Axon Registry

The Axon Registry^® is a clinical data registry focused on quality improvement. It is a centralized data warehouse that collects relevant patient data and performs statistical analysis on the quality of care provided and patient outcomes.  

Axon Registry Designated as QCDR 
The Centers for Medicare & Medicaid Services (CMS) approved the Axon Registry as a 2017 qualified clinical data registry (QCDR). This designation opens the door for AAN members looking for an easy way to submit quality data to CMS for the Merit-based Incentive Payment System (MIPS). 

The Axon Registry is approved by the American Board of Psychiatry and Neurology, Inc. as an MOC Part IV PIP Clinical Module activity.

Participation

This valuable tool will enable neurology practices to identify and improve gaps in the quality of neurological care, demonstrate their value to payers, and compare their performance to neurologists nationwide.  Review case studies to learn more about practices' experiences with the registry. 

• Watch these videos to learn more about the Axon Registry.
• Contact us for more information.
• Have questions about enrolling as a large institution? Read through our Large Institution FAQs for more information.

Integration Information
The EHR system that your practice utilizes will have an impact on the integration process with the Axon Registry. To learn how your EHR system will determine data transfer options, review  Axon Registry and EHR Compatibility.

How to Enroll 
The AAN is now enrolling practices wanting to participate in the Axon Registry. Please note that enrolled practices will be on-boarded quarterly in 2017 based on their number on the wait list. A practice is enrolled in the Axon Registry after completing the following three steps.

An AAN member ID is necessary to complete enrollment.

1. To start the process, submit your name via the interest form.
SUBMIT NOW

2. Once the interest form is completed, you will automatically receive an email with a link to the enrollment portal.

3. Your practice will be placed on the wait list once the enrollment portal is completed, the participation agreement is executed by our CEO, and you return to the enrollment portal to hit the "Submit Sign Up" button.

Supporting Documents

• FIGMD Push Technical Overview 
• FIGMD Pull Technical Overview
• Axon Registry Time Requirements
  
• Axon Registry Participation Steps- Overview
• Participation Agreement (Includes Data Use Agreement in Appendix B)

Registry Quality Measures

Axon Quality Measures

Below is the list of quality measures in the registry. They are grouped by disease state and whether they are eligible to submit for the MIPS program. MIPS requires that participants submit data for at least six measures including at least one outcome or, if unavailable, a high priority measure. 

Please note that CMS is looking at measures that they removed from MIPS submission eligibility in a second round of reviews that will be completed in mid-June. 

2017 MIPS Measures

Crosscutting

• Axon 16A MIPS 318 Falls: screening for fall risk
• Axon 16B MIPS 154 Falls: risk assessment
• Axon 16C MIPS 155 Falls: plan of care
• Axon 17 MIPS 130 Documentation of current medications in the medical record
• Axon 18 MIPS 047 Advanced care plan
• Axon 19 MIPS 374 Closing the referral loop

Dementia

• Axon 09 MIPS 282 Functional status assessment

Epilepsy  

• Axon 20 MIPS 268 Counseling for Women of Childbearing Potential with Epilepsy

Headache

• Axon 15 MIPS 435 Quality of life assessment for patients with primary headache disorder
• Axon 22 MIPS 419 Headache- advanced brain imaging NOT ordered

Parkinson's Disease

• Axon 04 MIPS 290 Psychiatric disorders or disturbances assessment

Sleep

• Axon 24 MIPS 276 Assessment of sleep symptoms

2017 CMS Approved non-MIPS Measures

Epilepsy

• Axon 03 Screening for psychiatric or behavioral health

Parkinson's Disease

• Axon 06 Querying about symptoms of autonomic dysfunction

Falls

• Axon 07 Neurology specific falls

Distal Symmetric Polyneuropathy

• Axon 11 Prediabetes screening
• Axon 26 Screening for unhealthy alcohol use (Axon 12 updated by CMS to include counseling)

Headache

• Axon 13 Medication prescribed for acute migraine attack
• Axon 25 Overuse of barbiturate and opioids for primary headache disorders (Combined measures Axon 14 and Axon 21 based on CMS requirements)

Multiple Sclerosis

• Axon 23 MS counseling for appropriate exercise

Quality Improvement Measures (Not eligible for MIPS submission)

Epilepsy

• Axon 01/02 Seizure frequency and seizure etiology (paired measure)

Parkinson's Disease

• Axon 05 MIPS 292 Querying about sleep disturbances

Dementia

• Axon 08 MIPS 280 Staging of dementia
• Axon 10 MIPS 285 Screening for depressive symptoms

Measure Validation

What steps are being taken to check the validity of the Axon Registry measures?

