Ophthalmic Innovation 2015 A View from the AAO

Transcription

1 Ophthalmic Innovation 215 A View from the AAO

2 Ophthalmic Innovation 215: a view from the AAO IRIS David W. Parke II, MD CEO American Academy of Ophthalmology

3 Introduction to AAO s IRIS Registry IRIS Registry (Intelligent Research In Sight) is the nation s first comprehensive eye disease clinical database Improve care delivery and patient outcomes Meet requirements of the federal Physician Quality Reporting System (PQRS) Uses HIPAA-compliant methods to upload data directly from any EHR system Advance the science of ophthalmology Real world data analytics

4 Quality Reporting TO Members IRIS Registry dashboard approach provides each participating physician with the ability to view performance against standards and peers Ophthalmologist able to customize query with risk-adjustment Physician able to drill down to patient level Physician owns individual data; AAO owns de-identified, aggregated data

5 Integrated with 39 EHRs Amazing Charts ChartMaker Medical Suite Compulink Cybax DoctorSoft eclinicalworks EyeDoc EMR Eyefinity ExamWRITER EyeMD EMR GE Centricity EMR Greenway Intergy Greenway/Primesuite HCIT EHR ifa systems EMR imedicware Integrity EMR for Eyes IO Practiceware KeyChart EMR Lytec ManagementPlus MaximEyes by First Insight Mastermind EHR MDIntelleSys MDoffice Medent MedEvolve Medflow Medinformatix EHR My Vision Express NexTech NextGen Origin Prime Clinical System PrognoCIS SRS TriMed EHR VersaSuite Vitera EHR WebChart by MIE

6 Participation in IRIS Registry Practices Physicians Electronic

7 Millions Unique Patients and Visits Timeline Patient Visits Unique Patients

8 Advantages Real world Big data Estimated 49% of U.S. visit volume (213-present) Current data Clinical data: outcomes, VA, IOP, free text Across all payers Across entire profession AMD, DR, and glaucoma management by comprehensive ophthalmologists

9 Percent # of Eye Conditions by Age 1% Mean = % 8% 7% 6+ 6% 5% 4% 3% % 1% % Age group

10 Top Ten Conditions ICD9 ICD9 description Count Percent code Senile nuclear sclerosis 1,757, Tear film insufficiency, unspecified 1,6, Presbyopia 1,4, Myopia 96, Vitreous degeneration 84, Hypermetropia 51, Regular astigmatism 498, After-cataract, obscuring vision 439, Nonexudative senile macular 41, degeneration Open angle; borderline findings, low 41, risk

11 Mean number Mean Visits by Insurance Plan Insurance plan Medicare Fee-for-Service Medicare Advantage Private Blue Shield Medicaid Others

12 CPT Codes Top Ten Eye Procedures CPT Description Count Percent 6728 Intravitreal injection with a pharmacologic agent 1,69, Cataract surgery with IOL 1-stage 767, After cataract laser surgery 249, Cataract surgery complex 79, Close tear duct opening 63, Laser surgery of eye 62, Revise eyelashes 59, Destruction of extensive or progressive retinopathy, photocoagulation 47, Destruction of localized lesion of retina, 44, photocoagulation Revision of iris 44,

13 Top Ten Eye Medications Prescribed Active ingredient Therapeutic class Patients % of patients PREDNISOLONE ACETATE Corticosteroid 195, DEXAMETHASONE Corticosteroid 178, LATANOPROST Prostaglandin 158, MOXIFLOXACIN Anti-bacterial 152, HYDROCHLORIDE BRIMONIDINE TARTRATE Alpha adrenergic agonist 148, TOBRAMYCIN Anti-bacterial 144, LOTEPREDNOL ETABONATE Corticosteroid 139, NEPAFENAC Nonsteroidal 129, DIFLUPREDNATE Corticosteroid 114, TIMOLOL Beta blocker 19,

14 Potential Patient Safety Event: IOL Exchange Time period: Cataract surgery procedures: 857,738 IOL exchange: 412 occurred within 9 days or.5% 1136 occurred within 1 year or.13%

15 Infectious Disease Surveillance

16 Top Conditions/Procedures Among Elderly: Jan 213-Sept 215 All AMD 1,321,746 POAG 1,42,336 Cataract Surgery 983,522 Diabetic Retinopathy 697,24

17 Glaucoma Patient Population: Jan 213 June ,581 unique patients with POAG Average age = 73 years Male = 42%; Female = 58% Race: White 74%; Black 15%, Hispanic 6% Average logmar Visual Acuity =.32 Average IOP 15.3 mmhg Average Cup/Disc =.54

18 Left Eye Visual Acuity

19 Left Eye IOP

20 Glaucoma Procedure Utilization January 213 June 214 Average Visual Fields/Glaucoma Patient = 3.2 Average OCTs/Glaucoma Patient = 1.3 Average ON Scanned Images/Glaucoma Patient = 2.7 Total Trabeculoplasties = 73,512

21 Randomized Registry Trial The Randomized Registry Trial-The Next Disruptive Technology in Clinical Research --Lauer & D Agostino, NEJM, Sept 213 Time for recruitment and costs were dramatically less in the randomized registry arm of the trial. The incremental cost of the Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial was $3,, or $5 for each participant who underwent randomization!

22 Why This Affects You New dataset that is largest comprehensive specialty registry in the world Larger than the complete Medicare dataset Will have over 1,, pt visit next yr and over 3,, unique patients Not just claims data but clinical data on processes, patterns, and outcomes of care Risk-adjusted

23 Why This Affects You Opportunities for industry and the profession to work together to mine this dataset Role in preparation for clinical trials Natural history; disease prevalence patterns Current real-world treatment and outcomes Trial design decrease in enrollment time Registry-based trial Post-market surveillance