Who comprises MPOG, and what are its goals?

The Multicenter Perioperative Outcomes Group is an international consortium of over 50 anesthesiology and surgical departments of institutions with perioperative information systems. The goals of MPOG are to accelerate outcomes research and investigate perioperative clinical practices to advance knowledge and improve patient care.

What data elements are tracked within MPOG?

The MPOG database contains high-quality data relevant to perioperative patient care. These include minute-to-minute physiologic data as recorded within the intraoperative record, as well as minute-to-minute patient care interventions including medication administration, fluid/blood product administration, ventilator settings, and procedure times.

In addition to intraoperative anesthesia record information, the MPOG database records:

  • Preop/PACU data – the MPOG data extract includes 4 hours before Anesthesia Start through 6 hours after Anesthesia End.
  • Patient diagnoses – available by discharge diagnoses, professional fee data, and the Anesthesia History & Physical
  • Laboratory values – 365 days before and after surgery date, as available within the electronic health record
  • Outcome measures – including in-hospital mortality, and diagnosis/laboratory based outcomes (e.g. acute kidney injury, myocardial infarction, postoperative pneumonia)

For ease of use and to promote research and quality improvement efforts, all database elements tracked within MPOG can be found within using our Concept Browser and Phenotype Browser search tools.

What is the goal of surgery registry integration?

Through tracking perioperative care practices, the MPOG consortium has been able to drive research and quality improvement efforts leading to multiple publications and quality reporting tools. Similar accomplishments have been made with surgery registries. Through database integration, however, there is great potential for new lines of research and cross-departmental collaboration leveraging the strengths within each database.

MPOG strives to build these promising new lines of research, and invites surgeons as collaborators on MPOG-initiated projects as well as supports surgeons on projects of their own.

What are the sources of funding for MPOG?

MPOG is maintained through three funding sources: anesthesia departmental support (both coordinating center and participating sites), nonprofit healthcare organization support via Blue Cross Blue Shield, and industry support for performing industry-sponsored studies.

How can I learn more about MPOG?

A full description of MPOG membership, infrastructure, goals, research publications, and quality improvement projects are available at the MPOG website: www.mpog.org. Additionally, MPOG offers Tips & Tricks as a series of instructional modules  describing the MPOG research process for those new to MPOG.

REGULATORY / LEGAL

What regulatory framework has MPOG established for responsible conduct of research?

  • IRB

The MPOG consortium has two types of IRB approvals used to conduct research. 

  1. At the coordinating center: an IRB is maintained which enables the collection of a limited dataset to be stored in a secure MPOG database. 
  2. At each participating center (“performance site”): a second institution-specific IRB is maintained in order to send each institution’s limited clinical dataset to the central MPOG database. 

If interested in adding surgical registry (e.g. STS or NSQIP) data to your MPOG dataset, an amendment to the performance site IRB is necessary and should include specific language ensuring that each registry integrated is listed. 

In the case of the STS Database, we recommend not using the term “cardiac” as this usually refers to STS adult cardiac surgical database alone (STS-ACSD). Instead, ‘Society of Thoracic Surgeons National Database’ can be used to to encompass all of the 4 components of this database and precludes requiring additional amendments in the future. 

IRB University of Michigan Performance Site Application Example (See Appendix A)

  • DUA (Data Use Agreement)

Additional DUA amendments are not needed to upload STS/NSQIP data as this is merged locally with locally owned data.  While surgical registry PHI and provider data does live locally, only a limited dataset and provider IDs are sent to the MPOG central database.

Michigan sites – Two DUA amendments must be executed:

  • MPOG DUA: allows sites to send a limited dataset which includes date of service but no other PHI.  Surgeon names are not PHI so are not restricted by the DUA, but surgeon names are removed and replaced with anonymized IDs at the local level prior to uploading data to the coordinating center.
  • Surgical CQI DUA amendment:
    1. HUM00130386 Enhancing the Multicenter Perioperative Outcomes Group (MPOG) and Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Database.  This lists MVC, MSQC, and Michigan Death Index (MDI).

For more information on DUA processes, please contact MPOG coordinating center administrator, Tory Lacca (lacca@med.umich.edu).

DATA SECURITY

What methods are used to ensure security of Protected Health Information (PHI) within the MPOG database?

