Practices need 'targeted' assistance, better-designed EHRs to meet CQMs

Assessing electronic clinical quality measures (CQMs) based on an electronic health record system's functionalities can help pinpoint how to improve EHR design and determine how to best help physician practices better patient care, according to a study published this month in eGEMS (Generating Evidence and Methods to Improve Patient Outcomes).

The researchers, from the New York Department of Health and Mental Hygiene, hypothesized that the performance on each of the CQMs would differ according to the practice's EHR functionalities. They created four CQMs: screening, assessment, control-BP and control-other. Using data from 93 practices, they identified three tertiles of CQM performance for each measure.

They found that over a one-year period (2010-2011) performance in the measures improved over time for all CQMs, but that performance differed significantly. Low-tier practices showed the highest gains in improvement, while average-tier practices had modest gains and premier-tier practices had gains in some measures and losses in others.

CQMs are a major component of the Meaningful Use program as well as ancillary uses, such as population health. However, they can be made more reliable. EHR design can have a big impact on how well a practice uses its EHR and how its care measures up.

The researchers suggested that practices need support and assistance with workflow adjustments tailored to which tier they were in. They also recommended that users and vendors collaborate to improve EHR design to improve data capture for CQMs.    

"[P]ractices are capable of quality improvement and that targeted technical assistance can further improve performance by addressing and overcoming specific barriers to EHR implementation and use," the researchers wrote. "As providers strive to attain the Meaningful Use stages, performance on EHR-based quality measures and relevant technical assistance will gain prominence. This analysis presents a viable approach to improving performance on EHR-based quality measures, particularly for small primary care practices in urban settings."

They also noted that it will take time for practices to overcome "obstacles" to EHR implementation and before EHR-based quality data "can be used to draw valid conclusions about the quality of care."

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