Transcript Slide 1

IRIS
A Qualified Clinical Data Registry
Consumer-Purchaser Alliance
September 9, 2014
William L. Rich III, MD, FACS
Medical Director for Health Policy
American Academy of Ophthalmology
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
 Dr. Rich has no financial conflicts
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Introduction to the
IRIS™ Registry
 IRIS™ Registry (Intelligent Research In Sight), the nation’s first
comprehensive, longitudinal eye disease clinical registry:
• Enables ophthalmologists across the country to use clinical
data to improve care delivery and patient outcomes.
• Uses scientifically valid and HIPAA-compliant methods to
collect data from patient records – directly from certified
electronic health record systems using a systems
integrator.
• Helps ophthalmology practices meet the requirements of
the federal Physician Quality Reporting System,
streamlining the way to quality-based payment bonuses.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
QCDR:
Qualified Clinical Data Registry
 Part of the “fiscal cliff” legislation of 2012
 “A PQRS reporting mechanism”
 For 2014 PQRS must report on nine measures
across three domains, and one outcome
measure
 For 2015 proposal to publicly report on three
outcome measures or two outcome and one
resource use measure.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Advantages of QCDR
 Allowed to report on up to 30 “native”, non NQF
measures.
 Enables specialties to CREATE valid, evidence
based outcome measures for populations not
addressed in PQRS (e.g. children ) or for patients
with diseases without a strong evidence
base/smaller economic impact. Many childhood
diseases treatments lack a strong evidence base
because of historic lack of research funding.
AMERICAN ACADEMY OF OPHTHALMOLOGY
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“Native Measures”
 Amblyopia-20/30 level of vision at age 7
 Strabismus -results of ET surgery- < 10 PD at 8
weeks.
 Impact of diabetic retinopathy treatments on
families and acuity.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
IRIS Principles
 Ophthalmologists own their data.
 Ophthalmologists give permission for data to
be distributed and reported.
 Academy owns aggregated data.
 Data protection/security/quality and audits in
place.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Benefits to Patients & Society
 Rapid cycle quality improvement and better outcomes.
 Surgical measures include validated patient reported
outcomes.
 22 surgical outcome measures including five for
children ( amblyopia and surgical esotropia).
 Individual physician level public reporting of outcomes
two years after introduction of a measure.
 Measures address adults and children; surgical
interventions, biologics and chronic disease.
 Ability to address disparities in care.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Benefits to Profession
 Infrastructure for specialty registries-AMD,
macular holes, cataract, corneal graft,
strabismus, glaucoma devices and drugs
 Drug and device surveillance
 Demonstrate value of our services
 CER & Clinical research.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Benefits to Professionals
 Quality improvement
 Benchmark performance-real time feedback
 Improve performance and patient outcomes
 Maintenance of certification/licensure
 Meet requirements for MOC/MOL-PIMS loaded into
registry and can be extracted electronically for ABO
submission.
 Financial compensation
 Receive payment incentives/avoid payment penalties
 Meaningful use for EHRs
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
The Value of IRIS™ Registry
Satisfy
multiple
regulatory
requirements
by providing
data to one
entity: the
IRIS™
Registry.
Your individual
performance
improvement
dashboard
Physician
Quality
Reporting
System
AMERICAN ACADEMY OF OPHTHALMOLOGY
Your data
extracted from
your EHR
system
IRIS Registry
Meaningful use
quality
measure
reporting
Meaningful use
stage 2 menu:
report to
registry
WWW.AAO.ORG
Quality
measures for
value-based
modifier
Research and Registries
 IRIS is an outpatient clinical registry with the
ability to follow patients longitudinally using
probabilistic matching (94%). Many facility
based registries record the short term
evaluation of devices and procedures but are
unable to measure the impact on the natural
course of disease: IRIS will.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Clinical research and registries
 Aggregated data allows researchers to identify
correlations related to outcomes and develop
predictive risk assessment models and
questions for further inquiry. Can measure
“real world” impact of RCT recommendations
on heterogeneous populations.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Factors Increasing Membership
Acceptance
 NO FEE!!
 Little impact on patient flow-high EHR
adoption
 Acceptance by subspecialties and academe
 Meaningful measures beyond PQRS/NQF
 Regulatory impact
AMERICAN ACADEMY OF OPHTHALMOLOGY
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Launch Goal-March 2014
 2200 ophthalmologists by 2017 with 18
million patients
AMERICAN ACADEMY OF OPHTHALMOLOGY
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Status of IRIS Registry
July 4, 2014
 Contracted
• 4,486 physicians
 Expressing Interest
• 7,634 physicians from 1401 practices
 Mapped to their EHR (24 vendors)
• 1549 physicians from 316 practices
 Number of Patient Visits
-8.1M visits representing 2.44 M patients
 38M patients in 2017!
AMERICAN ACADEMY OF OPHTHALMOLOGY
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QCDR “Issues”
 THERE IS NO EHR INTEROPERABILITY!!! Thus
need for a systems integrator.
 Cost is prohibitive
 Regulatory failure to ensure registry access to
EHR data from academic centers- epic problem.
 Tying QCDR to rapidly changing PQRS
requirements-nine measures in three domainsdramatically devours registry resources needed
to develop analytics and new outcome measures.
AMERICAN ACADEMY OF OPHTHALMOLOGY
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“Issues”
 2014 NPRM-unreasonable time line for public
reporting-same year as measure introduction
eliminates needed benchmarks and chance for
improvement prior to reporting.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG
Thank you!
[email protected]
AMERICAN ACADEMY OF OPHTHALMOLOGY
WWW.AAO.ORG