Frequently Asked Questions

AQI and NACOR

  1. Who are the stakeholders for the AQI?
  2. What are some of the advantages of registry participation?
  3. What is NACOR?
  4. What are the sources of NACOR data?
  5. Is there any cost associated with participating in the registry?
  6. Who may I contact if I have questions or need more information on the AQI and NACOR?

Data confidentiality

  1. What protections has AQI put in place to protect privacy and anonymity of NACOR data?
  2. Who has access to the AQI database?
  3. Are Registry participants considered 'covered entities' under HIPAA?
  4. Will fully-identified PHI be required for submission?
  5. What are the HIPAA implications of sending PHI to the Registry?

Data collection

  1. What types of data will the registry capture?
  2. What is the minimum data that must be provided in order to participate in the registry?
  3. Is there a specific type of billing software or specific data requirements for participation in the registry?
  4. Are there any special requirements if my practice has multiple sites/facilities?
  5. How often should data be uploaded to the registry?
  6. As a registry participant, is IRB compliance a requirement?

Becoming an AQI participant

  1. Once I have notified AQI of my interest, what happens next?
  2. What are the steps for becoming a registry participant?

Practice Reports

  1. How will the registry report data?
  2. What reports and measures will registry participants receive? How often will reports be generated and in what format?
  3. Will the AQI consider custom report requests from participants?

Multicenter Perioperative Outcomes (MPOG) and the AQI

  1. Can I be a member of either organization without being a member of the other?
  2. Do I need separate institutional approvals for sending data to each of these organizations?
  3. How much does it cost to become a member of MPOG and AQI?
  4. Who owns the data after I send it to MPOG or AQI?

Answers

AQI and NACOR

  1. What are some of the advantages of registry participation?

    AQI's NACOR data may be useful for various initiatives, including, but not limited to improving patient care, outcomes measurement and quality reporting to CMS.

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  2. What is National Anesthesia Clinical Outcomes Registry (NACOR)?

    NACOR is a data warehouse with more than 60 million cases performed by anesthesiology providers (e.g., physicians, certified registered nurse anesthetists, anesthesiology assistants) in the United States. NACOR is a CMS-approved Qualified Clinical Data Registry (QCDR) and Qualified Registry (QR).

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  3. What are the sources of NACOR data?

    The flow chart illustrates the data flow from practices into NACOR.

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  4. Is there any cost associated with participating in the registry?

    Please refer to the pricing chart for detailed information.

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  5. Who may I contact if I have questions or need more information on the AQI and NACOR?

    Questions may be directed to Ask AQI. You also may obtain more information by using the form provided on the AQI website.

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Data Confidentiality

  1. What protections has AQI put in place to protect privacy and anonymity of NACOR data?

    Patient data uploaded to the registry will be de-identified. Direct patient identifiers will not be part of the Registry. Facilities and providers will be de-identified before data are exported for any reason except when local sites export their own data for local usage. Nothing published using NACOR data will ever directly identify a patient, clinician or facility without their express permission. Clinicians participating in Quality Reporting for the purposes of submitting data to CMS provide their consent to publish aggregate data on Physician Compare. At no time is patient level data ever sent to CMS or to Physician Compare, only aggregate summary data for individual clinicians or group practices are sent.

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  2. Who has access to the AQI databases?

    AQI's databases are warehoused in partnership with ArborMetrix. Only select AQI and ArborMetrix employees have direct access to AQI's databases. ArborMetrix uses HIPAA-certified cloud services for their data warehouse.

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  3. Are registry participants considered 'covered entities' under HIPAA?

    Yes, registry participants are considered 'covered entities' under HIPAA. The HIPAA Privacy Rule provides federal protections for personal health information (PHI) held by 'covered entities.' At the same time, the Privacy Rule is balanced so that it permits the disclosure of PHI needed for patient care and other important purposes.

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  4. Will fully-identified PHI be required for submission?

    No, PHI is not required for NACOR reporting. The registry is accepting a 'limited data set' as defined by HIPAA. A 'limited data set' contains fields such as date of birth and zip code but does not include fields such as the patient's name or medical record number. HIPAA permits 'limited data set' disclosure with a data use agreement in effect between AQI and the registry participant.

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  5. What are the HIPAA implications of sending PHI to the registry?

    Participation in the NACOR is primarily for the purpose of 'health care operations.' HIPAA defines 'health care operations' to include quality assessment and improvement activities, including outcomes evaluation. The mission of the NACOR is to develop and maintain an ongoing registry of case data that helps anesthesiologists assess and improve patient care. PHI may be disclosed for these purposes with a Business Associate agreement in effect between the AQI and the participant. The HIPAA Privacy Rule allows business associates to provide data aggregation related to 'health care operations.' While NACOR is not currently collecting PHI, we would be permitted to do so in the future.

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Data Collection

  1. What types of data does the registry capture?

    The registry collects four types of data including practice demographics, case specific data, outcomes data and risk adjustment data. We understand that your practice may have some or all of this data and that is perfectly acceptable. The minimum dataset to participate is listed in the answer below.

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  2. What is the minimum data that must be provided in order to participate in the registry?

