An exclusive Vision Monday site with dynamic info and visual resources to help ECPs learn
how integrated technology improves patient care and build practice success

Professional Registries: Drilling Into Patient Information to Mine Big Data


It will soon be commonplace for eyecare professionals to automatically integrate with health care professional Registries to aggregate their own patient data for analysis and compare themselves to the benchmarks of their peers. In fact, several key eyecare professional Registries are already being formed.

These include the IRIS Registry ( in ophthalmology and the EyeCare Registry ( in optometry. The American Optometric Association also plans to launch a Registry for its members in June 2015.

Like Health Information Exchanges, Registries are part of the interoperability that is intended to save money while improving patient outcomes by enabling practitioners to electronically share and use secure, encrypted patient data. Information is automatically sent from medical providers’ electronic health record (EHR) systems to whichever Registries the practice has designated, and that information is combined with data from that doctor’s other patients to determine quality of care. Patient data is also anonymously and collectively aggregated with millions of other patient records from other similar specialists to generate real-life and real-time benchmarks of best practices to improve patient care.

In addition to being used to determine best practices, aggregated information from the patients of one particular doctor will also be used to help them adhere to quality reporting requirements such as the Physician Quality Reporting System (PQRS), which will have a direct impact on the level at which that practitioner will be reimbursed.

This is what is referred to as “outcomes-based” measurement and what experts say will determine and help drive all future professional reimbursement levels.

As with much of the transition converting health care reimbursements from pay-for-service to outcomes-based, change is slow and still in its early phases. Like the nascent Health Information Exchanges (see “Why ODs Must Embrace Health Information Exchange”) Registries are also still in their infancy. But this is a development that will take on more importance.

Ophthalmology’s IRIS Registry

Although it has only been in operation since early 2014, the IRIS Registry from the American Academy of Ophthalmology (AAO) is the longest and most active of the eyecare-related Registries already in existence. Getting its name from the acronym for Intelligent Research in Sight, the IRIS Registry performs statistical analysis of aggregated, de-identified patient data to produce easy-to-interpret, national and practice-level benchmark reports.

As an approved PQRS electronic health record submission vendor, the IRIS Registry can directly and automatically extract data for PQRS measures and submit it to the Centers for Medicare and Medicaid Services (CMS) on a practice’s behalf, eliminating the need for the traditional method of ophthalmologists manually reporting their data on their Medicare claims throughout the year.

Among the benefits of participating in Registries is the ability to compare the outcomes from one practice with a national average benchmark.
Open to participation from ophthalmologists based in the U.S. who are members of the AAO, the IRIS Registry can also be accessed by optometrists who are in a practice with an AAO member using IRIS, a representative of the organization told VM.

Following an official launch in 2014 and a limited rollout that began in 2013 with about 2,300 physicians in 47 states, currently about 5,000 ophthalmologists are contracted to report data to IRIS. This represents about four million unique patients registered, accounting for about 10 million individual patient visits.

This is still “really at the beginning of the process in the amount of analytics” that can be produced, according to Portland, Oregon-based ophthalmologist, Michael Chiang, who was instrumental in creating IRIS. “What we can do now in 2015 is very primitive to what we’ll be able to do,” he told VM, explaining that it’s still early for much specific data analytics because the registry has been live for less than a year.

Optometry’s EyeCare Registry

It takes at least six months to a year for a registry to have enough data to generate results, according to Ron Snyder, OD, of Boca Raton, Fla., who has launched the EyeCare Registry, primarily focused on optometry but open to both ODs and MDs.

He and Jim Grue, EyeCare Registry director of analytics, explained how a Registry’s data analysis can have superior results to traditional clinical studies, which are often geared toward one very specific population, often do not take into account comorbidities, and can take a lot of time to generate useful results.

As an example, they cited a study that illustrates just how effective a Registry’s analysis can be on patient care: “In 2006, a group of pediatricians decided to see if they could improve clinical outcomes for pediatric Crohn’s Disease patients. At that time, approximately 50 percent of pediatric Crohn’s patients were in remission at any given time. There were many different approaches and products, and it was difficult to determine which were the most effective. There were scientifically controlled studies that gave general guidelines, but these were in very controlled studies that didn’t necessarily represent many of the patients they were treating.

“The Registry gathered the data and analyzed the outcomes for each treatment. Some approaches and treatments seemed to get better results than others. Many providers using the less effective treatments changed to the ones that appeared to have better outcomes.

“Outcomes data began showing that certain approaches worked better for different patients, and by studying the variation in patients (age, sex, other comorbid conditions, other medications, etc.), the study eventually showed what approaches seemed to work most effectively for which patients. It also allowed the study to look at the effect of other issues such as what it took to get patient compliance, etc.

“By providers being able to compare the choices they were making against the outcomes of the choices other providers were making, they modified practice patterns and adopted new treatment strategies. The incidence of remission increased to 85 percent by 2012 just by tracking the clinical outcomes that were resulting from the decisions that participating providers were making.”

Replicating this model in other specialties can help determine the most effective care protocol for any given conditions within those specialties. For example, in eyecare, Registries could help determine the best practices for treating glaucoma, macular degeneration, even cataracts, and much more, simply by aggregating the results of specific treatments.

While the EyeCare Registry just launched at the end of 2014, it already has about 200 subscribers signed up to submit data as well as to provide revenue to the self-funded entity.

The AOA’s Registry
So new it had yet to be named at VM’s press time, the Registry due this year from the American Optometric Association (AOA) will be in alpha and beta testing over the next few months in preparation for a full launch at Optometry’s Meeting in Seattle this June.

Already in the works for more than four years, the AOA’s Registry will be open to all of the organizations’ nearly 34,000 members when it launches in June after alpha testing with about 20 practices and then beta testing with another 15 to 20 practices across the country. At first integrating with RevolutionEHR, Compulink and MaximEyes optometry-focused electronic health records software, the goal of the Registry is to eventually “integrate with all” EHRs over time, according to Jeffrey C. Michaels, OD, of Family Vision Care of Richmond, in Sandy Hook, Va., who chaired the committee to launch the AOA’s Registry.

“With a paradigm shift occurring in health care, Registries are becoming more and more important as an essential tool,” Michaels told VM. “The emphasis of the Registry is to integrate with EHRs, allowing optometrists to seamlessly and automatically submit data, so they can spend more time being optometrists not data typists.”

The aggregated patient data can then be used by optometrists “to be able to see the effect their care is having on their own patients,” said Michaels, and “for some outcomes they would also be able to benchmark themselves in comparison to other optometrists across the country.” In addition, the aggregated results will also enable practitioners to adhere to quality measures to help improve reimbursements. “With Medicare and other insurance providers putting such an emphasis on quality, the Registry is another tool allowing optometrists to provide the best health care possible.”