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CHICAGO -- The American Academy of Ophthalmology (AAO)'s , a quality of care database that is providing ophthalmologists with clinical benchmark data and practice patterns, hit a major milestone recently with collection of data from its 100 millionth patient visit.

Ophthalmologic practices started submitting data to the registry on January 1, 2013. By September 1, 2016, 14,000 physicians had submitted data from 28 million unique patient visits, making IRIS the world's largest clinical database, said AAO president during a press briefing at the .

Rich gave an update on the latest milestones achieved and insights generated from IRIS. By June 30, 2016, data were collected on:

• 3.7 million cataract surgery procedures involving 2.3 million unique patients
• 4.4 million anti-vascular endothelial growth factor (VEGF) intravitreal injections in 577,000 unique patients
• 2.2 million unique patients with age-related macular degeneration (AMD)
• 3.2 unique patients with open-angle glaucoma
• • 1.2 million unique patients with diabetic retinopathy

An advantage to IRIS is the capture of real-world data. "Most of the data that we have acted on in our lifetimes have been administrative claims data," said Rich. Since its launch, "IRIS has collected an estimated 49% of all eye care visits in the United States," he said. Unlike the Medicare database, "we look at all payers, all populations, even those without insurance, so this is a powerful tool for evaluation of patients."

He continued, "The exciting thing is the ability to accelerate the acquisition of knowledge and accelerate the adoption of new techniques...to affect patients and quality of life."

The IRIS registry has already proven to be a valuable tool to assess the prevalence of rare diseases and to identify risk factors, he said. For example, investigators were able to calculate prevalence rates of pathologic myopia in the U.S. using IRIS registry data from a sample of 259 practices combined with data from the National Health and Nutrition Examination Surveys (NHANES). From these sources, they calculated a prevalence of high myopia (≥ -6 D) of 3.92%, a prevalence of progressive myopia of 0.33% and a prevalence of myopic CNV of 0.017%. Major risk factors for progressive myopia and myopic choroidal neovascularization (CNV) were found to be myopic refraction, female sex and older age.

Further, the IRIS registry verified improvement in visual acuity over time with the use of anti-VEGF treatments in patients with AMD, and that endophthalmitis rates within 15 days of ant-VEGF injection are similar between three treatments used for this purpose (aflibercept, bevacizumab and ranibizumab), a finding obtained from pulling the results from 1.25 million consecutive injections.

Other advantages to IRIS were highlighted, including the use of HIPAA-complaint methods to collect data from patient records directly from electronic health record (EHR) systems. "That is its big advantage," said Rich. "We're integrated with 43 different EHRs." Notably, Epic is absent from this list, owing to a business decision by Epic Systems Corp., according to Rich.

Another benefit to IRIS is the help it provides practices in meeting the Centers for Medicare and Medicaid Services' (CMS) Physician Quality Reporting System (PRQS) requirements. In 2014, PQRS results on behalf of approximately 3,000 physicians were submitted through IRIS. In 2015, this number increased to approximately 6,000 physicians, and in 2016, it is expected to total 12,000 to 14,000 physicians. Over the past year, participating ophthalmologists have accrued more than $24 million in incentive savings and penalty avoidance by submitting quality information through IRIS to PQRS. "It's estimated that in the first 3 years that there will be somewhere over $1 billion in savings," said Rich.

At Asheville Eye Associates in North Carolina, IRIS improved the efficiency of PQRS reporting for nine clinical quality measures required by CMS, said , administrator at Asheville Eye Associates and Senior Secretary for Ophthalmic Practice at AAO. The success rate for PQRS using IRIS is 100% "but now the time to reporting has gone down to zero," he said. "There is a little up front time but once that up front time is put in, there is literally zero time spent on quality reporting. This is taking lean management to the max."

The possibility of streamlining clinical trial recruitment using the IRIS registry is on the horizon, Rich believes. "All of a sudden, people are starting to look at the ability to run clinical trials using an EHR-based registry, and the difference in cost is incredible," he said. "It means that we're going to be able to do more research for fewer dollars."