"Providers aren't paid to do panel management on a diabetic," Dr. Mostashari says. "They get paid the same whether the person's
blood sugar is controlled or not. It's only when a public health agency or a population health organization becomes the driver
that these issues rise to the surface." Ultimately, the New York City health department awarded its $20 million contract—which will provide EHRs and training to 2,500
physicians serving low-income and uninsured patients by 2010—to eClinicalWorks on the condition that it incorporate registry
functionality into its product and that it make the enhanced software available to all its clients nationwide at no additional
cost. "My hope is that we can make registries a part of the competitive market," says Dr. Mostashari, "that we can actually move
the market." Market forces may encourage greater adoption as well. Registries are effective quality improvement and documentation tools,
says CHCF's Frohlich, which could make them very useful in a pay-for-performance environment. Gary Wong, MD, Kaiser Permanente's physician lead for population care systems in the Southern California region, says his
organization's registry module has been integral to improving quality and evidence-based care. "We've seen improvements in cervical cancer screening rates, colorectal screening, cholesterol screening and mammography,"
he says. While stand-alone registries can serve an important function, advocates say, their real strength is tapped when they are incorporated
into an EHR, making information actionable. For example, he tells the story of visiting a sole practitioner whose office had just been outfitted with a new system. Knowing
she was an attentive physician, he asked her what percentage of her senior patients had been immunized against influenza.
She recalled providing the service, but did not have specific numbers. They explored her registry to see how many of her patients over age 65 who visited her office for any reason during flu season
were immunized—data revealed only 30% were vaccinated. Dr. Mostashari uses the example to illustrate that EHRs equipped with registries make it easier for physicians to deliver
evidence-based care at the time of the encounter. Shelly Reese is a freelance writer based in Cincinnati, Ohio.
| 