No patient identifiers are extracted as part of the data aggregation process. Since date of surgery is being extracted, the extracted data is considered to be a limited data set and a Data Use Agreement (DUA) between MPOG and each participating research center will need to be established (as described above). For more information on DUA processes, please contact MPOG coordinating center administrator, Tory Lacca (lacca@med.umich.edu).

All data uploaded to the MPOG central database are stored within a high-security data center owned by the University of Michigan. Building access is strictly controlled and servers are maintained by University of Michigan IT staff. Further information regarding measures to ensure patient privacy can be found here.

Are Protected Health Information (PHI) included in surgical registries uploaded to MPOG?

Though medical record numbers or social security numbers are required to locally match MPOG data to surgical registry data (e.g. STS or NSQIP), those elements remain stored locally and are not uploaded to the MPOG Central database.

Who has access to the MPOG database?

The MPOG database is maintained on a secure central server, with access to limited datasets granted on a project-specific basis to active members. Projects may be presented by MPOG contributing members, and are reviewed during research and quality improvement meetings as described below.

What institutions have currently been involved with surgery registry integration?

Current surgery registries establishing integration with MPOG include the National Surgical Quality Improvement Program (NSQIP and NSQIP-Pediatric) database as well as all four components of the Society of Thoracic Surgeons (STS) database:

  • STS – Adult Cardiac (STS-ACSD) “STS Cardiac”
  • STS – General Thoracic (STS-GTSD) “STS Thoracic”
  • STS – Congenital Heart (STS-CHSD)
  • STS – Intermacs (LVAD database)

Multiple MPOG sites are actively integrating NSQIP and STS data currently; a current list of active sites is available upon request (support@mpog.zendesk.com)

I am interested in a collaboration with MPOG, and I already have some ideas for research or quality improvement projects. How can I work with MPOG to drive these ideas forward?

The MPOG team is absolutely committed to your research and quality improvement interests, and seeks cross-departmental collaboration!

The MPOG consortium has an established Perioperative Clinical Research Committee (PCRC) to coordinate research and quality improvement efforts within the group. It accomplishes this goal by reviewing research proposals submitted, and periodically reviewing progress of all ongoing research projects.

The purpose of the committee is not to limit or provide obstacles to successful research programs, but to ensure appropriateness of clinical research and allocate research resources to complete projects. Our formalized steps for proposal can be found here. Additionally, for more information regarding preparing a research project proposal and the resources available within MPOG, please view our Tips & Tricks page.

Are there any examples of research publications achieved through surgery registry integration with MPOG?

Multiple research projects are currently being pursued by surgery and anesthesiology faculty at participating sites. An example of a completed publication utilizing elements from the MPOG and STS databases can be found here:

What is the time commitment required for the Surgical Registry Database Manager to import surgical registry data into the MPOG local database?

Time commitment is minimal, and expedited by the use of a surgical registry-specific import tool (e.g. STS Import Tool; NSQIP Import Tool). Usually less than one hour per upload is required. Uploads can be performed on the same intervals as when curated surgical registry  “harvest files” are submitted to surgical-registry specific coordinating centers (usually quarterly or bi-annually) as time permits.

The first time using the surgical registry-specific Import Tool to integrate MPOG data with surgical registry “harvest file” data may take longer as your Surgical Registry Database Manager becomes familiar with the Import Tool and develops a process workflow for integration at regular intervals.

STS Import Tool User Guide

NSQIP Import Tool User Guide

Are surgeon names included in the surgical data uploaded to MPOG Central?

During the Surgical Registry integration process which is performed locally at MPOG institutions using the Import Tools within the MPOG Application Suite, surgeon names are removed and replaced with anonymized IDs. Additionally, protected health information with the exception of dates of service, which remain covered in MPOG DUAs already established at MPOG performance sites, are also removed via the Import Tool. This integrated Limited Dataset with the above identifiers removed, is what is transferred to the secure MPOG Central database. 

DATA INTEGRATION/ACCESS

Time Commitment

The actual time needed to complete the integration is limited (a few hours). However, to ensure the process is smooth, it is important to identify the necessary stakeholders. There are 3 separate tasks:

  1. Clinical sponsorship (by surgeon and anesthesia champions specific to each surgical registry) – Identify who these champions are and have them find the time to have a conversation / come to agreement
  2. Regulatory approval (IRB amendment) – Add amendment to the performance site’s MPOG IRB, which states that surgical registry (e.g. STS, NSQIP, or other registry of interest) data will be integrated with MPOG.
  3. Database integration – Connect surgical registry (e.g. STS/NSQIP) IT with MPOG IT to complete this task via the STS/NSQIP Import tool.