    Our vision is to accept electronic data from every practice in the United States regardless of size or level of digitization. The minimum level of data required to participate in AQI is practice demographics (self-reported through the AQI website) and case specific data from the practice billing software. Every anesthesia practice has this information available.

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  3. Is there a specific type of billing software or specific data requirements for participation in the registry?

    No, there is not a specific type of billing software required in order to submit. AQI has already worked with many vendors who have developed data extracts for upload to the Registry. If your practice uses one of these vendors, the bridge is already built. New vendors will need to sign basic level agreements with AQI which outlines fundamental roles and responsibilities for each party before we can accept data. Once these agreements are in place, AQI will be available for questions to facilitate an extract which meets AQI specifications. AQI also will be available for questions if you elect to create your own data extract from your systems.

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  4. Are there any special requirements if my practice has multiple sites/facilities?

    There are no special requirements. You will participate in the registry as one entity and you will assign unique codes to each facility for your own identification purposes.

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  5. How often should data be uploaded to the registry?

    Data is uploaded on a monthly basis.

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  6. As a registry participant, is IRB compliance a requirement?

    No, the data submitted to the NACOR does not involve human subject research (such as clinical trials), so IRB compliance is not necessary. The main purpose of the data collected by the registry is for health care quality improvement and not research projects.

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Becoming a NACOR participant

  1. What are the steps for becoming a registry participant?

    Register your interest by completing the "Send Me Info" form here.

  2. Once I have notified AQI of my interest, what happens next?

    You will be sent more information via email, along with instruction for next steps.

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Practice Reports

  1. How will the registry report data?

    Data contributed to the AQI will be held in the strictest confidence, and will be reported in the aggregate only. Anesthesia practices contributing data will have online access to their practice report through the AQI Members Only web portal. Practice reports will mirror the data the practice uploads to the registry along with NACOR national benchmarks where available. For more specific uses, such as allowing individual contributors to assess and improve patient care, the AQI will request permission of the provider or practice first, and will limit disclosure to only those with a 'need to know.'

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  2. What reports and measures will registry participants receive? How often will reports be generated and in what format?

    Participant reports are available via the AQI website by logging into the Members Only area on the home page. Practice reports are accessed under the reports button and provide aggregate NACOR data along with data submitted by the participant. Reports may be filtered (where applicable) to provide more specific data on a provider, facility or anesthesia case.

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  3. Will the AQI consider custom report requests from participants?

    Custom reports will be considered on a case-by-case basis. Additional fees may be applicable depending on the time and resources allocated to performing the request.

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Mulitcenter Perioperative Outcomes (MPOG) and the AQI

  1. Can I be a member of either organization without being a member of the other?

    Answer: Yes. To be a full MPOG member you need to have implemented an AIMS and have 10,000 cases entered into the MPOG dataset. You also need to have institutional IRB approval for the research work you will be doing with the MPOG data. Other requirements can be found on the MPOG website. To be a participant in AQI you need to complete a data sharing agreement and allow practice data meeting at least minimal standards to be entered into the AQI dataset. If you are an MPOG member, you may have your AIMS data directly sent to the AQI dataset, if you so desire. All data in both databases is de-identified.

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  2. Do I need separate institutional approvals for sending data to each of these organizations?

    Answer: Yes. You need to complete a data use agreement for MPOG and a separate one for AQI. These are contracts that need to be signed by your organization and either MPOG or AQI. The agreements are similar. As a member of AQI you must also complete the agreement to have your data placed in the National Anesthesia Clinical Outcomes Registry (NACOR). To be a full member of MPOG you must have your institution approved by a site IRB to allow you to send data to the MPOG data repository and ultimately receive data from MPOG for your individual research proposals.

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  3. How much does it cost to become a member of MPOG and AQI?

    MPOG membership is "free" but it does require resources at your institution to assist in the technical operations of transmitting data. The entrance "fee" for full MPOG membership is 10,000 cases into the data repository. MPOG will be using grant money to fund its further development. AQI membership is similar. You will need to commit some resources in your practice to facilitate data transfer. The AQI participation fee to receive practice reports is $1,000 annually per anesthesiologist in the group, but is waived for anesthesiologists who are members of the American Society of Anesthesiologists (ASA). Custom data searches and custom reports can be requested, but may require funding to complete.

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  4. Who owns the data after I send it to MPOG or AQI?

    MPOG is a data repository housed at the University of Michigan. All the data any institution sends to the MPOG data repository always remains the property of the originating institution. It is held in the repository so that it can be shared with other institutions given IRB approval and approval of the MPOG Board for that specific study. At that point the specific data fields being requested will be made available to the individuals who have received approval for their research project. Aggregated AQI data – which is all de-identified – belongs to the AQI for purposes of national quality management reporting and creation of process and outcome benchmarks. However the AQI will never report data from individual hospitals, practices or providers without their express permission. AQI data will also be available for academic use, but will require IRB approval from the requestor’s institution and endorsement by the AQI Data Use Committee. If such a request would include data submitted by joint AQI/MPOG participants, then approval of the MPOG Data Use Committee will also be required.

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