Ophthalmic Innovation 215 A View from the AAO
Ophthalmic Innovation 215: a view from the AAO IRIS David W. Parke II, MD CEO American Academy of Ophthalmology
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
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
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
Participation in IRIS Registry 12 1 8 6 4 2 Practices Physicians Electronic
Millions Unique Patients and Visits 7 6 5 4 3 2 1 Timeline Patient Visits Unique Patients
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
Percent # of Eye Conditions by Age 1% Mean = 3.62 9% 8% 7% 6+ 6% 5% 4% 3% 5 4 3 2 1 2% 1% % -5 6-18 19-44 45-64 65-74 75-84 85+ Age group
Top Ten Conditions ICD9 ICD9 description Count Percent code 366.16 Senile nuclear sclerosis 1,757,588 25.83 375.15 Tear film insufficiency, unspecified 1,6,179 15.58 367.4 Presbyopia 1,4,96 15.3 367.1 Myopia 96,62 14.12 379.21 Vitreous degeneration 84,431 11.82 367. Hypermetropia 51,55 7.5 367.21 Regular astigmatism 498,32 7.32 366.53 After-cataract, obscuring vision 439,321 6.46 362.51 Nonexudative senile macular 41,938 6.4 degeneration 365.1 Open angle; borderline findings, low 41,691 6.4 risk
Mean number Mean Visits by Insurance Plan 5. 4.5 4. 3.5 4.54 4.8 3. 2.5 2. 1.5 2.6 2.56 2.29 2.3 1..5. Insurance plan Medicare Fee-for-Service Medicare Advantage Private Blue Shield Medicaid Others
CPT Codes Top Ten Eye Procedures CPT Description Count Percent 6728 Intravitreal injection with a pharmacologic agent 1,69,648 5.46 66984 Cataract surgery with IOL 1-stage 767,931 36.22 66821 After cataract laser surgery 249,319 11.76 66982 Cataract surgery complex 79,882 3.77 68761 Close tear duct opening 63,42 2.97 65855 Laser surgery of eye 62,966 2.97 6782 Revise eyelashes 59,235 2.79 67228 Destruction of extensive or progressive retinopathy, photocoagulation 47,374 2.23 6721 Destruction of localized lesion of retina, 44,97 2.12 photocoagulation 66761 Revision of iris 44,62 2.34
Top Ten Eye Medications Prescribed Active ingredient Therapeutic class Patients % of patients PREDNISOLONE ACETATE Corticosteroid 195,129 16.76 DEXAMETHASONE Corticosteroid 178,53 15.29 LATANOPROST Prostaglandin 158,62 13.62 MOXIFLOXACIN Anti-bacterial 152,115 13.6 HYDROCHLORIDE BRIMONIDINE TARTRATE Alpha adrenergic agonist 148,418 12.75 TOBRAMYCIN Anti-bacterial 144,239 12.39 LOTEPREDNOL ETABONATE Corticosteroid 139,826 12.1 NEPAFENAC Nonsteroidal 129,334 11.11 DIFLUPREDNATE Corticosteroid 114,814 9.86 TIMOLOL Beta blocker 19,733 9.42
Potential Patient Safety Event: IOL Exchange Time period: 213-214 Cataract surgery procedures: 857,738 IOL exchange: 412 occurred within 9 days or.5% 1136 occurred within 1 year or.13%
Infectious Disease Surveillance
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
Glaucoma Patient Population: Jan 213 June 214 334,581 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
Left Eye Visual Acuity
Left Eye IOP
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
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!
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
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