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Standardizing data input for electronic health records may improve their potential to measure care quality

Automated quality assessment using electronic health records (EHRs) does not appear to accurately reflect the quality of care for coronary artery disease (CAD), indicating that changes are needed in how data are routinely recorded in an EHR to improve the accuracy of this type of measurement. Researchers compared two ways to identify apparent care quality failures of patients with CAD from a large internal medicine practice. They compared simple automated review of electronic health records with a two-step process of automated review supplemented by manual review of electronic medical records for free-text notes made by care providers.

Seven CAD care performance measures that ranged from antiplatelet drug and lipid-lowering drug administration to blood pressure measurement and lipid measurement were reviewed. Based on automated measurement, performance varied from 81.6 percent for lipid measurement to 97.6 percent for blood pressure measurement. However, a review of free-text notes for cases failing an automated measure revealed that misclassification was common and that 15 to 81 percent of apparent quality failures either satisfied the performance measure or met valid exclusion criteria.

After chart review that included free-text data, adherence success rates were 1.5 to 14.2 percentage points higher and varied from 87.5 percent for lipid measurement and LDL cholesterol control to 99.2 percent for blood pressure measurement. Review of free text revealed that in the EHR, diagnoses were often used incorrectly, and data that would have fulfilled quality criteria were not always documented in searchable portions of patient records. For example, doctors wrote in their notes (not accessed by the EHR) that they told patients to use aspirin, but did not enter the aspirin into the EHR standardized medication list. The study was supported by the Agency for Healthcare Research and Quality (HS13690).

See "Assessing the validity of national quality measures for coronary artery disease using an electronic health record," by Stephen D. Persell, M.D., M.P.H., Jennifer M. Wright, M.D., Jason A. Thompson, B.A., and others, in the November 13, 2006, Archives of Internal Medicine 166, pp. 2272-2277.

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