The AAN is validating the measures and the data in Axon Registry in several ways.

1. Each practice will have three or more mapping calls with the registry vendor, FIGMD. The purpose of these calls is to review their practice's measure performances and show FIGMD where specific measure documentation is stored within their EHR. After each call, the client account manager on the call will work with the FIGMD mapping team to be sure that work flow is being accurately mapped. The practice is able to continue these mapping calls until they feel confident that their data is being accurately collected.
2. AAN staff, physicians, and representatives from FIGMD regularly review each registry measure to ensure that the algorithms being used are correctly calculating performance rates.
3. The AAN has reached out to multiple practices asking them to independently perform audits on their data and have chart reviews in order to ensure that they feel their practice's performance is being reflected accurately.
4. In 2017, the AAN will hire an external vendor to independently validate the data in the registry.

If you have concerns or questions about validating measures please reach out to registry staff at registry@aan.com.

Learn More

Discover additional general information, cost and requirements, enrollment, security and privacy, and technical requirements.

General

Why should neurologists participate in the Axon Registry?
Eligible physicians who sign up and meet the reporting requirements can use the Axon Registry to report clinical quality data to the Merit-based Incentive Payment System (MIPS). The Axon Registry will automatically extract and submit data to the Centers for Medicare & Medicaid Services (CMS) on a practice's behalf, ensuring participants avoid CMS's Value Based Payment Modifier (VBPM) payment penalties. Enrollment in the Axon Registry can help with receiving bonus credit under the Advancing Care Information component of MIPS for reporting to a specialized registry. Participating in the Axon Registry will meet Maintenance of Certification (MOC) Part IV requirements. Your participation in the Axon Registry, once your practice is using your dashboard for quality improvement, is transmitted to the American Board of Psychiatry and Neurology (ABPN) to aid in tracking your Maintenance of Certification Part IV Performance in Practice (PIP) Clinical Component. You can opt into this service in NeuroTracker.

How will the Axon Registry help me meet Maintenance of Certification Part IV requirements?
The Axon Registry is a mechanism to collect data on quality measures directly from the Electronic Health Record (EHR). The user dashboard provides feedback on performance, and then providers can make improvements to care. The American Board of Psychiatry and Neurology (ABPN) has acknowledged that these functions meet the requirements of Part IV Performance in Practice. Note that diplomates must still go and attest to this activity at the ABPN. Data transmitted is simply for audit purposes.

What is a clinical registry?
A clinical registry is a data collection and management system that extracts data from a patient's medical record and an office's practice management system to assess the quality of care for an individual patient and a population of patients. Medical specialty associations, including the American Academy of Ophthalmology, American College of Cardiology, and the Society of Thoracic Surgeons, have used registries to successfully identify gaps in care, improve outcomes, and advocate for fair reimbursement.   

Why is the AAN providing this resource?
The AAN is developing the Axon Registry as part of the Academy's mission of quality improvement in the delivery of neurological care. The data in Axon Registry will serve as the foundation for internal and specialty-wide quality initiatives. In addition, public and private payers are increasingly using quality data to determine physician payment. Participating providers will have group and individual quality data to use to demonstrate their value to public and private payers. 

How is the AAN delivering the technology? 
The AAN is collaborating with FIGMD, Inc., a company that specializes in integrating EHRs with registries, in the development of the Axon Registry. FIGMD has developed and maintained registries for the American Academy of Ophthalmology and American College of Cardiology and has completed integration projects for more than 50 major EHRs and is capable of working quickly with new EHR systems.    

How does the Axon Registry work?
The Axon Registry automatically extracts data from the office EHR and transmits data directly to the registry. From the dashboard portal, participating neurologists can access the data, run queries on their own patient population, benchmark practice performance, and uncover potential areas for quality improvement. The Axon Registry is designed to minimally affect practices and physician workflows. Once set-up and integration with the EHR are complete, the registry collects data in the background from discrete data fields and clinical notes.  

