AIM: Coronary quality measures in EHRs infrequent, yet ignored
Exceptions to recommended therapy in outpatient quality measures for coronary artery disease in EHRs occur infrequently and are usually valid. However, physicians frequently prescribed drugs even when exceptions were present, according to a recent study published in the Annals of Internal Medicine.
Karen S. Kmetik, PhD, of the American Medical Association in Chicago, and colleagues, sought to determine the frequency and validity of exceptions to outpatient quality measures and to test an EHR system for classifying the reasons for these exceptions.
Set across five internal medicine or cardiology practices, 47,075 patients with coronary artery disease were observed between 2006 and 2007 in a cross-sectional observational study.
Counts of adherence with and exceptions to four quality measures were measured, on the basis of automatic reports of recommended drug therapy by computer software and separate manual reviews of EHRs.
According to the authors, 3.5 percent of patients who had a drug recommended had an exception to the drug and were not prescribed it. Clinicians did prescribe the recommended drug for many other patients with exceptions.
In 538 randomly selected records, 92.6 percent of the exceptions reported automatically by computer software were also exceptions during manual review, the researchers found. Most medical exceptions were clinical contraindications, drug allergies or drug intolerances. In 592 randomly selected records, an unreported exception or a drug prescription was found during manual review for 74.6 percent of patients for whom automatic reporting recorded a quality failure.
While that study was limited by using a convenience sample of practices, nonstandardized data extraction methods, only drug-related quality measures and no financial incentives, the authors concluded that automated reports of quality failure often miss critical information.
Funding was provided by the Agency for Healthcare Research and Quality.
Karen S. Kmetik, PhD, of the American Medical Association in Chicago, and colleagues, sought to determine the frequency and validity of exceptions to outpatient quality measures and to test an EHR system for classifying the reasons for these exceptions.
Set across five internal medicine or cardiology practices, 47,075 patients with coronary artery disease were observed between 2006 and 2007 in a cross-sectional observational study.
Counts of adherence with and exceptions to four quality measures were measured, on the basis of automatic reports of recommended drug therapy by computer software and separate manual reviews of EHRs.
According to the authors, 3.5 percent of patients who had a drug recommended had an exception to the drug and were not prescribed it. Clinicians did prescribe the recommended drug for many other patients with exceptions.
In 538 randomly selected records, 92.6 percent of the exceptions reported automatically by computer software were also exceptions during manual review, the researchers found. Most medical exceptions were clinical contraindications, drug allergies or drug intolerances. In 592 randomly selected records, an unreported exception or a drug prescription was found during manual review for 74.6 percent of patients for whom automatic reporting recorded a quality failure.
While that study was limited by using a convenience sample of practices, nonstandardized data extraction methods, only drug-related quality measures and no financial incentives, the authors concluded that automated reports of quality failure often miss critical information.
Funding was provided by the Agency for Healthcare Research and Quality.