AHRQ-Funded Study Identifies Challenges of Using Data From Electronic Health Records for Quality Improvement
Electronic health record (EHR) systems need refinements in several areas to support quality improvement initiatives in primary care practices, according to a new AHRQ-funded study in Health Affairs. The authors represented several grantees of AHRQ’s EvidenceNOW initiative, a project developed to help primary care practices improve the delivery of services proven to prevent heart attacks and strokes. Authors studied nearly 1,500 small and medium-sized primary care practices between May 2015 and April 2017. They found that EHR reports were often not customizable for appropriate time periods, were restricted to specific patient populations (e.g., Medicare or Medicaid) or required extra fees by the vendor to create the necessary functionality. Practices owned by hospitals or health systems were more likely to be able to generate useful quality reports than solo or small practices, especially in rural areas. The authors concluded that significant additional investments are needed to ensure health information technology can be used to improve care and support new value-based payment initiatives. Access the abstract.
ABSTRACT
Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports—but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.
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