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Electronic Health Records Hold Promise in Improving Quality Care

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A study from Weill Cornell Medical College researchers investigating the use of electronic health records in assessing clinical quality measures has recently been touted by a branch of the U.S. Department of Health and Human Services.

The Agency for Healthcare Research and Quality, dedicated to improving the quality, safety, efficiency and effectiveness of health care for Americans, recently produced a web video on a study led by Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell. The research team, which included Dr. Lisa Kern, Associate Professor of Public Health and Medicine at Weill Cornell Medical College, scrutinized the capabilities of electronic systems in measuring quality of care delivered in ambulatory settings. While the research highlighted the promise of electronic health records in quality improvement, it also revealed a need to enhance that capability of systems to measure the delivery of effective care and the impact on health outcomes.

In a report entitled "Developing and Testing Quality Measures for Interoperable Electronic Health Records," the Agency hailed the study results as one that may have lasting implications in the continuing effort to improve health care quality. Whereas a manual review of medical records is slow and expensive and analysis of insurance claims limit researchers' ability to characterize the complexity of patients' health care, electronic health records allow an easy and rapid exchange of information across clinical settings.

"As health information exchange capabilities continue to become more widely available," the Agency wrote, "other primary care organizations can benefit from this research and be better poised to generate more meaningful clinical quality measures, leading to important improvements in quality."

Supported by funding by the Agency's Enabling Quality Measurement Through Health IT Initiative, the research team set out in 2007 to review relevant literature and identify potential quality measures. They first identified 1,000 measures, narrowed to a set of 60, and further whittled down by a diverse 36-member expert panel to a set of 18 prioritized measures of chronic disease management and preventative services.

To test electronic reporting of those final quality measures, the research team partnered with the Institute for Family Health, a federally-qualified health center that's utilized electronic health records since 2002. Testing the accuracy of electronic reporting is important, because the federal government through its EHR Incentive Program is spending $27 billion in financial incentives to reward providers who are able to electronically report quality measures. The research team found wide variation across quality measures in performance. They suggest that this variation needs to be addressed so that the financial incentives meant to reward high quality physicians actually do just that.

"Electronic health records and health information exchange hold great promise to improve the way in which health care is delivered," said Dr. Kaushal, also professor of pediatrics, professor of public health and professor of medicine. "Our research team is very, very interested in continuing efforts in this area."

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