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listed in. Only 9% were not on DMARD therapy. Thirty-four percent of individuals were using a biologic or targeted synthetic DMARD (n 5 20,759), while 67% were using a nonbiologic DMARD (n 5 40,272). Twenty-three percent were on biologic DMARD monotherapy. As expected, methotrexate was the most commonly used DMARD (43.5%), followed by hydroxychloroquine (23.3%). Performance on selected RISE quality measures is listed in Table 4. For example, performance on assessment of disease activity (NQF 2523) was 55.2%. Among those satisfying this measure, the most commonly used outcome measures were Routine Assessment of Patient Index Data 3 (RAPID-3; 56.0%) and Clinical Disease Activity Index (36.9%), with fewer patients having Simplified Disease Activity Index (0.04%), Disease Activity Score in 28 joints (3.8%), or Patient Activity Scale II (3.2%) scores recorded in the EHR. For functional status assessment (NQF 2524), performance was 53.6% and a majority of practices used the RAPID-3/modified Health Assessment Questionnaire (HAQ; 45.2% of scores reported in the EHR) or a version of the HAQ (original HAQ 38.5% or HAQ-II 3.3%). As is reflected in the medication data, 91.0% of patients met the criteria for DMARD therapy (NQF 2525). For tuberculosis Table 2. Selected rheumatologic diagnoses captured in the RISE registry* Diagnosis at last encounter ICD-9 codes No. Degenerative joint disease OA, generalized or localized Vasculitis Temporal arteritis 446.5 1,596 Granulomatosis with polyangiitis 446.4 686 Behc¸et’s disease 136.1 301 Henoch Schonlein 287.0 106 Takayasu disease 446.7 85 Goodpasture’s syndrome 446.21 4 Scleroderma 710.1 2,754 JIA 714.3, 714.31–714.33 1,342 Dermatomyositis/polymyositis 710.3, 710.4 2,366 Sarcoidosis 135 1,548 Relapsing polychondritis 733.99 886 Crystalline arthropathies Gout 274.xx 9,887 CPDD 275.49, 712.1–712.3, 712.8 1,131 Pain syndromes Myalgia or myositis (fibromyalgia) 729.1 49,345 Low back pain 724.1 34,768 Infectious arthritis Lyme disease 88.81 913 Septic arthritis 711.xx 284 * All data reflect values at end of last observed clinical encounter. Diagnoses are not mutually exclusive across diagnostic categories; for example, a patient may be captured twice in the Table if they have both rheumatoid arthritis (RA) and osteoarthritis (OA). RISE 5 Rheumatology Informatics System for Effectiveness; ICD-9 5 International Classification of Diseases, Ninth Revision; SLE 5 systemic lupus erythematosus; JIA 5 juvenile idiopathic arthritis; CPDD 5 calcium pyrophosphate deposition disease. 1870 Yazdany et al screening (NQF 2522), performance was 55.2%. Across all measures in Table 4, performance was highest for a measure regarding medication reconciliation (96.8%) and lowest for serum urate monitoring in gout patients (31.0%). Some information was missing for all variables, but the proportion of missing data was low for most sociodemographic data, except for insurance status (19.3%). Work is ongoing to understand the accuracy of diagnosis codes and medications in RISE, with initial data suggesting very good specificity for RA and for DMARDs (2). The extent of missingness as well as accuracy is expected to improve as mapping and validation procedures for RISE continue in the coming years. DISCUSSION Payment reform, a proliferation of new medication options, and the widespread introduction of EHRs are transforming the practice of rheumatology in the US. Given these changes, the ACR launched the RISE registry to help rheumatologists succeed in advancing the triple aim of improving the care experience, improving the health of populations, and reducing the costs of care (3). The enthusiastic participation of US
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