay, there we go. No, well, you're not gonna hear, but we'll listen to her. It's okay, I'm gonna do this, if you don't mind. Okay, there we go, improvised. I have a great experience of this because there's some special need through my leadership that require analyze where are my AMI patient coming from? Like, wow, okay, well, the electronic medical records could not provide that directly. So since we're participating in the registry, I was able to run a report and give them in the different zip code. And they were very impressed. They were like, wow, okay, here's my main patient. And then we did a special outreach because of this information. Oh, thank you. All right, so that was my past experience using the registry with a special need. And that was one of the examples. We have done some other things because with the registry information we have on site. Just do a real quick summary of what you said, because I'm not sure everybody could hear the first part of what you said. And you basically were talking about where are my acute MI patients coming from. Is that right? Yes, there was a special need for the leadership to know where are my AMI patient? How am I gonna address the community need? And it could not be, the information cannot be abstracted directly through our medical records because the different code, it was just too long a report since we are in the registry. So I was able to provide this report running data extractions and giving the leadership the information they need and I'm able to build a community outreach focused on the special area that is a higher percent, overall high percentage of our patient population and communicate and tell them, call 9-1-1. And during the sessions of the project, that was my past experience. Are you using some avenue of custom analyzing your data in any way? Yeah, yeah, we'll get ad hoc requests from physicians looking at a specific patient population maybe or specific criteria. We're able to pull it at that data level. Good, good. So not only is it about the patient outcomes as well, it's also about the care you provide. So again, the metric feedback that you get in regards to risk standardized mortality, risk standardized bleeding, all those type of metrics are just telling you, are you doing the best that you can with the resources that you have to minimize these outcomes knowing the patient's inherent risk to having it even prior to going into the cath lab. As well, we talked about AUC, I feel like a lot during this session, but AUC, I mean, I think that this- It's really the most complicated. Yes. I mean, speaking, and I think now that multiple registries have AUC, I'd be hard pressed to think that it's not as complicated in other registries as it is in cath PCI. But AUC is, it really took me a really long time to be able to speak to it with any confidence. And so I can only imagine, and I was really kind of flipping through it every single day, reading all the documents and speaking to it and really getting into the weeds. So I think when you're talking about showcasing the registry value, part of the responsibility may be on you to kind of frame it and put it into context about why and what and how to answer the basic questions like why is this information important? How did we arrive at this information? And also putting it into the context of, and this is probably important for other metrics as well, they're never, none of them are meant to have 100% perfect achievement. If everybody scored 100%, A plus, there'd be no reason to be in the registries. So you're going to be able to isolate some instances where there's some improvement opportunity. And I know it gets a little tricky with AUC. I think a lot of clinicians and physicians look at it very closely and they get pretty competitive about wanting to get a certain score and everything to be appropriate and nothing to be really appropriate. But so the documents are there to kind of support the way it's supposed to be used. And I think it's something that I rely on and I'm helping to support all of you out there and something that you probably need to rely on as well is those source documents that really, that just, they give all the information that you really need to articulate it to leadership. All right, John, as a user, I got to jump in and tell you, you think CAF PCI AUC is hard? It is nothing compared to EP. Okay. I wasn't going to say that, Sheila, but you're absolutely correct. It's unbelievably complicated because of the different procedure types and how it's broke up and things like that. I mean, it's all, you know, your point is well taken, but that has been very difficult. We're planning on solving that over lunch today. There you go, that's wonderful. So what I would like to say though, Sheila, if you don't mind, we have like three minutes left. We don't want to hold everybody up. So we are going to be wrapping this up very shortly. And, you know, if there were questions or if you added something to the conversation, you know, we didn't leave any time for answers because we really wanted to get through our conversation, but we'll definitely be available. And if you guys need us to answer, we will absolutely do that. I think the biggest takeaway from this part showcasing registry value is use your networking opportunities today. When you have lunch with people, don't just go isolate yourself somewhere. Meet people, meet people from your state, meet people from your online community and kind of learn from each other and how you're doing things. So to close things out, like I said, we have two minutes left before we're going to end the session. Let's just address the varieties of value that we have that you could use that maybe some of you don't think about in the realm of showcasing the work that you're doing. Yeah, I can speak to this one real quick because these outcomes are used for all of these preferred provider programs, like Shelly said, public reporting, accreditation, state regulatory requirements, federal reimbursement. Some of the registries are required by CMS for participation and reimbursement. This is where you showcase your value. Preferred provider programs, they look at your appropriate use criteria, non-classifiable and rarely appropriate. They look at your, in your cath PCI, they look at the bleed. They look at the, I don't think they look at AKI. I don't think they do, but they definitely look at door-to-balloon. So these are anything you could tie our registry information to research or finances, you're gonna get leadership to listen. But the hospital's getting money, is that what you're saying, in return for the performance in these metrics? Yeah, some of them it's related to reimbursement and others it's just being classified as a preferred provider. So, you know, one of the insurance providers, I don't know if I should say the name or not, but yeah, it's, you know, you're classified as a preferred provider because your outcomes are all at a certain standard. Let me take a moment. So we really appreciate your attention. You know, there's a million topics we can talk about. There's a million avenues we can go down, but like I said in the beginning, there's a lot of people who are, you know, at the beginning stages, a lot of people who are at the end stages with, you know, being just real valuable experts. Regardless of that, we are very hopeful that you're able to take something away. Maybe some of those can be starters for conversation for you when you are networking and talking amongst each other. And we're hopeful for that. We know we can't cover everything in an hour, but we really appreciate your participation here. This afternoon, we're gonna have another session. Actually, accreditation is gonna have a session where they're gonna have a very similar format. And then this afternoon, we come back at 3.15, I believe. 3.15, and we're gonna talk about analyzing your metric outcomes, prioritize areas for opportunity for quality improvement, and then using your dashboards to measure progress. And just a little teaser, we have screenshots of our upcoming new dashboard. We're not gonna be training on that dashboard right now, but we're gonna show you some screenshots of what that may look like. So again, we are at the hour. We really appreciate your attention, and we hope you got something from this. And thank you, thank you, thank you for coming and sharing with us. Thank you.

American College of Cardiology

ACC

NCDR

quality improvement

accreditation services

patient outcomes

clinical care delivery

registry data

cardiology

improvements in patient care