Clinicians MOU

Memorandum of Understanding

Title: Australian Spine Registry
Ethics Approval Number: HREC/16/MH93
Clinical Lead: Mr Michael Johnson

This Memorandum of Understanding ("MOU") is made and entered into by and between the Australian Spine Registry (ASR) and

Title(Required)

Surgeon Name(Required)

First Last

Purpose

The purpose of this Memorandum of Understanding (MOU) is to briefly explain the ASR’s purpose, structure and governance and to provide you with information concerning your involvement as a participant in the registry.

Aim

The aim of the Australian Spine Registry (ASR) is to obtain data related to spine surgery and its outcome for patients undergoing elective spine surgery in Australia.

The collection of this data will assist in individual patient care and provide population-based insights concerning spine surgery.

Background

The ASR is a clinical quality registry established by the Spine Society of Australia (SSA), which commenced collecting data in 2018. A clinical quality registry collects health information on groups of patients to monitor the quality of care provided. The ASR collects information on patients who have undergone elective spine surgery at participating hospitals in Australia. The data is stored in the Registry, which is located on a secure Australian server.

The registry is currently funded by the Australian Department of Health and Aged Care and a 5 year, $7 million Medical Research Future Fund (MRFF) grant. Additional funding will be sought in the future.

The ASR has obtained nationwide ethics approval from the Melbourne Health Hospital Ethics Committee. The registry is overseen by a Steering Committee consisting of 9 members:

Clinical Lead
Secretariat
Three (3) members of the Spine Society of Australia
An appointee from the Neurosurgical Society of Australasia (NSA)
An appointee from the Australian Orthopaedic Association (AOA)
A representative of the paediatric arm of the Australian Spine Registry
Consumer representative (1)

Benefits of Participation

The ASR benefits surgeons who participate in the registry in several ways:

The ASR database allows surgeons to run patient-level and aggregate data reports for their practice in real-time.
The ASR is recognised by the Royal Australian College of Surgeons (RACS) as a Continuing Medical Education (CME) audit activity that aims to improve the quality of patient care.
Surgeons will also be provided with a copy of the logo to use at their discretion, i.e. on their email signature, essential documents, letterheads, and website.

The ASR aims to collect and analyse data in a way that assists with the care of individual patients, providing general information about the efficacy of spinal care and acting as a catalyst for spine surgery clinical research.

Participation in the registry

Surgeon participation in the registry involves:

Entering all patient data into the registry database before and after surgery. This needs to be done within 90 days of surgery.
The effectiveness of the registry is dependent on the data being as accurate as possible. It would be greatly appreciated if any queries from our administrative staff relating to data quality or completeness, are responded to in a timely manner.

Responsibilities of the registry

The ASR and its staff will:

Maintain the confidentiality and security of the submitted data.
Use the data for approved registry purposes only, including quality improvement and reporting activities.
Provide feedback reports or benchmarking information to the Surgeon, as applicable.

Data Access

The surgeon will continue to have access to their own registry data and access to mass de-identified data through the dashboard. Surgeons can request other levels of data access through the ASR Steering Committee.

Confidentiality

The registry and its staff maintain the confidentiality and privacy of health information in accordance with Commonwealth and State legislation.

What do we need from you?

Please refer to the Patient Information Brochure to gain an understanding of the recruitment strategy adopted by the ASR.
If you wish to be involved, please complete and sign this Memorandum of Understanding to confirm your understanding and agreement to participate in the registry, and to enter your complete and accurate patient data accordingly.
Submit this completed form online using the SUBMIT button below or alternatively download the contents for manual completion, scan and send the signed form to [email protected]
Once we have received your signed participation form, we will provide you and your practice/hospital with the relevant training on data collection and entry.

Further information and who to contact

If you require any further information concerning this project or have any questions, please:

visit the website – spineregistry.org.au, or
contact the Australian Spine Registry via email: [email protected], or
Call one of our ASR Business Development and Research Associates – Jenny Wilson 0401 474 764 or Katherine Kindl 0433 001 373
Or the ASR Clinical Lead – Mr Michael Johnson 0400 839 499

Surgeon Registration Form

Name(Required)

First Last

My private practice / public hospital(s) affiliation details are (preferred address for Registry contact):

Address(Required)

Address Line 1 Address Line 2 Suburb State Postcode

Mobile number(Required)

Phone number

Email 1 (private email)(Required)

Email 2 (rooms or general email)

Practice Manager/PA Name and contact details(Required)

Hospital affiliations(Required)

I operate on patients under 18 years of age(Required)

Yes

I am interested in being a Principal Investigator (PI)(Required)

Yes

Surgeon's Signature

I would like to participate in the ASR and to enter the relevant medical data from all eligible patients treated by me at the participating hospital, provided the patient has not requested to opt out of the registry.