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rheumatologists has allowed the registry to grow quickly since its launch in 2014. RISE represents the first attempt to create a national EHR-enabled rheumatology registry in the US, thereby avoiding separate entry of data by clinicians or office staff. The registry has made headway in addressing some of the challenges of interoperability that have previously made data sharing across health systems difficult. This is because RISE’s clinical informatics structure was designed to be agnostic to the EHR system used by rheumatologists, and can be adapted to draw data from most certified systems. Central mapping of data also creates efficiencies for practices that have limited information technology support or data analytic software capabilities. Additionally, automation permits uploading of a clinician’s entire population of patients, preventing biases in patient selection. The data in RISE therefore provide a unique and inclusive view of rheumatology practices, because patients with all medical conditions managed by rheumatologists and all types of insurance are included. Initial data in RISE provide an interesting birds-eye view of the clinical characteristics of patients seen in participating rheumatology practices. Although prevalent rheumatologic conditions (e.g., osteoarthritis and RA) are well represented in the registry, RISE already includes data on individuals with several less common conditions, such as inflammatory myopathies and vasculitides. As we try to improve the quality of rheumatologic care across these conditions, we anticipate that data on the natural history, treatment patterns, and clinical outcomes on these disorders will make quality improvement efforts increasingly data driven. Moreover, the generalizability of data in RISE is anticipated to improve as the registry grows and better reflects the racial/ethnic and geographic diversity of patients seen by rheumatologists. In the area of RA, RISE has started to build a foundation for measuring and understanding outcomes, treatment patterns, and also patient safety. Two nationally endorsed RISE electronic clinical quality measures, assessment of disease activity (NQF 2523), and functional status assessment (NQF 2524), are the first examples of EHR-enabled measures that collect outcomes, including patient-reported outcomes, across the registry. We are encouraged by the fact that over one-half of rheumatologists participating in RISE are routinely capturing this information in practice. Measurement of these outcomes using validated tools enables evidence based care by facilitating a treat-to-target approach in RA, and also allows for tracking of outcomes and benchmarking across rheumatology practices. In addition, the considerable effort made by rheumatologists and their staff to collect this information in routine clinical care has resulted in one of the largest national efforts to collect patient-reported outcomes for a chronic disease via the EHR in the US. Another quality measure, DMARD therapy (NQF 2525), has created a foundation for ensuring that accurate information about medication utilization is collected across the registry. Not surprisingly, performance on this measure across rheumatology practices participating in RISE is high (91.0%). The data presented in this study Table 3. Active medications among individuals with rheumatoid arthritis at the last clinical encounter in the RISE registry* Medication N 5 60,354 Biologic or targeted synthetic DMARDs† 20,759 (34.4) Anti-TNF 4,924 (8.2) Etanercept 4,714 (7.8) Adalimumab 3,419 (5.7) Infliximab 1,034 (1.7) Golimumab 847 (1.4) Other biologic agents Abatacept 2,549 (4.2) Tocilizumab 1,248 (2.1) Rituximab 988 (1.6) Anakinra 26 (0.04)
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