The Challenge of Measuring Quality of Care From the Electronic Health Record

Abstract

The electronic health record (EHR) is seen by many as an ideal vehicle for measuring quality of health care and monitoring ongoing provider performance. It is anticipated that the availability of EHR-extracted data will allow quality assessment without the expensive and time-consuming process of medical record abstraction. A review of the data requirements for the indicators in the Quality Assessment Tools system suggests that only about a third of the indicators would be readily accessible from EHR data. Other factors involving complexity of required data elements, provider documentation habits, and EHR variability make the task of quality measurement more difficult than may be appreciated. Accurately identifying eligible cases for quality assessment and validly scoring those cases with EHR-extracted data will pose significant challenges but could potentially plummet the cost and therefore expand the use of quality assessment.

Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium

“…However, even when electronic health record data are available, challenges remain in creating comparable data across centers given the differences among systems and the lack of structured data for covariates of interest in studying screening processes of care (e.g., risk factors). 36,37 Finally, PROSPR's common data elements capture care that was delivered but do not include information on scheduled care.…”

Errors in Electronic Health Record–Based Data Query of Statin Prescriptions in Patients With Coronary Artery Disease in a Large, Academic, Multispecialty Clinic Practice

“…Nevertheless, recent studies suggest that EHR data query may have limited fidelity compared with manual chart review 7, 8. For this reason, it is critical that providers, healthcare institutions, and policy makers understand the limitations and common errors that result from trying to measure quality performance through EHR data query 9. This is especially important in light of ongoing programs such as Medicare's Physician Quality Reporting System (PQRS)10 and the recently implemented Medicare Quality Payment Program (a result of the Medicare Access and CHIP Reauthorization Act, or MACRA, legislation),11, 12 which ultimately aim to leverage EHR systems to link providers’ adherence to performance measures to their reimbursement 13, 14, 15, 16…”

The Delivery System Design of a Community Mental Health Center and Provision of Quality: Cardiometabolic Screening for Persons with a Severe Mental Illness Prescribed Atypical Antipsychotic Medication

“…Future studies can address challenges of using real clinical data to study outcomes and identify the infrastructure needed to support this type of research involving clinical data, given the discrepancies between clinical and administrative data (Kmetik, Chung & Sims, 2007;Roth, Lim, Pevnick, Asch & McGlynn, 2009). The importance of matching the evidence with care, in a model that allows a seamless flow, is imperative to the provision of quality care.…”

“…It is difficult to compare full provision of quality care, defined as adherence to the ADA and APA monitoring protocol, because most studies on metabolic monitoring used claims data. Claims and administrative data were created for billing purposes (Roth, Lim, Pevnick, Asch & McGlynn, 2009); therefore, assessment of non-billable measures, such as weight, body mass index, blood pressure, or waist circumference cannot be assessed.…”

“…Electronic medical records were created to capture clinical data, not intended for research, claims data and administrative data were created for billing purposes and lack the quality of clinical information, therefore, when extracted is less precise when compared to manual extraction (Roth, Lim, Pevnick, Asch & McGlynn, 2009). Quality performance rates are known to differ when looking at administrative data, clinical data, or a combined approach to data collection.…”