What data would I have access to as a participant?
AAN staff is in the process of developing the capability for users to run quality reports that provide results for all measures at clinician, practice, and national levels. Currently, participants have access to their own performance data and in the future will be able to compare their performance and outcomes to their own practice partners or to similar practices at the regional and national levels. 

Is it necessary to have an EHR system to participate in the Axon Registry?
Yes. Encounter data from the practice EHR  is transferred into the Axon Registry by one of two EHR-driven methods: the Pull method and the Push method.  Please refer to the TECHNICAL REQUIREMENTS section below and the FIGMD Push vs. Pull Technical Overview document for a comprehensive description.

Axon Registry Articles

• Neurology Today^® article published December 2016. "AAN Launches Axon Registry to Enable Compliance with Neurology-Specific Quality Measures: Feedback from Early Adopters" by Lola Butcher. 
• Case Studies: The Axon Registry
• AANnews article published December 2016. “President's Column: Registry Success is Good News for AAN Members," by Terrance L. Cascino, MD, FAAN
• Neurology® article published November 2016. "Introducing the Axon Registry: An opportunity to improve quality of neurologic care," by Bruce Sigsbee, MD, FAAN, James N. Goldenberg, MD, FAAN, Christopher T. Bever Jr, MD, FAAN, Becky Schierman, MPH, and Lyell K. Jones, MD, FAAN
• Neurology® article published November 2016. "The AAN's Axon Registry: Mastering how we are measured," by Neil A. Busis, MD, and Gary M. Franklin, MD, MPH
• Neurology^® Clinical Practice article published September 2015: “Quality improvement and practice-based research in neurology using the electronic medical record,” by Demetrius M. Maraganore, MD; Roberta Frigerio, MD; Nazia Kazmi, MS; Steven L. Meyers, MD; Meredith Sefa, MS; Shaun A. Walters, MS, and Jonathan C. Silverstein, MD, MS
• Neurology^® Clinical Practice article published on December 10, 2015: "The breadth and burden of data collection in clinical practice," by James N. Goldenberg, MD, FAAN
• Neurology^® article published on October 30, 2015: "Practice improvement requires more than guidelines and quality measures," by Bruce Sigsbee, MD, FAAN; Christopher T. Bever, Jr., MD, MBA, FAAN, and Lyell K. Jones, MD, FAAN

COST AND REQUIREMENTS OF PARTICIPATION

What are the costs for participating in the Axon Registry?
To encourage widespread adoption, the AAN is initially offering multi-year, fee-free access to member neurologists who sign the agreements and integrate their EHR with the Axon Registry. Please note that some EHRs have a fee for integrating with a registry, check with your EHR representative for more information.

ENROLLMENT

Do you have to be an AAN member to participate in the Axon Registry?
Yes. Participation in the Axon Registry is open to US-based practicing AAN members. It is not required that all physicians participate, but participation by all physicians in the practice is strongly encouraged to generate data that most accurately reflects practice performance. 

• Send your questions to registry@aan.com.

Can academic medical practices participate in the Axon Registry?
Any practitioner in the US who is a member of the AAN can participate in the Axon Registry as long as they meet the participation criteria. If you have more questions read through our Large Institution FAQs.

Will the Axon Registry include patient data from other health care settings (hospitals, long term care (LTC), skilled nursing facilities)?
Only ambulatory encounter data will be in the Axon Registry. The Axon Registry is designed for outpatient neurologist participation. There are no plans to include inpatient or LTC measures.

As an international neurologist, can I participate?

The Axon Registry is currently open only to AAN members practicing in the United States and its territories. In the future, the AAN will examine expanding the Axon Registry to include international members. 

Are all AAN US members expected to participate?
Participation in the registry is not a member requirement, but all members are strongly encouraged to do so. Participation will help improve the quality of care provided by not only their individual practices but by the profession as a whole.

Do all physicians in a practice need to participate in the Axon Registry?
It is not required that all physicians participate, but participation by all physicians in the practice is strongly encouraged to generate data that most accurately reflects practice performance.

SECURITY AND PRIVACY

What identifiable data on physicians or patients will be associated with my data?
Practices that join the Axon Registry enter into an agreement with the AAN, which includes a HIPAA-compliant Business Associate Agreement and Data Use Agreement (for the use of limited data set information). The Axon Registry collects, stores, and reports data on a neurologist's behalf to payers and certification bodies, taking every measure possible to safeguard it. The AAN's technology partner, FIGMD, is compliant with all local and federal regulations governing these areas, including HIPAA provisions and the recently updated provisions as part of the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health Act.  

