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Ophthalmic Innovation 2015“A View from the AAO”
David W. Parke II, MDCEO
American Academy of Ophthalmology
Ophthalmic Innovation 2015: a view from the AAO—IRIS®
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AMERICAN ACADEMY OF OPHTHALMOLOGY
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 uploaddata directly from any EHR system
• Advance the science of ophthalmology
• “Real world data” analytics
Introduction to AAO’s IRIS Registry
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AMERICAN ACADEMY OF OPHTHALMOLOGY
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
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AMERICAN ACADEMY OF OPHTHALMOLOGY
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
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2000
4000
6000
8000
10000
12000
Practices
Physicians
Electronic
Participation in IRIS Registry
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10
20
30
40
50
60
70
Mill
ion
s
Timeline
Patient Visits Unique Patients
Unique Patients and Visits
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AMERICAN ACADEMY OF OPHTHALMOLOGY
Real world
Big data• Estimated 49% of U.S. visit volume (2013-present)
Current data
Clinical data: outcomes, VA, IOP, free text
Across all payers
Across entire profession• AMD, DR, and glaucoma management by comprehensive
ophthalmologists
Advantages
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AMERICAN ACADEMY OF OPHTHALMOLOGY
# of Eye Conditions by Age
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-5 6-18 19-44 45-64 65-74 75-84 85+
Per
cen
t
Age group
6+
5
4
3
2
1
0
Mean = 3.62
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AMERICAN ACADEMY OF OPHTHALMOLOGY
ICD9 code
ICD9 description Count Percent
366.16 Senile nuclear sclerosis 1,757,588 25.83
375.15 Tear film insufficiency, unspecified 1,060,179 15.58
367.4 Presbyopia 1,040,906 15.30
367.1 Myopia 960,602 14.12
379.21 Vitreous degeneration 804,431 11.82
367.0 Hypermetropia 510,550 7.50
367.21 Regular astigmatism 498,302 7.32
366.53 After-cataract, obscuring vision 439,321 6.46
362.51 Nonexudative senile macular degeneration
410,938 6.04
365.01 Open angle; borderline findings, low risk
410,691 6.04
Top Ten Conditions
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AMERICAN ACADEMY OF OPHTHALMOLOGY
Mean Visits by Insurance Plan
4.54
4.08
2.60 2.562.29 2.30
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
Medicare Fee-for-Service Medicare Advantage Private Blue Shield Medicaid Others
Mea
n n
um
ber
Insurance plan
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AMERICAN ACADEMY OF OPHTHALMOLOGY
CPT
Codes
CPT Description Count Percent
67208 Intravitreal injection with a pharmacologic agent 1,069,648 50.46
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 63,042 2.97
65855 Laser surgery of eye 62,966 2.97
67820 Revise eyelashes 59,235 2.79
67228 Destruction of extensive or progressive retinopathy,
photocoagulation
47,374 2.23
67210 Destruction of localized lesion of retina,
photocoagulation
44,970 2.12
66761 Revision of iris 44,602 2.34
Top Ten Eye Procedures
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AMERICAN ACADEMY OF OPHTHALMOLOGY
Active ingredient Therapeutic class Patients % of
patients
PREDNISOLONE ACETATE Corticosteroid 195,129 16.76
DEXAMETHASONE Corticosteroid 178,053 15.29
LATANOPROST Prostaglandin 158,620 13.62
MOXIFLOXACIN
HYDROCHLORIDE
Anti-bacterial 152,115 13.06
BRIMONIDINE TARTRATE Alpha adrenergic agonist 148,418 12.75
TOBRAMYCIN Anti-bacterial 144,239 12.39
LOTEPREDNOL ETABONATE Corticosteroid 139,826 12.01
NEPAFENAC Nonsteroidal 129,334 11.11
DIFLUPREDNATE Corticosteroid 114,814 9.86
TIMOLOL Beta blocker 109,733 9.42
Top Ten Eye Medications Prescribed
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AMERICAN ACADEMY OF OPHTHALMOLOGY
Potential Patient Safety Event: IOL Exchange
Time period: 2013-2014
Cataract surgery procedures: 857,738
IOL exchange:
• 412 occurred within 90 days or .05%
• 1136 occurred within 1 year or .13%
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AMERICAN ACADEMY OF OPHTHALMOLOGY
Infectious Disease Surveillance
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AMERICAN ACADEMY OF OPHTHALMOLOGY
All AMD 1,321,746
POAG 1,042,336
Cataract Surgery 983,522
Diabetic Retinopathy 697,240
Top Conditions/Procedures Among Elderly: Jan 2013-Sept 2015
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AMERICAN ACADEMY OF OPHTHALMOLOGY
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 = 0.32
Average IOP 15.3 mmHg
Average Cup/Disc = 0.54
Glaucoma Patient Population:Jan 2013 – June 2014
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AMERICAN ACADEMY OF OPHTHALMOLOGY
Left Eye Visual Acuity
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Left Eye IOP
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AMERICAN ACADEMY OF OPHTHALMOLOGY
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
Glaucoma Procedure UtilizationJanuary 2013 – June 2014
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AMERICAN ACADEMY OF OPHTHALMOLOGY
Randomized Registry Trial
The Randomized Registry Trial-The Next Disruptive Technology in Clinical Research --Lauer & D’Agostino, NEJM, Sept 2013
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 $300,000, or $50 for each participant who underwent randomization!
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Why This Affects You
New dataset that is largest comprehensive specialty registry in the world
Larger than the complete Medicare dataset
Will have over 100,000,000 pt visit next yr and over 30,000,000 unique patients
Not just claims data but clinical data on processes, patterns, and outcomes of care
• Risk-adjusted
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AMERICAN ACADEMY OF OPHTHALMOLOGY
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
