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EMR Quality Data May Not Be Very Accurate

Posted on January 18, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study suggests that the quality data residing in EMRs may or may not reflect the actual state of the patient population. The study, which appears in the Annals of Internal Medicine, concludes that the accuracy of EMR-based quality measures can be questionable, sometimes overestimating and sometimes underestimating the delivery of quality care.

The study, done by Weill Cornell Medical College, analyzed clinical data from EMRs run by one of the largest community health center networks in New York state, reports Healthcare IT News.  Researchers from Weill Cornell looked at the accuracy of EMR reporting for 12 quality measures (11 of which are Meaningful Use standards).

After comparing their analysis with a manual check, researchers found that in three areas, reports drawn from EMRs weren’t as accurate as they should be. They underestimated the percentage of patients getting prescriptions for asthma and those getting vaccinations to protect against bacterial pneumonia. Another problem measure predicted that more patients with diabetes had healthy cholesterol levels than actually did.

What’s causing the gap in accuracy? For one thing, doctors and nurses entering data in EMRs may be entering data in fields that aren’t being captured by quality reporting algorithms, HIN’s piece suggests.

While the story doesn’t say this, I think there’s also some gaps in quality reporting generally which have existed since well before EMRs became commonplace.  I don’t know how to address the issue — other than perhaps appoint a nurse-manager to track the progress of quality reporting and ride herd on their colleagues — but given how important quality reporting is, it seems that it will be necessary to devote more resources to the problem.

Study: EMRs Improve Ambulatory Care

Posted on October 30, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study done by researchers from the Weill Cornell Medical College has concluded that community-based physicians who move to EMRs can improve care meaningfully.

The study, which was done in collaboration with New York’s Health Information Technology Collaborative, gathered baseline year data gathered from 500+ physicians in ambulatory practices and 75,000 patients with five different health plans in New York’s Hudson Valley.  They then compared quality scores for EMR-using physicians and those without EMRs.

Researchers concluded that 56 percent of physicians who were using EMRs scored significantly higher on quality of care provided, particularly in managing chlamydia, diabetes, colorectal cancer and breast cancer.  A combined score across nine quality measures also also suggested that EMRs helped generated better care than paper-based records overall.

What made the study results particularly interesting, researchers said, was that the physicians using EMRs used off-the-shelf systems which hadn’t been specialized to achieve these kind of results.

Researchers seem to think that the improved ambulatory results are just the tip of the iceberg:

EHRs may improve the quality of care by making information more accessible to physicians, providing medical decision-making support in real time and allowing patients and providers to communicate regularly and securely,” says Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell. “However, the real value of these systems is their ability to organize data and to allow transformative models of health care delivery, such as the patient-centered medical home, to be layered on top.” 

Interesting. I would have assumed that reminders and warnings had generated , as they certainly help doctors make sure overworked doctors are on target with tests, avoid drug interactions and the like. But researchers like Dr. Kaushal and her colleagues seem to think that the big EMR payoff will come as EMR systems change the core models doctors use to deliver care.

Given that new models are all but inevitable at this point, I guess we’ll get to find out!