AQUA Registry Gears Up to Address Quality, Regulatory Issues in Urology

The American Urological Association (AUA) Quality Registry (AQUA) has achieved status as Qualified Clinical Data Registry, an initial step toward the development of a roadmap for Maintenance of Certification credit.

The AQUA software has been installed at 89 practices, representing more than 850 urologists. An additional 259 practices, comprising more than 2500 urologists, have agreed to participate in the registry and are awaiting installation of the AQUA software. Matthew R. Cooperberg, MD, MPH, Helen Diller Family Chair in Urology, University of California, San Francisco, discussed the registry and its benefits at the 2016 AUA Practice Management Conference.

A review of the first 75 practices to join the registry showed representation in 29 states; a mix of small, medium, and large urology practices; and nearly 700 urology providers. The first 36 practices contributed more than 14,000 patients with prostate cancer to the registry from 2014 to 2016.

“AQUA collects detailed national process and outcomes data for patients with urologic diseases. The primary goal is quality assessment and improvement through local feedback to practices. Secondary goals are to fuel next-generation health services and clinical outcomes research and inform urology policy efforts,” said Dr Cooperberg.

“Participating urologists get automatic PQRS [Physician Quality Reporting System] and Meaningful Use credit. Participation may help satisfy Maintenance of Certification reporting requirements, and discussions with the American Board of Urology are ongoing toward that end. There also are plans for blue ribbon certification through the AUA,” he added.

Data Collection

The University of California, San Francisco, has 20 years of experience in contributing to and managing the CaPSURE prostate cancer database. Although providing a multitude of useful information, the program, initially pharma-supported, proved to be expensive and labor-intensive. Similarly, Blue Cross Blue Shield–supported Michigan Urological Surgery Improvement Collaborative has collected statewide data from urology practices to support quality initiatives but has also proved to be expensive and labor-intensive, said Dr Cooperberg.

AQUA has partnered with the software development company FIGmd to produce a program that can automate the process of figuring out data directly from the electronic medical record (EMR) to minimize the data entry burden. Urology is the third specialty to launch a registry based on the FIGmd platform, after cardiology and ophthalmology. An additional 15 specialties are taking steps to launch their own registries, said Dr Cooperberg.

The AQUA registry connector is integrated directly with the EMR database, said Tim Parr, Vice President of Technology, FIGmd. Data are extracted automatically, encrypted, and transferred via a secure connection to AQUA nightly. Data are processed and incorporated into the AQUA data repository as received.

“You can then view your quality measure data anytime on the AQUA registry dashboard. Data collected for AQUA may be used for reporting to CMS [the Centers for Medicare & Medicaid Services] with no additional effort,” said Mr Parr.

“This method of data collection has zero impact on physician workflow. Physicians continue to see patients and document just as they do today. As we collect the data from the EHR/EMR, we can adapt to individual usage patterns. We can process structured and unstructured data, including data in notes and text fields,” Mr Parr added.

Ownership of Data

The AUA maintains the AQUA database, but individual participating practices retain ownership of their data. Practice-level data are shown only with the individual practice contributing the data, which has been benchmarked against the aggregate data. The system can accommodate patient-reported outcomes.

“No practice will see any other individual practice’s data,” noted Dr Cooperberg.

Data are handled in accordance with HIPAA (Health Insurance Portability and Accountability Act) requirements, and are encrypted while at rest or in motion, said Mr Parr. Participants have secure access to the registry dashboard.


The move toward specialty-specific data registries has been fueled by the Medicare Access and CHIP Reauthorization Act (MACRA), which mandates that all physicians be enrolled in 1 of 2 quality-reporting systems by 2019—the Merit-Based Incentive Payment System (MIPS) or an alternative payment model.

The majority of specialties are migrating toward the MIPS option, which maintains the fee-for-service model. This option has 4 key components, including quality reporting (ie, PQRS); a value-based payment modifier; an EHR incentive program (“meaningful use”); and clinical practice improvement.

MACRA imposes payment penalties on Medicare payments for nonparticipation, which will increase annually toward the 2019 deadline.

“If you choose MIPS, participation in the AQUA Registry will help satisfy all 4 components of the option. By participating, you may learn things about your own practice,” said Dr Cooperberg.

AQUA participants can gain valuable insight into your practice, Mr Parr agreed. Data are available for review and analysis within 2 to 3 weeks of collection. Performance can be evaluated across the entire practice, by an individual provider, and by service location.

Benefits of Participating in AQUA

The anticipated benefits from participating in AQUA include:

  • A clinician dashboard for patient-level tracking and practice-level quality assurance and improvement initiatives
  • A patient dashboard for decision support and survivorship
  • Improved care through local and internal data exposure
  • Next-generation research opportunities in health services, outcomes, and comparative effectiveness.

For 2016, AQUA has included 18 standard (PQRS-derived) Qualified Clinical Data Registry measures, the majority of which are not directly applicable to urology practices, such as screening for influenza, colorectal cancer, and hypertension.

However, some measures are directly applicable to urology, including:

  • The assessment of urinary incontinence in women
  • A plan of care for urinary incontinence in women
  • Avoidance of bone scans in low-risk prostate cancer
  • The use of androgen-deprivation therapy with radiation for patients with high-risk prostate cancer.

In addition, AQUA has incorporated 11 urology-specific quality measures that were derived from the AUA guidelines, such as the documentation of stage, primary and secondary Gleason grade, and clinical stage for prostate cancer; nonuse of ultrasound in cryptorchidism evaluation; and testosterone measurement ordered within 6 months of starting testosterone replacement.

In addition to developing a roadmap for Maintenance of Certification credit, ongoing activities in AQUA include the development of quality measures for stone disease and female urology, and the development of an active template for the different types of EMR systems.

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