EHR Quality Measurement In Its Infancy, Study Says
EHR Quality Measurement In Its Infancy, Study SaysJohns Hopkins research describes some of the other electronic performance measures that could beused with EHRs.Quality performance measures based on data in electronic health records are still in their infancy andhave yet to tap many of the unique features of EHRs, according to a new study in the InternationalJournal for Quality in Health Care. The study, which was re-published in Medscape, provides aconceptual framework for defining levels of electronic quality measures, or e-QMs.The study proposes the following five-level typology for defining e-QMs:--Translated e-QMs. Measures designed for use with paper records, such as whether patients withdiabetes have received HbA1c tests. These measures can use claims data or information from chartabstraction, as well as EHRs.--Health IT-assisted. Measures that could be derived from non-EHR data sources, such as blood pressureor body mass index information, but that require EHRs for reporting on 100% of a patient population.--Health IT-enabled. Metrics that take advantage of an EHRs features, such as the percentage ofabnormal test results read and acted upon by a clinician within 24 hours of receipt, or the percentage ofrelevant clinical alerts that are acted upon.--Health IT system management. Measures of how providers use health IT systems, such as thepercentage of all prescriptions ordered via electronic prescribing.--E-iatrogenesis. Measures of patient harm caused at least in part by the health IT system, such as thepercentage of patients for whom the wrong drug was ordered because of an error in an e-prescribingsystem, or the percentage of critical lab findings that did not lead to patient notification.[Read about how new technologies are revolutionizing healthcare IT. See How Mobile, Cloud AreTransforming Healthcare. ]Although about half of U.S. doctors have some kind of EHR, less than a quarter of health care is"substantially documented" in electronic records, the study said. As a result, many physicians with EHRsare stuck at level 1 of e-QM capability.Academic healthcare organizations and health IT pioneers such as Kaiser Permanente are capable ofcollecting level 2 quality data, said Jonathan P. Weiner, the lead author of the study and a Johns Hopkinsprofessor of health policy and management, in an interview with InformationWeek Healthcare."Sophisticated systems have moved into stage 2. They wouldnt think about gathering data on blood
pressure or lab results on 100% of their sample with a paper chart audit, but its not a big deal to do thatwith an EHR."Even the most advanced organizations, however, have just begun collecting level 3 data, Weiner said."Ive been working with some of the leaders in health IT, and theyre barely scratching the surface interms of new ways to measure performance. Theyve nailed the current ways of doing it. An EHR allowsone to get there more quickly, but I havent seen many go beyond that."Weiner noted that there are structural barriers to level 3 performance measures, including thecomplexities of workflow and diagnosis. Moreover, he said, physicians dont want to go through a "click-tree hell" in which they have to navigate multiple menus to perform simple actions. Thats one reasonwhy much of the data in EHRs is in the form of free text, rather than structured data.In the American Hospital Associations comments on the Meaningful Use Stage 2 proposals, the AHApointed out that many hospitals have had difficulty using their EHRs to collect quality data for tworeasons touched on in the Johns Hopkins study. First, the association noted, the underlying measuresthemselves were developed for manual chart abstraction and had to be adapted to the EHR--in otherwords, they were "translated e-QMs." And second, much of the requisite data is locked up in dictated orwritten physician notes. In other words, the hospitals either havent introduced electronic physiciandocumentation, or the doctors arent using it.Weiner agreed with AHAs critique. But as EHRs become more familiar to physicians, he said, theirdocumentation is bound to improve because it is the medico-legal basis of their records. Also, when EHRquality data begins to matter in reimbursement, physicians will want to document what theyve done ina structured manner. Down the line, he added, natural language processing might make it easier fordoctors to enter structured data.Weiner said the measurement of errors caused by EHRs is very important. "We dont want to build ininefficiencies or safety problems or outright errors," he noted. But he also seconded the observation ofDean Sittig, an expert at the University of Texas Health Sciences Center in Houston: The benefits of EHRsin preventing medical errors far outweigh their potential to cause mistakes.Get the new, all-digital Healthcare CIO 25 issue of InformationWeek Healthcare. Its our second annualhonor roll of the health IT leaders driving healthcares transformation. (Free registration required.)--------Source: http://www.informationweek.com/news/healthcare/EMR/240001355
This is what we feel:“Lack of uniformity won’t help”, Remarks Dr. Charu Chitalia – Director Operations, Acroseas GlobalSolutions, while commenting on the current state of EMR implementation. “The doctors are at differentlevels of their internal practices with reference to note-taking and documentation. This is somehow notaligned with the levels of implementation outlined by the authorities. If there’s an absence ofsynchronized implementation and adoption respectively, then the vast sums of investments done so farwould land meaningless”, remarks Dr. Chitalia.