Scrutinize Your Data the Right Way

The emergency treatment of stroke may be the most complex multidisciplinary operation a hospital chooses to undertake.  The field of Cardiology faced this challenge two decades ago and solved this problem with Point-Of-Service concurrent data documentation and the concerted use of registries to enable continuous ongoing Process Improvement.  From the standpoint of clinicians, the complicated history, physical exams, and diagnostic studies can be overwhelming.  Hospitals are tasked with oversight of not only the well-being of patients, but also the activities of nurses, medical staff and ancillary services.   This has stimulated the creation of numerous performance standards and clinical practice guidelines designed to ensure physician and hospital competence and improve patient care.   Consequently, hospital accreditation organizations such as the Joint Commission incorporate these guidelines into their own mandates in order to facilitate improvement in the quality of patient care and clinical outcomes.

There are also legal and regulatory issues that pertain to patient care and clinical outcomes.  It is in the national interest to have efficient high-quality healthcare for the betterment of the population as a whole.  Rules and regulations pertaining to both the provision of healthcare (e.g., performance mandates such as “Pay for performance”) as well as patient privacy have been formulated.  For these reasons, both medical and regulatory, it is important that hospitals and staff be in compliance with these mandates.  To explore compliance requirements further , and this give the flavor of our unique feature of SERET registry which is Cost-Effictivines and Utility Analysis Metrics .

To learn more about how SECRET can meet your needs, go to What It DeliversWhy It’s Unique or How It Works.  To schedule a personal demonstration or learn more about SECRET, Use Contact us form.

Fulfilling the Mandates of the Joint Commission

Beginning in 2001, the need for a stroke registry was formally recognized by multiple societies and associations in the first definition of Primary Stroke centers.  Ten years later, the American Stroke Association (ASA) took a significant step toward formalizing the stroke registry requirement by publishing the following milestone document:


“To facilitate data collection in a standardized way and to avoid the redundant efforts that would occur if Comprehensive Stroke Centers (CSCs) designed their own databases, we expect that CSCs will make use of national databases or registries to collect data required for metrics and to collect additional detailed data that will assist in quality improvement……”

Predicated on this ASA document, new certification requirements for Advanced Primary and Comprehensive Stroke Centers were released by the Joint Commission mandating stroke registries:

From the Joint Commission in 2011:

“Primary Stroke centers should have a database or registry for tracking the number and type of patients with stroke seen, their treatments, timelines for receiving treatments, and some measurement of their outcomes..”

From the Joint Commission in 2012:

“The Comprehensive Stroke Center uses a stroke registry… Measurement data must be internally trended over time and may be compared to an external data source for comparative purposes.”

In 2013, and updated 2015 , and 2018 , added to the growing list of milestone guidelines and consensus statements around the use of a stroke registry was the Multisociety Consensus Quality Improvement Guidelines for Intra-Arterial Catheter Directed Treatment of Acute Ischemic Stroke .  The most definitive mandate to date, the paper was published under the banner of a consortium of medical societies/specialties that perform nearly all of the endovascular stroke procedures in the United States, Canada and Europe.  Specifically, the guidelines require that “100 percent of patients have the required process and outcomes data entered into a national database, trial, or registry” in order to document and monitor overall quality of patient care.

Today, over 1000 Primary Stroke Centers and growing numbers of newly designated Comprehensive Stroke Centers are considering how best to fulfill the stroke registry requirements put forth by the Joint Commission and guidelines recommended by multiple societies.  SECRET, the only dedicated process improvement system available, tracks numerous performance measures across the entire spectrum of emergency stroke treatment, including data points specified by the Joint Commission for Primary and Comprehensive Stroke Centers.  Unique in this capability, SECRET captures everything you need, as shown in this Stroke Measures Charts  to help you understand and improve your processes of care and clinical outcomes.  For a more in-depth look at the actual reports that will provide real-time rationale for recommended procedural adjustments, and which will be based upon the cost-effectiveness and cost utility analysis for your own center , go to About us .

Learn more about how SECRET complies with multiple standards and guidelines, and is designed in accordance with strict privacy and security protocols.


Security Prioritization

As explained in the section on Privacy, SECRET uses de-identified data and is not subject to the rigorous rules concerning Protected Health Information (PHI).  As such, it is much easier for multiple researchers from various institutions to access and use SECRET information while analyzing stroke treatment and results without risk of exposing an individual patient’s, or physician’s, identity. That being said, SECRET still integrates security safeguards as a matter of priority.  Specifically, all login and passwords follow high-security requirements and passwords are changed every 90 days.  Additionally, SECRET data is encrypted and transmitted via secure Internet connection to the server/storage center utilizing a “Hypertext Transfer Protocol Secure” (HTTPS) for secure transmission on top of a Secure Socket Layer (SSL) for encryption. SECRET uses https for all transmissions outside your institution to Bit Refinery, the server and data hosting site.


