Quality Measure Reporting For EHRs Needs Work

Mistakes indicate a need for redefined quality measures suited for EHRs, say researchers who conducted Weill Cornell study.
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Although most clinical quality measures remain accurate when measured electronically, some need to be refined to better suit documentation patterns in an electronic health record, concluded a recent study done by researchers at Weill Cornell Medical College. And with providers and hospitals being offered up to $27 billion in federal incentives to electronically demonstrate improvements in care quality, the study reveals how challenging it can be to measure quality in an "electronic era," said Rainu Kaushal, MD, report author, in a statement.

The study, recently published in the Annals of Internal Medicine and supported by the Agency for Healthcare Research and Quality (AHRQ), sought to gauge the accuracy of electronic reporting for 12 quality measures released by the Centers for Medicare & Medicaid Services last fall. Nine of the 12 measures proved to be reliable, but three failed to remain consistent.

In an interview with InformationWeek Healthcare, Lisa Kern, MD, a director of research at Weill Cornell, said this variation in quality measurement proves there is a need for redefined quality measures suited for EHRs. She and her team identified 1,154 patients who received care at a network of clinics. For every patient they identified which quality measurements were applicable to them.

[ For another point of view on PHRs, see Why Personal Health Records Have Flopped. ]

For every patient, the team collected data in two different ways: with a manual review of electronic record data, and with automated reporting through a program designed to extract data from an EHR. This program, she said, allowed researchers to view data all at once, and see agreements between the manual review and the automated report without having to individually review quality measurements for each patient.

"We looked at the two methods of review; they were fairly consistent for nine of the 12 measures, but for three measures, there was a significant disagreement between the two methods," she said.

For example, electronic reporting resulted in one measure underestimating the percentage of patients receiving prescriptions for asthma and vaccinations to protect against pneumonia. Another measure suggested more patients with diabetes had their cholesterol under control then actually did. Part of the problem, researchers suggested, could be that physicians and nurses inputting information are doing so in places in the EHR system that aren't being captured by quality reporting algorithms.

The report concluded that there is substantial "measure-to-measure variability" when it comes to the accuracy of electronically reported clinical measures, leaving room for practicing physicians to become increasingly concerned with the ability of quality reports to accurately represent the care they provide.

"If electronic reports are not proven to be accurate, their ability to change physicians' behavior to achieve higher quality, the underlying goal, will be undermined," the report read. In conclusion, researchers suggested national programs that link financial incentives to quality reporting should require EHR vendors to demonstrate the accuracy of their automated reports.

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