IRIS Registry: Much more than MIPS
Click Here to Manage Email Alerts
My retina group practice has been contributing data to the American Academy of Ophthalmology’s IRIS Registry since its inception.
Our initial motivation in contributing data was to take advantage of the Medicare quality reporting features now known as the Merit-based Incentive Payment System (MIPS). Without the IRIS Registry, complying with these federal government requirements would have been a huge time and financial burden. But the IRIS Registry’s ability to work seamlessly with our EHR system has made the process relatively painless, allowing us to qualify for incentive payments and avoid penalties.
Thanks to the IRIS Registry dashboard, we have been able to monitor our progress against the required federal benchmarks. For example, when the dashboard showed that one of our seven physicians was scoring poorly on the medication reconciliation measure, we were able to uncover a simple documentation-related misunderstanding by that doctor and correct it early.
Facilitating research
The huge volume of data in the IRIS Registry — more than 360 million patient visits reported by 13,000 ophthalmologists — has value well beyond MIPS reporting, however. The aggregation of all this information, along with the data curation and data science capabilities of Verana Health, allows us to ask important clinical questions that cannot be answered on the individual doctor level, or even by a large practice with many patients. Such questions might include the risk factors for development of endophthalmitis, a rare complication of cataract surgery, or retinal intravitreal injections, for which it is difficult to assess trends without large numbers.
Another big data research question that I am interested in is why patients stop receiving anti-VEGF injections. We know that patients with neovascular age-related macular degeneration achieve the best outcomes when they get regular anti-VEGF injections, so I was surprised by the high loss to follow-up (22%) reported by Obeid and colleagues at a large, multi-office retinal practice. By analyzing data from the IRIS Registry, I was able to confirm that the national rate is, unfortunately, still high. An analysis of records for 177,723 treatment-naive patients who were newly diagnosed with AMD and received their first anti-VEGF therapy injection showed that nearly 11% did not return within 12 months after their last injection.
Multivariate logistic regression showed that risk factors for loss to follow-up included increasing age (Table 1), male gender, unilateral involvement, African American race, Hispanic ethnicity, private insurance and Medicaid-only insurance. With more awareness of the factors that contribute to missing injection appointments, we can focus outreach efforts on the patient populations that are most at risk in order to improve AMD outcomes and reduce the public health burden of this disease. This work also highlights the need to develop more patient-centered strategies to improve adherence in following up for their neovascular AMD care.
The data available electronically from EHR systems allows us to begin to answer these types of questions in order to unlock deep clinical insights in ophthalmology. But the challenge with such a vast trove of clinical data is that it can be difficult to access and interpret correctly. So, in addition to the IRIS Registry itself, we need the expertise of Verana Health to make the data easier to view and analyze and to ensure that we are asking of these databases what we actually want to know.
In addition to large-scale, real-world data studies such as the one I described here, these data science capabilities are also being put to use to help ophthalmologists more quickly identify clinical trial candidates from our own patient population. For some clinical trials, including those for rare diseases, it can take many months just to identify patients who meet all the inclusion/exclusion criteria and then years after that to follow the effects of the intervention being studied. Through Verana Trial Connect, faster trial enrollment could accelerate the results of randomized controlled trials, which are key to isolating the effects of a new drug or treatment.
In fact, we are just beginning to understand all the ways that big data can be used in ophthalmology. It can help us as ophthalmologists follow important trends and determine whether we are following best practices in clinical care. And on a more macro level, it has the potential to inform research at multiple time points, from national epidemiological studies to randomized controlled trials of new therapies to post-approval, real-world studies that provide more nuanced information about how treatments work in clinical practice.
- Reference:
- Obeid A, et al. JAMA Ophthalmol. 2018;doi:10.1001/jamaophthalmol.2018.3578.
- For more information:
- Rahul N. Khurana, MD, can be reached at Northern California Retina Vitreous Associates, 2495 Hospital Drive, Suite #545, Mountain View, CA 94040; email: rnkhurana@gmail.com.
Collapse
Read more about
Click Here to Manage Email Alerts