IRIS Registry may do more than improve patient outcomes

Take-home message: The IRIS Registry can improve patient outcomes by giving physicians access to information that could identify potential areas of quality improvement based on their patient population.

Reviewed by Michael F. Chiang, MD

Portland, OR-Few physicians would argue with the goal of improving patient outcomes, but it’s easy to lose sight of this ideal amid the pressures of daily medical practice.

However, the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight), a national clinical data registry to improve eye care that was launched in 2014, is designed to help physicians get the information they need to make adjustments in patient care, said Michael F. Chiang, MD.

IRIS Registry is both a data registry and reporting tool, generating benchmark reports from a dataset of electronic health records and patient information.

“What we’re seeing is a convergence of technology, policymaking, big data, analytics, and patient care. There’s going to be an evolution of the healthcare delivery process, and I think the IRIS registry is a huge step in all of this,” said Dr. Chiang, Knowles Professor of Ophthalmology and Medical Informatics and Clinical Epidemiology at the Oregon Health and Science University Casey Eye Institute. He is also a member of the American Academy of Ophthalmology’s IRIS Registry Executive Committee and chairman of the Academy Task Force on IRIS Registry Analytics and Research.

"Clinical dashboard"

A “clinical dashboard” is the means by which physicians can visualize their performance on specific measures within IRIS Registry, for example achieving good visual acuity within 90 days following cataract surgery.

“When we as doctors see what measures we’re doing well on as well as what measures we’re not doing well on, that’s how we can identify gaps in care and where we can improve,” Dr. Chiang said.

Results from the first year of the IRIS Registry already show some improvement in performance, he added.

For instance, complication rates after cataract surgery improved from 2% to 1% and counseling patients with age-related macular degeneration about antioxidant supplements improved from 46% to 54%.

The IRIS Registry also taps advances in technology to obtain “big data.” By interfacing with EHRs, the registry as of Nov. 1, 2015, included information on 61 million patient visits and 17.6 million unique patients, while data sets from a few decades ago relied on either sampling or time-consuming manual data entry, and even the largest often had far less information than is already available via IRIS Registry. So far, more than 10,000 ophthalmologists have submitted to the IRIS Registry.

“This will create unprecedented opportunities that extend beyond quality improvement and into areas such as monitoring of outcomes from medical and surgical procedures, natural history of disease, post-market surveillance of new devices, and clinical research,” Dr. Chiang said.

Setting stage for clinical research

Setting stage for clinical research

The registry also may prove to be an asset if a new model of clinical research is validated. Carrying out clinical trials within the framework of existing high-quality registries may make them dramatically less expensive and more efficient.

In an often-cited example of this model, the TASTE trial (Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia) had an incremental cost of $300,000, or $50 for each participant who underwent randomization. This was possible since the investigators built their study on clinical information that was already being gathered for a large registry on coronary angiography and angioplasty and other preexisting databases.

In a 2013 editorial on the TASTE trial and the potentially “disruptive” new model, Lauer and D’Agostino cited the potential of the randomized registry trial but added that questions about the quality of the underlying data sets would need to be addressed.

Dr. Chiang echoed the commentary’s point that randomized trials costing hundreds of millions of dollars are no longer affordable and that registries and other digital platforms may enable investigators to design and conduct mega-trials with bigger data and smaller budgets.

While the idea of using analytics for quality control may unnerve some in the medical community, it is highly likely they’ve already come into contact with it outside of the office, Dr. Chiang said, explaining that amazon.com uses it to make product recommendations to shoppers, sports franchises analyze data to select players and plays, and Facebook targets advertising to users based on their posts and search history.

“Applying these methods toward clinical research will create enormous opportunities for the future of ophthalmic care, research, and quality improvement,” he added.

References

1.      Lauer MS, D’Agostino RB Sr. The Randomized Registry Trial-The Next Disruptive Technology in Clinical Research? N Engl J Med. 2013;369:1579-1581.

2.      Fröbert O, Lagerqvist B, Oliverna G et al. Thrombus Aspiration During ST-Segment Elevation Myocardial Infarction. N Engl J Med. 2013; 369:1587-1597.

Michael F. Chiang, MD

E: chiangm@ohsu.edu

This article was adapted from Dr. Chiang’s presentation at the 2015 meeting of the American Academy of Ophthalmology. Dr. Chiang is an unpaid board member for Clarity Medical Systems and has received funding from the National Eye Institute.