PowerPoint Presentation and Incident Action Plan

By Deborah J. Cohen, David A. Dorr, Kyle Knierim, C. Annette DuBard, Jennifer R. Hemler, Jennifer D. Hall, Miguel Marino, Leif I. Solberg, K. John McConnell, Len M. Nichols, Donald E. Nease Jr., Samuel T. Edwards, Winfred Y. Wu, Hang Pham-Singer, Abel N. Kho, Robert L. Phillips Jr., Luke V. Rasmussen, F. Daniel Duffy, and Bijal A. Balasubramanian

Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

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.

S ince 2008, adoption of office-based physician electronic health records (EHRs) has more than doubled.1

Federal investment played a critical role in accelerating EHR adoption

through a combination of financial incentives (the EHR Incentive Program) and technical as- sistance programs (Regional Extension Cen- ters).2–6 The expectation was that widespread adoption of EHRs would efficiently generate meaningful data, enabling accurate measure- ment of quality, informing practice quality im- provement efforts, and ultimately leading to im- proved care processes and outcomes.