IRIS® Registry and Its Impact

The Academy’s IRIS^® Registry does far more than help physicians avoid payment penalty. In a session during Mid-Year Forum 2016, several ophthalmologists shared how they’ve used the registry to improve their own performance and that of their practice. Following is a detailed summary of the session.

Abstract

The IRIS^® Registry (Intelligent Research in Sight) is the nation's first comprehensive eye disease clinical registry. Launched in 2014, the IRIS Registry helps members assess and improve their own patient care and more easily report for federal programs like the Physician Quality Reporting System. The Academy has developed 18 subspecialty outcome measures for quality improvement. In a live demonstration of the IRIS Registry dashboard, Academy members will learn how to use feedback on their outcomes and drill down to specific patient outcomes to compare and to improve their practice performance in preparation for future federal value-based purchasing programs.

Background Information

The IRIS Registry is a centralized data repository and reporting tool that collects data from electronic health records and performs statistical analysis of aggregated, deidentified patient data to produce easy-to-interpret, national and practice-level benchmark reports. These reports can validate the quality of care ophthalmologists provide and pinpoint opportunities for improvement. By assessing quality of care rates and studying best practices, ophthalmologists can develop plans for improving patient follow-up and outcomes. The ophthalmology database provides significant benefits for eye physicians and surgeons, including participation in PQRS. As an approved 2014 Certified Electronic Health Record Technology, the IRIS Registry can electronically extract data and calculate quality measures and submit it to the Centers for Medicare and Medicaid Services on a practice's behalf, eliminating the need for the traditional method of ophthalmologists manually reporting their data on their Medicare claims. These quality measures can count both for meaningful use electronic clinical quality measures and PQRS when reported for over the entire year. Also, EHR integrated practices can attest to meaningful use Public Health Objective 10, measure option 3, specialized registry reporting when using the IRIS Registry. 

The Merit-Based Incentive Payments System payment adjustments begin in 2019, based on performance in 2017 reporting year. This program raises the stakes by measuring physician performance on cost and quality and replaces the existing incentive programs (PQRS\, meaningful use, value-based modifier). The Academy is advocating that CMS uses EHR-based participation in the IRIS Registry database as a means of successful participation in MIPS because the Academy has already developed a range of clinically meaningful measures for IRIS Registry participants. The Academy is advocating for a tight alignment of the IRIS Registry with MIPS as a means of participation to meet the four components: quality, resource use, clinical practice-improvement activities and meaningful use of an EHR. The MIPS proposed and final rules are expected from CMS this year.

Summary of Comments from Guest Speakers

Introduction to the IRIS Registry Dashboard 

Timothy Parr, Vice-President, Technology, FIGMD

View Tim Parr's presentation

• Parr demonstrated the use of the dashboard to evaluate performance rates on quality measures and to compare with the average rate of all other physicians participating in the IRIS Registry.
• The dashboard is accessible through any browser.
• Performance rates can be viewed for the practice as a whole, by office location and by individual physician.
• There is an easy color schema to view overall performance status: a green color indicates that the rate is higher than the average registry rate, yellow indicates that the rate is slightly below the average registry rate and red indicates that the rate is below the average registry rate.
• For each quality measure, you can view the details of a rolling, four-quarter trend graph.
• The gray line represents the individual rate and the blue line represents the average registry rate.
• A chart shows the number of patients in the numerator (patients who met the criteria of the measure) and the denominator of the measure (patients who were eligible for the measure) and this can provide details on the patients that met or did not meet the measure for only those authorized in the practice.
• A new feature - an analytics capability, will be started to rollout to IRIS Registry practices in the summer of 2016.
• This will allow the physician to look at specific cohorts of patients with or without ocular comorbidities and to see how these patients fare in terms of complications and outcomes. For example, he showed a fairly straightforward evaluation of patients receiving cataract surgery and with or without age-related macular degeneration and the complication rate in each group. These results can be displayed in a variety of charts and exported into Excel.

Use of the Academy IRIS Registry to Improve My Practice’s Quality 

George Williams, MD, Secretary for Federal Affairs, American Academy of Ophthalmology

View Dr. Williams' presentation

• The benefits of “big data” and the potential of the IRIS Registry to look at practice trends, patient outcomes, including visual acuity, complication rates and other clinical endpoints and comparison of different technologies.
• For example, retinal detachment surgeries were evaluated and the rates of return to the operating room within 30 days varied among different surgery approaches, which is consistent with our real-world experiences.
• This big data will be able to give us valuable insights and information to identify areas of improvement for the future.
• In the earlier demonstration, the dashboard was shown to provide views of performance by physicians, by location and by practice as a whole.
• The dashboard allows the practice and the individual to compare themselves to national averages of their peers and allows them the ability to drill-down to see which patients didn’t meet measure criteria and to improve their performance rates going forward.
• A total of 19 new subspecialty outcome measures are being introduced and mapped with practices’ EHR systems to allow physicians to track measures that are most relevant to their practice focus.
• Dr. Williams provided a live demonstration of his own dashboard and examples of his performance rates on quality measures being reported to CMS and on the new measures being mapped.
• The IRIS Registry dashboard is a powerful tool to review and evaluate your practice in an up to date and clinically relevant context.

