A Systematic Review of Electronic Medical Record Driven Quality Measurement and Feedback Systems

Abstract

Historically, quality measurement analyses utilize manual chart abstraction from data collected primarily for administrative purposes. These methods are resource-intensive, time-delayed, and often lack clinical relevance. Electronic Medical Records (EMRs) have increased data availability and opportunities for quality measurement. However, little is known about the effectiveness of Measurement Feedback Systems (MFSs) in utilizing EMR data. This study explores the effectiveness and characteristics of EMR-enabled MFSs in tertiary care. The search strategy guided by the PICO Framework was executed in four databases. Two reviewers screened abstracts and manuscripts. Data on effect and intervention characteristics were extracted using a tailored version of the Cochrane EPOC abstraction tool. Due to study heterogeneity, a narrative synthesis was conducted and reported according to PRISMA guidelines. A total of 14 unique MFS studies were extracted and synthesized, of which 12 had positive effects on outcomes. Findings indicate that quality measurement using EMR data is feasible in certain contexts and successful MFSs often incorporated electronic feedback methods, supported by clinical leadership and action planning. EMR-enabled MFSs have the potential to reduce the burden of data collection for quality measurement but further research is needed to evaluate EMR-enabled MFSs to translate and scale findings to broader implementation contexts.

How the commercial virtual care industry gathers, uses and values patient data: a Canadian qualitative study

“…Our finding that some companies are promoting pharmaceutical products through virtual care platforms by adjusting patient care pathways is worrisome as it permits industry to directly influence clinical care 98. Adjusting patient care pathways and evaluating the impact on quality of care has the potential to improve health outcomes 99–102. However, studies show that pharmaceutical industry influence over medical care prioritises a company’s commercial objectives rather than quality patient care and has caused substantial patient harm 56 98 103–106…”

Qualitative study of international key informants’ perspectives on the current and future state of healthcare quality measurement and feedback

“…It is well-documented that the impact of measurement feedback systems is variable 5 6. These interviews highlighted that while there is a lack of published evidence providing consistent and definitive correlations to improved quality of care and patient outcomes, rich information exists in expert knowledge.…”

“…However, the effectiveness was variable and dependent on factors, including the feedback recipients’ baseline performance and how the feedback is provided 5. Despite data collection and technology advances over the last decade, the translation and impact of measurement feedback systems on patient outcomes and quality of care remain inconsistent 5 6. In 2019, Grimshaw et al suggested that future research should focus on how, when and why measurement feedback systems are most effective,7 as the literature often lacks implementation context and feedback processes 6 8.…”

“…Despite data collection and technology advances over the last decade, the translation and impact of measurement feedback systems on patient outcomes and quality of care remain inconsistent 5 6. In 2019, Grimshaw et al suggested that future research should focus on how, when and why measurement feedback systems are most effective,7 as the literature often lacks implementation context and feedback processes 6 8. Recent research has focused on specific elements of measurement and feedback, which may contribute to their effectiveness, including the data source of quality measurement,6 health professional perceptions and psychological elements of receiving feedback,9 10 the use of theory in the design of feedback11 12 and computer-supported feedback 13 14.…”

“…In 2019, Grimshaw et al suggested that future research should focus on how, when and why measurement feedback systems are most effective,7 as the literature often lacks implementation context and feedback processes 6 8. Recent research has focused on specific elements of measurement and feedback, which may contribute to their effectiveness, including the data source of quality measurement,6 health professional perceptions and psychological elements of receiving feedback,9 10 the use of theory in the design of feedback11 12 and computer-supported feedback 13 14. While this work has explored measurement feedback system design and how it is received, additional implementation barriers may prevent the uptake of even the most evidence-based interventions.…”