Healthcare Technology Featured Article

January 15, 2013

New Study Reveals Issues with Quality Measurement for Electronic Health Records

While you may not be aware of it, there’s a revolution going on in healthcare. What kind of revolution? One that involves the nation’s healthcare providers’ move away from paper patient files to electronic health records (EHR).

EHR has been an ongoing effort for some time; it hasn’t been cheap and it hasn’t been easy. The federal government is one of the largest proponents of HER; it has offered healthcare providers and hospitals up to $27 billion in federal financial incentives to switch to digital patient documentation in an effort to improve patient care. 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.

The Affordable Care Act (ACA), the controversial legislation passed by Congress and signed into law by President Obama in 2010, sets standards for electronic health records; it creates standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records is expected to reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care.

Before the rules governing EHRs fully kick in under the terms of the Affordable Care Act, the federal government and health institutions are still refining ways to demonstrate quality in reporting. A new, federally-funded study by Weill Cornell Medical College demonstrates ways in which quality measurement from EHRs 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.

The new research has been published in the January 15 issue of Annals of Internal Medicine.

"This study reveals how challenging it is to measure quality in an electronic era. Many measures are accurate, but some need refinement," said 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," continued Dr. Kaushal.

To arrive at its conclusions, 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 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, said the researchers.

"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,” said Dr. Kaushal. “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.”

Edited by Rich Steeves

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