Developing and using a data repository for quality improvement: the genesis of IRIS

In 1991 the Inova Health System, a regional hospital system in Fairfax, Virginia, started developing a patient data repository, the Inova Research Information System (IRIS), to support clinical quality improvement, managed care contracting, and technology assessment.

The prototype was built with the help of five key early user groups; each group, led by an influential physician, was eager to have access to data important to their work in an integrated and standardized electronic format.

IRIS serves as the principal resource that QI committees, risk managers, managed care contracting officers, and others turn to for data to support their studies of the processes of care used and patient outcomes. Clinicians should use data analysis to identify opportunities for QI and implement change in their processes of care as a result. IRIS has already been used to make selected comparisons of patient management. For example, at Inova's largest hospital, for patients with a primary diagnosis of acute myocardial infarction (but without any unrelated secondary diagnoses), the length of stay was significantly shorter (5.5 days) when the attending physician was a cardiologist rather than an internist (7.5 days) or family practitioner (7.7 days).

IRIS represents an architecture of study of patients, clinicians, and administrators--and the outcomes and the results produced. By the end of 1995 three years of integrated clinical and financial data on inpatients will be available, permitting creation of a feed-back loop for continuous clinical and managerial learning.