Who operates the Surgical Registry Harvest files and is this automatic or manual? How does it pull data from Epic?

The Surgical Registry Harvest Files are integrated with MPOG data, through a process initiated by the Surgical Registry-specific Database Manager at your site and in collaboration with your site’s MPOG technical support person. This process would occur on the same interval (usually every 3 or 6 months) that the Surgical Registry Database Manager is submitting Harvest Files to the surgical registry central database. 

There is no additional data pulled from Epic beyond what is already being pulled to your local MPOG database, independent of MPOG-Surgical Registry integration. Only Surgical Registry data is being added; this integration effort is facilitated by the Surgical Registry-specific (e.g. STS, NSQIP) Import Tools

Who verifies the matching of Surgical Registry IDs/ MRNs and how is this done locally? Whose responsibility should this be?

Matching is done locally by using a medical record number or unique patient identifier such as SSN. Personnel representing a particular registry at each performance site can verify case matching by reviewing a small sample of integrated cases locally during the first data import. 

If a site does not have an MRN or SSN in the harvest file, a second file is needed for linking purposes (links STS ID to MRN or other unique patient identifier). Once the Surgical Registry Import tool is run using this linking key, this linking key can be archived or destroyed locally, and this data is not uploaded to MPOG central repository. 

Once the upload to MPOG is complete, how do we validate the data?

MPOG data and surgical registry data each have separate validation processes already in place, independent of the database integration. Beyond confirming that the matching correctly occurred, there is no additional required validation prior to upload to MPOG central.

Once the initial integration is complete, who is responsible for the recurring data upload?

The upload is a collaborative effort in which the site’s surgical registry database manager will use the Surgical Registry-specific Import tool to integrate the Surgical Registry data with MPOG data, as handled by the site’s MPOG IT. Once Surgical Registry IT learns the flow of this process and navigates the initial integration, all future uploads require minimal effort, and can be done with either the same frequency as uploads of Surgical Registry harvest files to the Surgical Registry coordinating center (usually every 3-6 months), or lesser frequency (e.g. annually) if preferred

Is the integration retrospective as well as prospective? How does switching EHRs impact historical data integration?

The integration is both retrospective and prospective. If a site has previously switched to a new EHR, we recommend integrating data back to the go-live date. Integrating data prior to an EHR switch is supported as far back as 2014 if a site’s departmental IT can support this effort.

DATA OWNERSHIP

Once the upload to MPOG is complete, who owns the data?

MPOG acts as a steward for the integrated data, but does not “own” any of this data.

Developers at MPOG central serve as Honest Brokers to manage access privileges to secure data enclaves specific to research or quality improvement projects, but each MPOG institution retains the sole rights to the data they contribute to the central MPOG database, and can choose to withdraw their data from the central MPOG database at any time. More details found in our MPOG Bylaws, Section XI “Data Ownership” . 

Who has access to the surgical registry data within the MPOG server? Can we use the multi-center data for research and quality improvement projects?

Although the MPOG-Surgical Registry integrated data is stored on a secure central server at the University of Michigan, access to this multicenter dataset, whether for research or QI purposes, is regulated by research or quality committees composed of members across all active MPOG sites.

Research and QI projects involving MPOG-Surgical Registry integrated data are approved on a project-specific basis. Surgeon champions representing the registry of interest are included in the project review/approval processes. Furthermore, as anesthesiologists at sites may propose research/QI projects using integrated data, surgeon champions from various registries are encouraged to do so as well.

Single-center data is accessible to the performance site for use in any fashion with the approval from hospital leadership. 

TROUBLESHOOTING

If there are issues, Surgical Registry and MPOG site IT will need to be involved to determine why key data elements are missing (i.e. MRN, STS case number, etc.). If both MRN and SSN are missing from the file, a separate file joining Surgical Registry IDs and MRNs or SSNs will need to be generated. The MPOG Coordinating Center can provide sample queries for how to extract these elements if helpful for local site integration efforts.

Who is the contact for questions/issues with the MPOG server or accessibility?

The MPOG site Anesthesia IT Champion and local technical support personnel.