IRIS Springs Into Action

The AAO’s registry, in combination with EHR, could be a valuable resource for retinal physicians.

RISHI P. SINGH, MD

The American Academy of Ophthalmology launched the Intelligent Research In Sight (IRIS) registry in early 2014. Thus far, the rollout has been quite successful. More than 2,300 physicians have joined IRIS in 47 states, and the registry currently holds more than five million patient records and is expected to ultimately house more than 20 million records in two years.

But what is the value of these registry data? How do practices participate in the program? And what are the pros and cons of participating in such a program? This article will explore these issues and discuss our personal experience with integrating IRIS into our practice.

WHAT IS THE VALUE OF REGISTRY DATA?

Disease or patient registries are collections of secondary data related to patients with specific diagnoses or medical conditions or who are undergoing certain procedures. These collections play an important role in postmarketing surveillance of pharmaceuticals, providing the “real-world outcomes” of medical care (Figure).¹

Figure. A variety of studies have highlighted real-world utilization of anti-VEGF drugs.

Registries are less complex and simpler to set up than electronic health records, which, according to a recent survey, are only used by 9% of small offices in which almost half of the US doctors work.²

According to the New York Times, “The use of [registries for artificial joints] has proven beneficial abroad,” as well as in within the United States. For example, “[i]n Australia, regulators use such data from registries to force manufacturers to justify why poorly performing hips or knees should remain available, and products have been withdrawn as a result.”³

Why can’t registries work off of existing claims databases? Claims databases from insurers such as the Center for Medicare and Medicaid Services (CMS), for example, allow for searches of their claims files for research and reporting purposes.

However, there are significant drawbacks of claims studies. CMS data represent a finite subset of the population. Currently, only 44 million beneficiaries — some 15% of the US population — are enrolled in Medicare. Almost half of the beneficiaries have incomes less than 200% of the US federal poverty level and therefore may, because of socioeconomic reasons, represent a population that differs from the national average.

The system does not record items such as VA or tonometry values, so determining the patients’ ultimate outcomes is difficult. Finally, when we study diseases that are not necessarily a function of age, the CMS claims data are not very useful because younger patients are excluded. Thus, claims data have significant limits, reducing their generalizability.

The quality of a disease registry is based on the quality of data fed into it and all the processes involved in updating it and keeping its integrity. In every registry, there is a risk of “garbage in, garbage out.”

How IRIS Differs

The IRIS database was established differently to extract discrete data from the patients’ EHRs. The data are then transmitted on a scheduled basis directly to the IRIS registry by placing a program on the EHR program server behind the firewall.

The AAO has partnered on the development of the ophthalmology registry with FIGMD, Inc. (Schaumburg, IL), a company that specializes in integrating EHRs with registries. FIGMD has completed integration projects for more than 50 major EHRs, and it is capable of working quickly with new systems.

By automatically reporting these discrete data from the physician’s EHR system, the registry avoids many of the errors of traditional registries and claims-based analyses.

HOW DO PRACTICES PARTICIPATE IN THE PROGRAM?

To encourage widespread adoption, the AAO has initially offered multiyear, fee-free access to member physicians who sign the agreements and integrate their EHRs into the IRIS registry.

It should be noted that you must have IT support in your practice to participate in the program. The AAO estimates that your IT staff can expect to spend, on average, one to two hours per week for three to four weeks during the initial installation process and mapping of your EHR to the specific registry fields.

Following installation, the AAO estimates that no additional work is required, unless the practice’s EHR software is updated in the future. However, the reality is that upgrades from year to year of your EHR system can require remapping and reconfiguration to occur on an annual basis. Participation in the program requires users to fill out forms that are available at the AAO Web site.

PROS AND CONS OF PARTICIPATING

There are some significant pros worth considering before participating in the IRIS registry. Ultimately, the IRIS registry may help to improve patient care by tracking interventions, identifying gaps in care, and assisting in the measuring of outcomes.

By identifying populations at risk for complications, the IRIS registry could be quite valuable. For example, the registry might show that a particular systemic medication causes a high rate of cataract complications, necessitating a return to the OR for additional maneuvers.

The IRIS registry will also help to better manage the patient population for whom you care. As an example, the registry may identify those patients with a history of diabetes without a recent return for a dilated eye exam. The registry will also help to benchmark individual and practice-based performance.

Soon, registry participants will be able to compare their performance and outcomes to similar practices at the regional and national levels. There will also be the ability to run quality reports on meeting measurements for the Physician Quality Reporting System on the fly and to compare reports among physicians within your own group.

There are also some significant cons to consider before venturing into the process of the IRIS registry. Not all of the outcomes and outputs from the IRIS system have been completely developed. IT support is a must, especially because the software is installed behind the firewall of the server.

While there is a list of EHRs compatible with the system, the largest EHR vendors for hospital-based practices (Epic Systems [Verona, WI], Meditech [Westwood, MA], Cerner [Allentown, NJ], McKesson [Swedesboro, NJ) are still not represented on the AAO’s list.

There currently is no cost to participate, but at some point, the AAO might decide to change the pricing structure to have participants pay for utilization of the reports. Finally, there is nothing to prevent the AAO from selling the collective data from IRIS to third parties, such as market research companies or pharmaceutical companies.

OUR EXPERIENCE THUS FAR

We had planned on integrating the IRIS system into our practice approximately one year ago. Our EHR administrators objected to the installation of third-party software that communicated patient data out of the system. The major issue that we initially encountered was that our EHR did not communicate with the IRIS system, and we would have to invest significant IT hours into creating an exported document from our system.

We are now awaiting an upgrade of our EHR system, which will allow for a specific IRIS outgoing encounter summary interface that should greatly reduce the IT needs for the configuration process. However, the batch exportation of data to IRIS still must be performed manually with our Epic system.

CONCLUSIONS

The IRIS registry represents an avant-garde approach to age-old issues with claims and registry information. The data will be fast, more reliable, and available at the participants’ fingertips once ready.

We are excited to participate in the AAO’s initiative once our EHR system undergoes an upgrade, which should significantly reduce the IT support needed to make our system live within the IRIS system. RP

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