IRIS: collecting data, saving money

Nearly two years old, the Academy’s database is exceeding even its creators’ expectations.

By OM staff and correspondent reports

The IRIS ophthalmic database is becoming a legend in its own time.

From Jan. 1, 2013 to June 30, 2016, the IRIS registry, brainchild of the AAO, has collected exam data from 28 million unique patients and 100 million patient visits. These include:

• 3.3 million patients with open-angle glaucoma

• 2.4 million patients with cataracts

• 2.3 million patients with AMD

• 1.3 million patients with diabetic retinopathy

“That kind of data is beyond anything we’ve frankly, imagined,” George A. Williams, the Academy’s secretary for Federal Affairs, said in a release. “We’re very excited about the potential for this to make us better doctors, both at an individual and professional level.”

Researchers, understandably salivating, have been mining the data. In the past year, the IRIS registry has shown up in PubMed-listed journal articles four times, with the last entry a singular one: researchers used IRIS data to search for the prevalence of myopic choroidal neovascularization, then coalesced data from NHANES and the U.S. Census Bureau to arrive at an overall myopia figure. Then, the researchers went one step further to find the prevalence for two retinal complications linked to high myopia.¹

Other important numbers

The centralized database collects and provides statistical analyses of ambulatory encounters with patients seen by more than 60% of ophthalmologists across America.

And those ophthalmologists have saved more than $24 million in penalty avoidances by submitting quality information through IRIS to CMS’ Physician Quality Reporting System (PQRS), according to the Academy.

William L. Rich III, MD, AAO president, said during the Academy meeting in October that the registry is designed to respond to physicians’ Medicare quality reporting needs. “The power of the IRIS registry continues to astound the eye-care community,” he said.

Some background

The IRIS registry was designed to address the quality of care metrics required by the CMS’ new payment models. And, as physicians transition to the latest payment reimbursement requirement, the Merit-Based Incentive Payment System, or MIPS, the Academy says it will evolve the reporting functions of the IRIS registry to meet its requirements.

Today, roughly 83% of physicians use EHR systems to gather, interpret and apply patient data and demographic information, according to the Office of the National Coordinator (ONC) of Health IT. In addition, 60% of those doctors now use EHRs to read image results, while 80% write computerized prescription orders, recording clinical notes, patient medications and viewing lab reports, the ONC reports.

Collecting and analyzing that data allow doctors and hospitals to better understand what does or does not work when treating patients. It can also identify gaps in quality, which shows physicians where they can improve to take better care of their patients.

Understanding the IRIS registry

The IRIS registry is the nation’s first EHR comprehensive eye disease registry.

With its main goal of helping ophthalmologists provide better care for their patients, the registry’s vast storehouse of information affords participating physicians easy-to-interpret, national benchmark reports. Data from IRIS regarding outcomes from medical and surgical care can be used to either validate an ophthalmologist’s quality of patient care or pinpoint areas that may need improvement.

Through monthly reports from IRIS, ophthalmologists can compare their performance with national benchmarks for performance. Doctors can also search the database for medical conditions and demographics.

Assisting with MIPS

The IRIS registry can also aid ophthalmologists in adapting to federal regulations, especially new payment reimbursement requirements. In particular, MIPS and the Alternative Payment Models (APMs) have recently made fundamental changes to the Medicare payment structure.

Other advantages

Another benefit of the collaboration: The IRIS registry is expected to help ophthalmologists with recertification processes for the AAO by linking and simplifying its ABO Practice Improvement Modules (PIMs) to the IRIS registry.

The AAO is also working on integrating IRIS with EPIC-based systems at several academic medical centers, according to Flora Lum, MD, AAO’s president of Quality and Data Science.

Alongside other sources data sources, the CDC is evaluating the use of IRIS to establish a new eye health surveillance system to provide population estimates of vision loss, eye diseases, eye health disparities and barriers and facilitators to access to eye care.

User case study

At the AAO meeting in Chicago, Robert E. Wiggins, MD, of Asheville (N.C.) Eye Associates demonstrated IRIS’ impact. While physicians, patients, payers and the government all want quality care, the act of reporting on quality takes its toll on a physician’s time and money. Dr. Wiggins cited a study in March 2016 Health Affairs that showed physicians and staff spend an average 15.1 hours per week reporting on quality measures, which translates to a total cost of about $15.4 billion. This results in physician burnout, increased time away from patients and longer wait times, which actually hurt their quality of care.

Through the years, Asheville Eye Associates transitioned from using a paper form regarding whether a quality measure was performed, to using an EHR to report. “Our vendor had a series of nine steps or clicks that we had to go through to document that we performed that quality measure on that patient,” said Dr. Wiggins.

Despite working their way to a 100% success rate, physicians were less than thrilled. “If they had tomatoes, they would have thrown them at me,” said Dr. Wiggins. “They said, ‘This new system is horrible. We don’t care if we’re getting bonuses or not. This is bogging down the clinic.’”

IRIS has simplified reporting on quality measures, so Dr. Wiggins can improve quality measures. These data are automatically pulled; no more clicks or fear of thrown tomatoes for Dr. Wiggins. The practice still receives a 100% success rate, but the time spent reporting quality is nil.

“I’m a big believer in lean management and getting waste out of processes,” he said. “This is taking lean management to the max.”

Conclusion

The IRIS registry has shown it holds opportunities for clinical research and population-based health. These data will allow for better tracking of the natural history of disease, examine the outcomes of medical and surgical interventions, perform post-market surveillance of new devices and drugs, and identify patients who meet eligibility criteria for clinical trials.

Said Dr. Rich: “There is no other resource in the world that can provide ophthalmologists and public health decision-makers with a real-time, real-world picture about the value, efficacy and potential to improve medical and surgical eye care.” OM

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