CASE STUDY #1

In 1999, the newly renamed American Vein and Lymphatic Society was experiencing dramatic growth. New technology and new treatments for Chronic Venous Insuffiency had been developed. Endovenous Ablation greatly improved patient experience and soon replaced Varicose Vein Stripping. Doctors were very busy treating patients and building theirs practices. The early miscellaneous CPT code was robust but vague. By 2005, the AMA which controls the CPT process and the RUC Value system was issuing new codes, making it very attractive to take the endovenous revolution to a less costly office based procedure. These new codes would dramatically affect the number of procedures done, with cannibilzation of vein stripping and replacement with ablation and an increase in procedure volumes of over 400% in a very short period of time. Over the past decade, CMS also made adjustments to the RUC and RVU’s (relative Value Units) assigned to the procedure and ultimately reduce payments to the treating physician.

Endovenous Ablation was such a Shot Gun start and meteoric procedural volume counts that robust clinical studies about the disease were ignored by self motivated competitive industry studies and real science was limited to a physician’s experience and their personal experiences. Even as of this writing there has not been a randomized study of the safety and efficacy of endovenous ablation versus Vein Stripping. The new techniques were so immediately successful that the thought of a proper study would mean one group would have to endure the old treatment and that simply wasn’t going to happen in an ethical medical community.

NO DATA! NO CLINICAL DATA! No CMS Support!

In response to the data void for research, and criticism of the CMS MEDCAC meeting, the AVLS created the Venous Pro Registry 1.0. The plan was simple enough. Everyone was moving to Electronic records. Let’s have our membership send us their data.

This made lots of sense because the clinical treatment of venous disease increased 7-fold between the years of 2002 and 2018. Let’s tell them what data fields we want to collect from their EMRS. Give them an EXCEL Spread sheet and have them send us the data.

The challenge here was EXEL is not a very dynamic tool and Physicians practices were time and resource challenged to mine their files for these data points. Moreover, this work needed to be performed on a regular basis and the physicians don’t have the time for a voluntary yet time consuming process.

With 648 data fields to be collected, they had a big job ahead of themselves. AVLS membership was broad with 11 different disciplines as members, from Primary care to Thoracic surgeons, Dermatologists and Vascular Surgeons, they all talked different languages, and so did their EMRs.”

After 4 years of frustrating delays and changes in the registry, the AVLS was no further ahead with the problem; “We are asking our membership to do something that sounds easy in the beginning but in reality, they are unwilling to do it. There’s a lot of ongoing work that needs attention” Said Dean Bender, President of the AVLS, “And its simply too much to ask of them”

EMERSONS, DATA MIGRATION:

Emersons are the translating tools needed to collect data where it resides, in whatever language it is in. It then migrates it to format such that at its destination in the Registry everyone is speaking the same language, reading from the same page, singing from the same hymnal, you get what I mean. Much like the claims data translated and migrated from EMRs to ANSI 836X12, Emersons can translate from EMRs and migrate to Registries. “This new translation tool has changed the course of our Registry and in a short period of time. We now just ask willing contributors for access to their EMR and we will take it from there. From Anywhere to Anywhere essentially” Said Dean Bender. Currently, the AVLS is working to help physicians remove the barriers the EMRs have to access their own data. Simultaneously AIAI is using Emersons to amass data into the PRO Registry 2.X. Currently there are 212 practices from 7 different platforms that have contributed data on 1.8M patient procedures. The AVLS research committee has recently published its first paper using registry Data. “There is tremendous enthusiasm from not only the ALVS membership, but from the medical device industry to amass data and start asking it more questions about chronic venous disease.

We are on the precipice of the next leap forward in our understanding of this medical condition” – so says Dr Marlin Schul past president of the AVLS.