Alice Goodman

November 28, 2013

NEW ORLEANS — The nation's oldest medical specialty society — the American Academy of Ophthalmology (AAO) — is launching the country's first comprehensive eye disease registry.

Intelligent Research in Sight (IRIS) will open in April 2014.

"IRIS is expected to have a groundbreaking effect on improving quality and outcomes for physicians, group ophthalmology practices, and the entire profession," said William Rich III, MD, medical director of health policy for the AAO.

The registry will build on the success of registries in other medical specialties. "We have added the longitudinal ability to follow patients, and now we have the technology of overlaying interventions. This is a game-changer," Dr. Rich told reporters attending a news conference here at the AAO 2013 Annual Meeting.

"IRIS is not just another registry," said cardiologist David May, MD. "Cardiology registries do not allow us to monitor patients longitudinally. IRIS allows the ophthalmologist to follow a patient's disease process through treatment and after treatment. It is revolutionizing. For the first time in medicine, a disease process and the interventions we deliver can be monitored."

Dr. May, who is managing partner of Cardiovascular Specialists PA, in Denton, Flower Mound, and Lewisville, Texas, oversees participation in the PINNACLE registry, the largest outpatient cardiovascular registry in the world. "Ophthalmologists are smarter than cardiologists, they pick diseases they can treat during the day," Dr. May joked.

IRIS is a centralized collection and reporting software tool that compiles and processes data from electronic health records, allowing ophthalmologists to analyze their own practices, compare their practice with those of their peers, and flag areas that need to be improved. This can happen individually, within a group practice, and nationally.

It is revolutionizing. For the first time in medicine, a disease process and the interventions we deliver can be monitored.

Ophthalmologists will be able to manage their patients at a national level; study specific conditions, risk factors, demographics, and outcomes; identify trends and track interventions; and ask specific clinical questions.

The registry, designed by a team of ophthalmologists in 2012, currently comprises data from 124 ophthalmology practices with 685 providers and about 370,000 patient encounters in 332 locations from 35 states. Once IRIS is live, the goal will be to expand participation so that by 2017, the database will include more than 18 million patient encounters, Dr. Rich explained.

"One of our focuses is to show value. As the paradigm moves from fee for service to value, we have a lot of hoops to jump through. Data from IRIS will allow us to satisfy many of the mandated quality-improvement programs, and this will have a financial impact," Dr. Rich said. "Penalties involved in not meeting standards can make a practice unsustainable. The capabilities of IRIS should appeal not just to 'qualaholics', but also to regular practitioners. We want to eliminate those onerous penalties. We may have to report on as many as 9 measures."

"We are harnessing data that allow the individual ophthalmologist to see how his practices compare with those of others in the field," said Michael Chiang, MD, from the Oregon Health & Sciences University in Portland. "The process takes electronic health records and maps out datafields. The registry can work with any system."

IRIS will speed up the process of maintenance of board certification by automating collection data directly from health records. "Board certification maintenance was previously a laborious process," Dr. Chiang noted.

In the future, IRIS will be used to track subspecialty medical and surgical outcomes for cataracts, glaucoma, retina, pediatrics, and other areas. "This database will have millions of patients, and we can have enormous postmarketing surveillance of drugs and devices. We can also have screen shots of how physicians will see risk-adjusted data," he explained.

In addition to tracking a physician's performance, quality details will be displayed in different ways. The administrator of a practice can see how each provider is doing by creating bar graphs and tables, and the interactive process allows a user to click on an individual doctor and on his patient data, Dr. Chiang reported. This provides immediate feedback on performance and identifies opportunities for improvement.

When IRIS is rolled out in the spring, it will be widely available to AAO members, and the first 2000 members to sign up will receive it at no cost for the first 2 years. For more information, visit the IRIS Web site.

Dr. Rich and Dr. May have disclosed no relevant financial relationships. Dr. Chiang disclosed an unpaid position as board member of Clarity Medical Systems, and grant support from the National Eye Institute.

American Academy of Ophthalmology (AAO) 2013 Annual Meeting. Presented November 17, 2013.


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