Hypertension study ties EHR data quality to training, management

Data quality remains an issue in electronic health records, according to a West Virginia study of hypertension cases that found use of free text was a common cause of indentification errors. The authors looked at barriers to outcomes research, quality improvement and practice redesign, such as the National Committee for Quality Assurance's Patient-Centered Medical Home program.

The West Virginia researchers imported anonymous EHR data from 11 West Virginia primary care centers into an external system, in this case a public-domain patient registry, in an attempt to search for hypertension cases. Through the EHR data--patient diagnoses, demographics, vitals, laboratory results and services--they could look at coding consistency and completeness, according to a report published in Perspectives in Health Information Management.

They used three methods to identify hypertension cases: those diagnosed based on ICD-9-CM codes; those based on free-text entries, and those whose last two or more blood pressure readings were greater than or equal to 140/90 mm Hg, but without ICD-9-CM code or free-text diagnosis.

Using ICD-9-CM codes alone, 12,919 patients were identified. Searching free-text diagnoses added 898 cases to the mix, while looking at the last two blood pressure readings brought in 1,076 more. Use of ICD-9-CM codes alone missed 13.3 percent of cases as identified using all three methods.

They found the implications critical for quality of care, because initially identifying patients is fundamental to quality improvement. They wrote, "This study highlights the need for training in data quality and management, even on basic levels such as using EHR templates and discrete fields for data entry rather than free-text fields. Targeted training is advisable because various members of a care team, such as physicians, nurses, medical assistants, and front-office staff, contribute data to the EHR at various points in the care process."

Electronic quality measures based on electronic health records data are expected to become the norm, as FierceEMR reported this week.

The VA has been at the forefront of using EHRs to help manage blood pressure, according to CMIO. A recent study published in Circulation found control rates improved from 43 percent to 76 percent between 2000 and 2010, though the research came with some qualifiers. The EHRs helped, though, by triggering reminders for prescription refills and more frequent appointments until control was achieved.

And better blood pressure control was reported in a study published last year in the American Journal of Managed Care in which clinical decision support as well as EHRs were combined, as required under meaningful use legislation.

To learn more:
- read the Perspectives in Health Information Management article
- here's the CMIO report
- here's the study in the American Journal of Managed Care