CORR Insights®: What Factors Are Associated with Patient-reported Outcome Measure Questionnaire Completion for an Electronic Shoulder Arthroplasty Registry?

The Health Information Technology for Economic and Clinical Health Act, part of the American Reinvestment and Recovery Act, requires eligible providers to demonstrate meaningful use of electronic health records, and has gone through various stages of implementation during the past decade [8]. The Merit-based Incentive Payment System, an important component of this program, calls for public health and clinical data registry reporting to support the goals of quality, safety, and reduction of health disparities [4]. The Qualified Clinical Data Registries list includes the Centers for Medicare & Medicaid Services-approved registries that are authorized to submit reports from eligible clinicians to the Merit-based Incentive Payment System program. Specialty societies, collaboratives, health informational technology vendors, and individual hospitals can create and maintain these registries [5]. The American Academy of Orthopaedic Surgeons Registry Program is one such example. More than 20 years ago, Berry et al. [3] described the difficulties of maintaining an institutional registry for hip arthroplasties at the Mayo Clinic, citing high costs, the need for dedicated personnel, and difficulties maintaining adequate follow-up. The conversion of paper-based patient-reported outcome measurement (PROM) tools to electronic or online programs promised increased efficiency for clinicians and a decreased burden on patients [11, 14]. Reducing hurdles for patients is crucial because patient participation is required to ensure that clinical outcome tools yield valid and reliable outcome measurements. Despite widely available outcome tools on various electronic platforms in the modern era, it remains unclear whether this conversion has lived up to the hype. Further, the costs (in terms of dollars and administrative burdens) of the conversion and implementation of electronic PROMs have not been thoroughly described. Finally, we are just beginning to determine the return on our investment, measured in quality and reduction of disparities. Ling et al. [10] conducted a retrospective study of an institutional shoulder arthroplasty registry after converting to an electronic platform and determined low follow-up proportions, a high resource burden in terms of the need for manual assistance, andmost concerning, differences in the completion rate of questionnaires based on race, gender, level of education, and preoperative function. Their findings of selection bias in those completing PROMs is worrisome because conclusions derived from such a registry are not generalizable to the population at large, and therefore do not meet the goals of the conversion to electronic health records and required registry reporting. Equally troubling is that evidence-based registries inform national benchmarking, risk-adjustment, This CORR Insights is a commentary on the article "What Factors Are Associated with Patient-reported Outcome Measure Questionnaire Completion for an Electronic Shoulder Arthroplasty Registry? ” by Ling et al. available at: DOI: 10.1097/CORR. 0000000000001424. The author certifies that neither he, nor any members of his immediate family, has funding or commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. U. Srikumaran ✉, Division of Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, 10700 Charter Drive, Suite 140, Columbia, MD 21044 USA, Email: us@jhmi.edu U. Srikumaran, Division of Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Columbia, MD, USA