Researchers identify ways to improve quality of care measurement from electronic health records
Health care providers and hospitals are being offered up to $27 billion in federal financial incentives to use electronic health records (EHRs) in ways that demonstrably improve the quality of care. The incentives are based, in part, on the ability to electronically report clinical quality measures. By 2014, providers nationwide will be expected to document and report care electronically, and by 2015, they will face financial penalties if they don't meaningfully use EHRs.
A new, federally-funded study by Weill Cornell Medical College in the Jan. 15 issue of Annals of Internal Medicine demonstrates ways in which quality measurement from EHRs—which are primarily designed for documentation of clinical care for individual patients—can be improved. In a large cross-sectional study in New York state, researchers demonstrated that the accuracy of quality measures can vary widely. Electronic reporting, although generally accurate, can both underestimate and overestimate quality.
"This study reveals how challenging it is to measure quality in an electronic era. Many measures are accurate, but some need refinement," says the study's senior author, Dr. Rainu Kaushal, director of the Center for Healthcare Informatics Policy, chief of the Division of Quality and Medical Informatics and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell.
"Getting electronic quality measurement right is critically important to ensure that we are accurately measuring and incentivizing high performance by physicians so that we ultimately deliver the highest possible quality of care. Many efforts to do this are underway across the country," continues Dr. Kaushal, also a professor of pediatrics, medicine, and public health at Weill Cornell and a pediatrician at the Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
For this study, Weill Cornell researchers analyzed clinical data from the EHRs of one of the largest community health center networks in New York state. The research team examined the accuracy of electronic reporting for 12 quality measures, 11 of which are included in the federal government's set of measures for incentives. What they found was fairly good consistency for nine measures, but not for the other three.
"The variation in quality measurement that we found in a leading electronic health record system speaks to the need to test and iteratively refine traditional quality measures so that they are suited to the documentation patterns in EHRs," says the study's lead investigator, Dr. Lisa Kern, a general internist and associate director for research at the Center for Healthcare Informatics at Weill Cornell.
The automated reports generally performed well. However, they underestimated the percentage of patients receiving prescriptions for asthma and receiving vaccinations to protect from bacterial pneumonia. A third measure suggested that more patients with diabetes had cholesterol under control than actually did. The automated report said 57 percent of eligible diabetic patients had cholesterol controlled, while a manual check of the charts showed it was actually only 37 percent. Part of the problem is that physicians and nurses filling out the EHRs may be typing in information in a place that is not being captured by quality reporting algorithms.
"EHRs create the opportunity to measure and provide feedback to clinicians regarding quality performance in real time, thereby improving clinical practice," says Dr. Kern, who is also an associate professor of public health and medicine at Weill Cornell.
Dr. Kaushal adds, "EHRs are not just electronic versions of paper records but rather tools that enable transformation in the way care is delivered, documented, measured and improved. The federal meaningful use program will enable the deployment of these promising systems across the country, thereby enabling health care to enter the digital age."
More information: This study was funded by the federal Agency for Healthcare Research and Quality and featured in an AHRQ exemplary video, entitled "Developing and Testing Quality Measures for Interoperable Electronic Health Records." To view the video, visit: healthit.ahrq.gov/… KaushalVideo
Journal reference: Annals of Internal Medicine
Provided by Weill Cornell Medical College
- Electronic health records shown to improve the quality of patient care Oct 09, 2012 | not rated yet | 0
- Doctors who go digital provide higher quality healthcare Oct 17, 2012 | not rated yet | 0
- Electronic health records with technical assistance can improve patient care in New York City Jan 07, 2013 | not rated yet | 0
- California physicians unprepared for electronic health record regulations: report Jun 15, 2012 | not rated yet | 0
- Electronic health records may lower malpractice settlements Nov 25, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Research shows that the earlier the age at which youth take their first alcoholic drink, the greater the risk of developing alcohol problems. Thus, age at first drink (AFD) is generally considered a powerful predictor of ...
Health 11 hours ago | not rated yet | 0
One quarter of British lawmakers believe there is an "unhealthy" drinking culture in the Houses of Parliament, according to a survey published on Friday.
Health 17 hours ago | not rated yet | 0
Researchers at the University of Cincinnati (UC) have found that the race and sex of study personnel can influence a patient's decision on whether or not to participate in clinical research.
Health 17 hours ago | not rated yet | 0
The processes to allow people to self-manage their own illness are not being used appropriately by health professionals to the benefit of their patients, new research suggests.
Health 18 hours ago | not rated yet | 0
Control of heart disease risk factors varies widely among outpatient practices, according to a study presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2013.
Health 19 hours ago | not rated yet | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
2 hours ago | not rated yet | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
3 hours ago | not rated yet | 0 |
The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...
14 hours ago | not rated yet | 0 |
(Medical Xpress)—What if the quality of your work depends more on your focus on the piano keys or canvas or laptop than your musical or painting or computing skills? If target users can be convinced, they ...
15 hours ago | 3.7 / 5 (3) | 0 |
In 2008 researchers from the University of Southern Denmark showed that the drug thioridazine, which has previously been used to treat schizophrenia, is also a powerful weapon against antibiotic-resistant bacteria such as ...
12 hours ago | 3.7 / 5 (3) | 0 |
(Medical Xpress)—Working with lab mice models of multiple sclerosis (MS), UC Davis scientists have detected a novel molecular target for the design of drugs that could be safer and more effective than current FDA-approved ...
12 hours ago | 5 / 5 (2) | 0 |