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The IRIS Registry: Bringing the Power of Big Data to Your Fingertips
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For ophthalmologists interested in measuring quality outcomes and identifying gaps in quality of care, it usually takes months, if not longer, to procure and process the necessary data. It took David F. Chang, MD, and John R. Campbell, MD, years of study, for example, to identify the use of Flomax in men as a cause of dropped nuclei and other complications in cataract surgery.

Now imagine a scenario where those months and years become minutes, a scenario where you can instantly access cataract-complication rates — crossed with prescription drug use — from practices in your region and compare them with others around the country. With more than 20 million patient records soon to be available at the push of a button, the Academy’s IRIS™ Registry (Intelligent Research In Sight) promises to make this a reality.

What Is It?
The IRIS Registry is the nation’s first electronic health record (EHR)–based comprehensive eye disease database. Relevant data will be automatically and securely extracted from participants’ office EHR systems on a scheduled basis and transmitted directly to the IRIS Registry. The registry will then serve as a centralized repository and reporting tool that collects and performs statistical analysis of patient data to produce easy-to-interpret, national and inter-practice benchmark reports.

Why Should Ophthalmologists Care?
With the help of subspecialty and state societies and many volunteers, the Academy developed the IRIS Registry with several purposes in mind for physicians who participate:

  • Improve patient care — Measure quality outcomes, monitor patient interactions and track interventions.
  • Manage patient populations — Gauge clinical conditions for entire patient groups by running reports on specific care criteria.
  • Benchmark practice performance — Run quality reports on demand and compare with other clinicians and practices around the country.
  • Enhance quality and practice efficiency — Analyze practice procedures and demonstrate resource use to payers and purchasers.
  • Streamline quality reporting and participation in incentive programs — Submit EHR data for the CMS Physician Quality Reporting System (PQRS) automatically to earn a Medicare bonus and avoid the PQRS penalty.
  • Create a community of quality — Interact with colleagues to share quality-improvement strategies and broaden and strengthen professional networks.

Why Now?
As an organization, the Academy has always strived to improve and innovate ophthalmic patient care; the IRIS Registry is the next logical step. With EHRs and other technological advances becoming increasingly ubiquitous in the medical world, physicians already have the real-time framework to perform their own data analysis. The IRIS Registry simply facilitates this process.

And with the demonstrated success of registries developed by the American College of Cardiology, the Society of Thoracic Surgeons and the American Gastroenterological Association, the timing is ideal for the Academy to join the early adopters of this type of information technology.

“We are at one of the first times in history when we, as an ophthalmology and medical community, have been able to collect and aggregate clinical data on a large scale,” Michael Chiang, MD, said in an email interview. “This will create opportunities to revolutionize the way that we care for our patients, understand our clinical outcomes and address public health issues relevant to ophthalmology.” As the chair of the Academy Medical Information Technology and a member of the Ophthalmic Technology Assessment Committees, Dr. Chiang has been closely involved in the registry’s development.

But What Does It Mean for YOs?
Once the IRIS Registry is in place and fully populated, it will have significant ramifications for young ophthalmologists’ entire career span. From how they practice to how they train, it will be a dramatically different YO experience.

In training. Currently, although program directors must evaluate resident competency as they move through training, there are few simple ways to quantify performance. As a result, the Academy has discussed the possibility of adapting the IRIS Registry for use in training programs. “This would provide opportunities to examine training outcomes and eventually find ways to improve them,” Dr. Chiang said.

In practice. “Once in practice, YOs will have real-time feedback on performance, outcomes and improvement,” said William L. Rich III, MD, the Academy’s medical director of health policy, in an email. “They will be able to benchmark their performance with their peers or any reference group they choose.” Dr. Rich also noted that the IRIS Registry will be particularly useful as ophthalmology moves to more bundled-payment models that reward physicians for performance related to populations of patients.

