Kanger Chatrian, Brown Lisanne, Mukherjee Snigdha, Xin Haichang, Diana Mark L, Khurshid Anjum
Louisiana Public Health Institute.
University of Alabama at Birmingham.
EGEMS (Wash DC). 2014 Oct 23;2(3):1102. doi: 10.13063/2327-9214.1102. eCollection 2014.
Quality incentive programs, such as Meaningful Use, operate under the assumption that clinical quality measures can be reliably extracted from EHRs. Safety Net providers, particularly Federally Qualified Health Centers and Look-Alikes, tend to be high adopters of EHRs; however, recent reports have shown that only about 9% of FQHCs and Look-Alikes were demonstrating meaningful use as of 2013. Our experience working with the Crescent City Beacon Community (CCBC) found that many health centers relied on chart audits to report quality measures as opposed to electronically generating reports directly from their EHRs due to distrust in the data. This paper describes a step-by-step process for improving the reliability of data extracted from EHRs to increase reliability of quality measure reports, to support quality improvement, and to achieve alignment with national clinical quality reporting requirements.
Lack of standardization in data capture and reporting within EHRs drives distrust in EHR-reported data. Practices or communities attempting to achieve standardization may look to CCBC's experience for guidance on where to start and the level of resources required in order to execute a data standardization project. During the time of this data standardization project, CCBC was launching an HIE. Lack of trust in EHR data was a driver for distrust in the HIE data.
We present a case study where a five-step process was used to harmonize measures, reduce data errors, and increase trust in EHR clinical outcomes reports among a community of Safety Net providers using a common EHR. Primary outcomes were the incidence of reporting errors and the potential effect of error types on quality measure percentages. The activities and level of resources required to achieve these results were also documented by the CCBC program.
Implementation of a community-wide data reporting project resulted in measure harmonization, reduced reporting burden, and error reduction in EHR-generated clinical outcomes reporting across participating clinics over a nine-month period. Increased accuracy of clinical outcomes reports provided physicians and clinical care teams with better information to guide their decision-making around quality improvement planning.
A number of challenges exist to achieving reliable population level quality reporting from EHRs at the practice, vendor, and community levels. Our experience demonstrates that quality measure reporting from EHRs is not a straightforward process, and it requires time and close collaboration between clinics and vendors to improve reliability of reports. Our experience found that practices valued the opportunity and step-wise process to validate their data locally (out of their EHRs) prior to reporting out of the HIE.
Communities can achieve higher levels of confidence in quality measure reporting at the population level by establishing collaborative user groups that work with EHR vendors as partners and use technical assistance to build relationships and trust in EHR-generated reports. While this paper describes the first phase of our work around improving standardization and reliability of EHR reports, vendors should continue to explore modifications for improving data capture (at the front-end) via standardized data entry templates.
诸如“有意义使用”之类的质量激励计划是在临床质量指标能够从电子健康记录（EHR）中可靠提取的假设下运作的。安全网提供者，尤其是联邦合格健康中心及其类似机构，往往是电子健康记录的高采用者；然而，最近的报告显示，截至2013年，只有约9%的联邦合格健康中心及其类似机构展示了有意义的使用情况。我们在与新月城灯塔社区（CCBC）合作的过程中发现，由于对数据不信任，许多健康中心依赖图表审核来报告质量指标，而不是直接从其电子健康记录中电子生成报告。本文描述了一个逐步提高从电子健康记录中提取数据的可靠性的过程，以提高质量指标报告的可靠性，支持质量改进，并符合国家临床质量报告要求。
电子健康记录中数据捕获和报告缺乏标准化导致对电子健康记录报告的数据不信任。试图实现标准化的实践或社区可能会借鉴CCBC的经验，以了解从何处入手以及执行数据标准化项目所需的资源水平。在这个数据标准化项目期间，CCBC正在启动一个卫生信息交换（HIE）。对电子健康记录数据的不信任是对卫生信息交换数据不信任的一个驱动因素。
我们展示了一个案例研究，其中使用了一个五步流程来协调指标（措施）、减少数据错误，并在使用通用电子健康记录的安全网提供者社区中提高对电子健康记录临床结果报告的信任。主要结果是报告错误的发生率以及错误类型对质量指标百分比的潜在影响。CCBC项目也记录了实现这些结果所需的活动和资源水平。
在九个月的时间里，实施全社区范围的数据报告项目导致了指标协调、报告负担减轻，以及参与诊所的电子健康记录生成的临床结果报告中的错误减少。临床结果报告准确性的提高为医生和临床护理团队提供了更好的信息，以指导他们围绕质量改进计划的决策。
在实践、供应商和社区层面，要从电子健康记录中获得可靠的人群层面质量报告存在许多挑战。我们的经验表明，从电子健康记录中报告质量指标并非一个简单的过程，它需要诊所和供应商之间的时间和密切合作来提高报告的可靠性。我们的经验发现，实践机构重视在从卫生信息交换中报告之前在本地（在其电子健康记录之外）验证其数据的机会和逐步流程。
社区可以通过建立与电子健康记录供应商作为合作伙伴合作的协作用户组，并利用技术援助来建立对电子健康记录生成的报告的关系和信任，从而在人群层面的质量指标报告中获得更高的信心水平。虽然本文描述了我们围绕提高电子健康记录报告的标准化和可靠性工作的第一阶段，但供应商应继续探索通过标准化数据输入模板改进（前端）数据捕获的修改方法。
