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电子健康记录衍生的质量测量在绩效监测中的有效性。

Validity of electronic health record-derived quality measurement for performance monitoring.

机构信息

Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, New York, USA.

出版信息

J Am Med Inform Assoc. 2012 Jul-Aug;19(4):604-9. doi: 10.1136/amiajnl-2011-000557. Epub 2012 Jan 16.

DOI:10.1136/amiajnl-2011-000557
PMID:22249967
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3384112/
Abstract

BACKGROUND

Since 2007, New York City's primary care information project has assisted over 3000 providers to adopt and use a prevention-oriented electronic health record (EHR). Participating practices were taught to re-adjust their workflows to use the EHR built-in population health monitoring tools, including automated quality measures, patient registries and a clinical decision support system. Practices received a comprehensive suite of technical assistance, which included quality improvement, EHR customization and configuration, privacy and security training, and revenue cycle optimization. These services were aimed at helping providers understand how to use their EHR to track and improve the quality of care delivered to patients.

MATERIALS AND METHODS

Retrospective electronic chart reviews of 4081 patient records across 57 practices were analyzed to determine the validity of EHR-derived quality measures and documented preventive services.

RESULTS

Results from this study show that workflow and documentation habits have a profound impact on EHR-derived quality measures. Compared with the manual review of electronic charts, EHR-derived measures can undercount practice performance, with a disproportionately negative impact on the number of patients captured as receiving a clinical preventive service or meeting a recommended treatment goal.

CONCLUSION

This study provides a cautionary note in using EHR-derived measurement for public reporting of provider performance or use for payment.

摘要

背景

自 2007 年以来，纽约市的初级保健信息项目已经帮助 3000 多名医疗服务提供者采用并使用了以预防为导向的电子健康记录 (EHR)。参与的实践被教导重新调整其工作流程，以使用 EHR 内置的人群健康监测工具，包括自动化质量措施、患者登记册和临床决策支持系统。实践获得了一整套技术援助，包括质量改进、EHR 定制和配置、隐私和安全培训以及收入周期优化。这些服务旨在帮助提供者了解如何使用他们的 EHR 来跟踪和改善向患者提供的护理质量。

材料和方法

对 57 家实践中的 4081 份患者记录进行了回顾性电子图表审查，以确定 EHR 衍生的质量措施和记录的预防服务的有效性。

结果

这项研究的结果表明，工作流程和文档记录习惯对 EHR 衍生的质量措施有深远的影响。与电子图表的手动审查相比，EHR 衍生的措施可能会低估实践表现，对记录为接受临床预防服务或达到推荐治疗目标的患者数量产生不成比例的负面影响。

结论

本研究在使用 EHR 衍生的测量值进行提供者绩效的公共报告或用于支付时提供了一个警示。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b16/3384112/1b4ff658758d/amiajnl-2011-000557fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b16/3384112/1b4ff658758d/amiajnl-2011-000557fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b16/3384112/1b4ff658758d/amiajnl-2011-000557fig1.jpg

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