As a provider, Bit Refinery can never access your sensitive data and only provides a secure infrastructure and high-availability hosting site that follows all security and privacy compliance rules.  Indeed, since the actual stored information is “de-identified,” safety is exponentially maximized.  Bit Refinery’s infrastructure is built to accommodate any level of workload, and redundancy is built into every level.  In addition to the fully redundant structure that is hosting your sensitive data, Bit Refinery is one of the only cloud-hosting providers that includes encrypted Veeam backups to a separate storage device for every customer.  In addition, all users (hospitals, etc.) can download all of their data 24/7/365.


SECRET was created from the ground up utilizing the services of a sophisticated custom Open Sources and from scratch programing from group of experts from Alexandria University including Faculty of medicine , engineering and AAST (Arab academy for science and technology). in partnership with experts in the field of stroke diagnosis and treatment and interventional neurology from all Egyptian Universities including Cairo , Ain-shams , Elazahr , Assuit , Tanta , Mansoura, Higher council of military medical academy , designed SECRET to be the premier database and analysis tool for both processes of care and clinical outcomes in the emergency treatment of acute ischemic stroke.  The technical nuances of the SECRET platform, allowing users to customize not only data input but to then be able to perform complex analyses, is unique in the world of stroke .

Learn more about how SECRET is designed in accordance with strict privacyprotocols, and complies with Joint Commission mandates and multiple standards and guidelines.


Aligning with Standards and Guidelines

Leading up to the Joint Commission mandate for utilization of a stroke registry, various guidelines were published, some reflecting multi-society collaboration, to emphasize the growing understanding that, ultimately, data is key to improving delivery of stroke care and potentially, patient outcomes. See below for a brief description of key papers:

Performance and Training Standards for Endovascular Ischemic Stroke Treatment published in 2009, and updated 2017,  by a coalition of medical societies to include the American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Cerebrovascular Section, Society of NeuroInterventional Surgery and the Society of Vascular & Interventional Neurology.  These standards mandate the tracking of procedural and clinical outcomes for all patients treated with endovascular techniques.

Training Guidelines for Intra-Arterial Catheter-Directed Treatment of Acute Ischemic Stroke published in 2009 , updated 2016, by the Society of Interventional Radiology.  These Guidelines state that an interventional stroke therapy outcomes registry is necessary to monitor ongoing processes as well as procedural results and clinical outcomes.

Metrics for measuring Quality of Care in Comprehensive Stroke Centers published in 2011 , updated 2018 , by the American Stroke Association.  These metrics recommend the use of a national database or registry to collect data, rather than a local database, in order to avoid redundant efforts that would occur if comprehensive stroke centers designed their own database.

The international Multi-Society Consensus Quality Improvement Guidelines for Intra-Arterial Catheter Directed Treatment of Acute Ischemic Stroke was written by eight international medical societies directly involved in endovascular stroke therapy.  These guidelines are the first to specifically mandate benchmarks for individual physician performance, as well as to specify metrics for the major institutional processes that would influence physician performance and patient outcomes. This paper states that “100 percent of patients have the required processes and outcomes data entered into a national database, trial, or registry.”

The Guidelines for the Early Management of Patients with Acute Ischemic Stroke, authored by the American Stroke Association in March 2013 and updated 2018 represents the most exhaustive standards for all aspects of emergency stroke care.

Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke published in 2013 and updated separately and in combination in 2017 and 2018 by a multispecialty workgroup from STIR (Stroke Imaging Repository) with endorsement by the American Academy of Neurology/Stroke System Work Group, American Association of Neurological Surgeon/Congress of Neurological Surgeon Cerebrovascular Section, American Society of Neuroradiology, Society of Neurointerventional Surgery, and Society of Vascular and Interventional Neurology. These standards mandate the tracking of specific process details for all patients treated with endovascular techniques.

Learn more about how SECRET complies with the Joint Commission and is designed in accordance with strict privacy and security protocols.


SECRET is the only stroke registry that fulfills the requirements of the following entities:

  • American Stroke Association
  • Brain Attack Coalition
  • Society of Vascular and Interventional Neurology
  • Society of NeuroInterventional Surgery
  • American Society of Neuroradiology
  • Canadian Interventional Radiology Association
  • Cardiovascular and Interventional Radiology Society of Europe
  • Society of Cardiac Angiography and Interventions
  • Society of Interventional Radiology
  • European Society of Minimally Invasive Neurological Therapy
  • Middle East North Africa Stroke and interventional neurotherapies organization
  • Mission thrombectomy 2020