How I Use the IRIS Registry in My Practice 

Aaron Weingeist, MD, Director, Leadership Development Program, American Academy of Ophthalmology

View Dr. Weingeist's presentation

• Dr. Weingeist discussed how he uses the IRIS Registry in his practice to improve quality and to document that he is involved in a quality improvement program.
• He showed his individual dashboard performance for the reporting year of 2015 and areas of strength and where improvements could be made in the mapping of his EHR documentation.
• For the quality measure, Diabetic Retinopathy: Documentation of the presence or absence of macular edema and the level of severity of diabetic retinopathy, Dr. Weingeist was able to make steady increases in performance rates from the first quarter to the last quarter of 2015.
• For the quality measure Diabetic Retinopathy: Communication with the physician managing ongoing diabetes care, a similar trend of improvement was seen over the reporting year.
• The benefits of IRIS Registry: allowing monitoring of PQRS measures over the year, showing areas that need improvement, permitting comparison/friendly competition among partners within his practice and demonstrating quality to the hospital system. The local hospital had requested that the practice participate in a quality improvement program and permitted their ongoing participation in the IRIS Registry to count towards this requirement.
• The interaction with the IRIS Registry allowed Dr. Weingeist to refine EHR template language that will be conducive to meeting measure criteria and permitted quarterly tracking of measures so that there are no surprises at the end of the year with the final results.
• The use of the IRIS Registry helps Dr. Weingeist to think about documenting what he does in a manner that conforms to the CMS guidelines, works to decrease the risk of incurring reimbursement penalties and permits the demonstration of quality to their hospital and insurance carriers without necessitating embarkation on a totally new program.

IRIS Quality Reporting: Improving Workflow and Physician and Patient Satisfaction 

Robert Wiggins, MD, MHA, Senior Secretary for Practice Management, American Academy of Ophthalmology

View Dr. Wiggins' presentation

• Quality of care is a measurement wanted by many, but that in actuality, quality reporting was reported as taking a toll on physicians and their practices.
• An article reported that an average of 15 hours per week in each practice, mainly by staff effort, was spent on quality reporting, which could add up to $15 billion per year over the entire nation.
• Another survey of physicians reported that quality reporting could lead to physician burnout, taking valuable time away from direct patient interactions.
• A survey of patient satisfaction found that longer wait times for patients correlated with greater dissatisfaction with physicians, the quality of information and instructions provided and overall treatment by providers and staff.
• The history of PQRS reporting at Dr. Wiggins’ practice:
• During 2007-2010, they did claims-based reporting on three PQRS measures. In the first couple of years, there wasn’t good success because feedback on reporting was provided too late to benefit and learn from in the following year. By 2010, the practice was 100 percent successful on claims reporting.
• During 2011-2014, the practice successfully submitted claims-based reporting electronically for all three years. However, this took nine clicks in the workflow in their EHR system to document the measures for claims-based reporting and took its toll on the practice.
• For 2014 and 2015, the PQRS requirement increased from three to nine measures and the practice integrated the IRIS Registry, allowing the extraction of data in the background without an impact on EHR function. The practice worked with the registry vendor, FIGMD, in locating the relevant data locations within the EHR. Once that was done, the time for reporting was minimized.
• Dr. Wiggins concluded that doctors and staff should be working on measures that contribute directly to patient outcomes in a way that doesn’t impact workflow at a practice level and can lead to enhanced patient satisfaction.
• These measures include the new subspecialty outcome measures that were developed jointly by the Academy and the subspecialty societies. For example, there are two measures jointly developed with American Association of Pediatric Ophthalmology and Strabismus on amblyopia and esotropia that will be of interest to track.
• In the not so distant future, Dr. Wiggins can imagine a dashboard at the fingertips of the clinician that has current data on productivity, billing, efficiency, patient satisfaction, costs and quality of care as a tool.

Summary of Audience Comments

• What if I am performing cataract surgery on a patient with another condition that would adversely affect their outcome, such as age-related macular degeneration or diabetic retinopathy? Wouldn’t I be shown to have worse performance rates than other ophthalmologists? Answer: No, the cataract surgery outcome rates have been stratified so that patients with ocular comorbidities or pre-existing conditions that would be expected to adversely affect their surgical outcome would not be included in the calculation of performance. The cataract surgery outcome measure was intended to measure performance on an uncomplicated cataract surgery in a patient without having any comorbidities expected to have an adverse effect on the outcome.
• How can I map the new measures that are in the MIPS with my EHR system? Answer: We don’t know yet which measures will be included within MIPS. The proposed rule is expected soon and the final rule will be issued in the fall of 2016. There are new subspecialty outcome measures that will be started to be mapped with practices with EHR integrations this spring.
• When Dr. Rich first announced the IRIS Registry and its benefits, it was difficult to grasp and visualize. Now, I applaud Dr. Rich and the Academy for its vision and implementation as a tool to help the members. How do the numbers regarding the time required for quality reporting (i.e., 15 hours per week and $40,000 over the year) relate to physician time and effort? Answer: The time and the estimated costs for quality reporting was mainly attributable to staff time and only partially to physician time.
• How can I provide the dashboard views to my physicians? Answer: Dashboard access can be provided to any physicians in the practice that the practice lead physician or practice administrator designates. The dashboard also will have the feature to print and export reports this year.
• Does the IRIS Registry integrate with Epic Systems? Answer: It is definitely possible that the IRIS Registry can integrate with Epic Systems and there are a few technical approaches available to do so. Several Epic institutions have contracted with the IRIS Registry and efforts are currently underway to integrate and map to the Epic System in these different settings.

High Priority Objectives

• Tools to benchmark ophthalmologists, office locations and group practices built into the IRIS Registry dashboard provide individuals the data and feedback to review and improve their performance on an ongoing basis.
• The IRIS Registry will play an important role for ophthalmology in the future payment system, MIPS, for demonstrating quality, clinical practice improvement, meaningful use of an EHR and even resource use.
• As highlighted in the hearing on public reporting, transparency and reporting performance rates from registries are important to patients and the public.

Review more sessions in the Mid-Year Forum 2016 report.