“YOs will be able to view their populations as they relate to diabetes, glaucoma, postop grafts, cataracts, etc., see how they are performing and use the registry to explore the variables that might impact a population’s outcomes,” he wrote. And over time, the registry will include elements to help YOs meet Maintenance of Certification requirements as well as tools to help the Academy identify topic areas around which CME activities might be developed.

A smooth transition. Academy leaders expect that, unlike their older peers, YOs will ultimately adapt much faster to this new e-environment. “YOs understand the power of ‘big data,’” Dr. Rich said, because this form of data collection has already dramatically restructured retail function in the United States — whether to determine where products are located in a retail store or assist in targeting individuals for personalized advertisements. “Big data will soon also completely revolutionize how we do drug and device surveillance,” he added, “as well as how we evaluate the efficacy of treatments beyond randomized clinical trials.”

How Can I Participate?
Participation in the IRIS Registry is voluntary. The registry will be opened to all U.S. Academy members beginning the first quarter of 2014. The first 2,000 members to sign up will get free participation for the first two years. YOs will therefore have to be in a practice environment before they are able to fully participate. Eventually, all YOs will be able to participate in certain aspects of the registry as part of a practice-based research network that will enable evaluation of new drugs, devices and procedures after their introduction into the marketplace.

A small group of early-access ophthalmologists — including YO Suzann Pershing, MD — are already currently enrolled and working closely with Academy staff, physician leadership and the IRIS Registry development partner to optimize all aspects of the registry’s practice integration. 

“Despite being a YO,” said Dr. Pershing in an email, “I'm a classic late adopter (I still don't use Facebook or Twitter), but even I am excited at the prospect of gaining true value from technology in the form of this registry.” Beyond its immediate and practical benefits, she noted, “the beauty of this methodology is the potential — and intent — to ultimately extract data directly from visit notes, incorporating natural language processing algorithms to accurately identify and interpret data findings.”

Contact irisregistry@aao.org if you are interested in learning more about this early-access phase.

How Do I Find Out More Information?
Online. Visit the Academy’s website for further details about the registry’s EHR integration as well as data and technical specifications, security and privacy concerns, enrollment and cost and requirements of participation.

The Academy is also offering a sample data report as well as a webinar that provides a comprehensive overview of the entire IRIS Registry venture. A free Oct. 7 webinar will cover in detail how you can use the registry to qualify for federal incentive programs and avoid the PQRS penalties.

At the Annual Meeting. And if you are heading to New Orleans this November, don’t miss the following registry-related events:

Sunday, Nov. 17

  • During the Opening Session (8:30 to 10 a.m. in The Great Hall, Ernest N. Morial Convention Center), Drs. Rich and Chiang will join Academy CEO David W. Parke II, MD, and Michael X. Repka, MD, Academy medical director for governmental affairs, for a panel discussion of the registry.
  • Later that day, Dr. Parke will provide an update on the IRIS Registry at the fall Council meeting. All Academy members can attend, but you must register separately to do so.
  • An “IRIS Registry Project” presentation will also be held (Noon to 1:45 p.m.) in Theater 1 of the Learning Lounge (Hall G, Booth 3647).
  • And to celebrate the official launch of the registry, the Academy will hold a special event at the Academy Resource Center from 3 to 5 p.m.

Monday, Nov. 18

  • During the cosponsored American Medical Association symposium “Quality Measures in Ophthalmology: The Future Landscapes” (Course # SYM17; 8:30 to 10 a.m. in New Orleans Theater C), Dr. Rich will present “An Ophthalmic Clinical Registry: A Pathway to Improved Quality and Outcomes” (9:02 to 9:12 a.m.) and offer an overview of the IRIS Registry.
  • He will also present “Introducing the Academy’s IRIS Registry: How to Meet Regulatory Requirements for Quality Measures” at the Technology pavilion later that day (12:30 to 1:30 p.m. in Hall I1, Booth 5145).
For more information about these Annual Meeting events, check out the Academy’s online Program Search.

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About the author: Mike Mott is a contributing writer for YO Info and a former assistant editor for EyeNet Magazine.

 
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