Post-EHR clinical quality measure performance 'mixed'

Transitioning to electronic health records can improve clinical quality measurement, but not necessarily across all measures and not in the short term, according to a new study in eGEMs (Generating Evidence and Methods to Improve Patient Outcomes).

The researchers, from the New York City Department of Health and Mental Hygiene and Montefiore Medical Center, reviewed whether small, independent medical practices improved in the performance of nine clinical quality measures--such as Body Mass Index recorded, blood pressure control and smoking cessation intervention offered--when they adopted EHRs. The researchers reviewed the paper and electronic charts for 6,007 patients in 35 small primary care practices for the study.

The results were mixed.

"For seven measures, population-level performance rates did not change before EHR adoption," the researchers said. "Rates of antithrombotic therapy and smoking status recorded increased soon after EHR adoption; increases in blood pressure control occurred later. Rates of hemoglobin A1c testing, BMI recorded, and cholesterol testing decreased before rebounding; smoking cessation intervention, hemoglobin A1c control and cholesterol control did not significantly change."

The researchers attributed the results in part to the level of complexity of the new workflows needed to document preventative services, as well as the variation in practice workflow styles. For example, measures that improved soon after EHR adoption tended to be those that involved a patient's single office visit. Measures involving more follow up took longer to improve.

The study mirrors other recent reports that work flow issues continue to thwart physicians' efforts to adopt EHRs, and many of them are considering moving to a different EHR product. According to KLAS research published in September, only 25 percent of ambulatory providers feel that their EHRs and Meaningful Use were having a positive impact on patient care.

All of the practices in the study were able to equal or surpass their pre-EHR performance on at least three measures by the end of the 18-month study, but none could do so for all nine measures.

"Policies and incentive programs intended to drive improvement should include in their timelines consideration of the complexity of clinical tasks and documentation needed to capture performance on measures, and should also include assistance with workflow redesign to fully integrate EHRs into medical practice," the researchers said.

To learn more:
- read the study (.pdf)