Provider data: 
Axon Registry will have access to the provider's National Provider Identification number, Tax Identification Number for the practice, and individual performance data. The Axon Registry will not publish any identifiable provider or practice data without permission.

Patient data:
Protected Health Information (PHI) is being submitted only to FIGMD and then (via FIGMD) to CMS for quality improvement purposes. A limited data set will be provided, but not sold, to a partner analytics center, who will conduct data analysis on behalf of the AAN and other data requesters. The limited data set will not be provided to or sold to data requesters, including industry. The AAN will not have access to fully identifiable, individual patient data, but may have access to limited data set information. 

Who will have access to my data?
The Axon Registry collects, stores, and reports data on a neurologist's behalf to payers and certification bodies, taking every measure possible to safeguard it. The AAN's technology partner, FIGMD, is compliant with all local and federal regulations governing these areas, including HIPAA provisions and the recently updated provisions as part of the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health Act.

How will the AAN use the data in the Axon Registry? 
The AAN will only have access to aggregated data, either in the form of de-identified patient data or a limited data set. The AAN will not have access to fully identified individual patient data or individual provider data. Based on the aggregate data, the AAN will calculate benchmarks upon which to compare neurologists' outcomes, analyze patient populations, and study practice patterns. The AAN will also use these data to improve its products and services, including guidelines, measures, advocacy, and education. 

In addition, this will be a valuable neurology-focused database and we will be able to provide real world evidence to researchers seeking to conduct secondary data analysis. These analyses will improve the care and outcomes of patients with neurologic disease. The AAN's yet-to-be-contracted data analytics center will conduct data analysis on behalf of the AAN and data requesters based on this data. The AAN may charge for the reports generated from this analysis to help offset the costs of operating the Axon Registry.

TECHNICAL REQUIREMENTS

Where is the Axon Registry located?
The AAN Axon Registry is supported by cloud-based services, with infrastructure located in the US. The Axon Registry vendor, FIGMD, has technical infrastructure support in India. The Axon Registry is not located at the AAN headquarters in Minneapolis, Minnesota.

Do we need to install anything on our practice computer system?
You will need to install the Registry Practice Connector (RPC) software either on the practice EHR database server, or on a computer that has access to the EHR database (or a current copy). RPC software runs as a service and requires Microsoft Windows operating system with Microsoft .NET Framework 3.0 installed.

A read-only user account is required for the RPC to directly access the EHR database (not via the EHR application). The RPC establishes a connection to FIGMD’s system on port 7171 using a 256-bit Rijndael encryption key. Sessions on this connection are always initiated from the medical practice side. The connection can never be started from FIGMD’s system.

How will practice clinical data get to the Axon Registry?
The practice RPC connects with FIGMD’s system for the purpose of initiating the transmission of the patient/encounter related clinical data to the Axon Registry. The upload takes place via https: port 443 using a 2048-bit RSA encryption key. The upload sessions are always initiated from the practice side and can never be initiated from FIGMD’s system.

What can we do if we can’t install software on a computer with access to the EHR database?
There is an option whereby the RPC software is installed locally or remotely and configured to retrieve the EHR vendor supplied data file and deliver it to FIGMD’s system.

When the RPC is installed locally, the upload takes place via https: port 443 using a 2048-bit RSA encryption key. These upload sessions are always initiated from the practice side and can never be initiated from FIGMD’s system.

How is protected health information (PHI) used?
The patient/encounter-related clinical data uploaded to FIGMD’s system is separated into de-identified clinical data and PHI data. The PHI data is secured until re-identification is needed for PQRS submission to CMS. The PHI data is not used in any other way. The AAN does not receive any PHI data.

How is the clinical data stored?
The de-identified clinical data is stored in a HL7 CDA-compliant format.

What data is available to Enterprise Quality Management Systems?
The following web service-based application programming interfaces (APIs) provide structured data for enterprise-wide quality initiatives:

1. Provider level calculated performance score: These are delivered in a structured QRDA Level 3
2. Encounter level calculated performance score: These are delivered in a HL7 DFT message generated per encounter
3. Registry Data Dictionary imputed values: These are delivered via a csv file

• Quality Measures
• MACRA
• Alternative Payment Models