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Health Affairs: PCPs’ EHRs Struggle with Quality Improvement Reporting

April 3, 2018
by Rajiv Leventhal
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Although federal value-based payment programs require providers to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate, many technology systems are not up to the task, according to new research in the April issue of Health Affairs.

The researchers, from Oregon Health & Science University, University of Colorado School of Medicine, and elsewhere, examined survey responses from nearly 1,500 primary care practices across 12 states, supplemented with qualitative data. Meaningful use participation, which requires the use of a federally-certified EHR, was associated with the ability to generate reports—but the reports did not necessarily support quality improvement initiatives, the analysis revealed.

Specifically, the study’s authors stated, “Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. As such, “The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures,” they said.

As the researchers explained, there were 17 core standards defined in Stages 1 and 2 of the meaningful use program (2015 to 17). Stage 3 began in 2017 and expanded the requirements to include health information exchange (HIE), interoperability, and advanced quality measurement to maximize clinical effectiveness and efficiency by supporting quality improvement. As of 2017, the MU program defined 64 electronic clinical quality measures that are aligned with national quality standards. The rationale behind using these measures was to reduce the need for clinicians’ involvement in reporting by using data already collected within the EHR and automating the electronic submission of results.

For the study, data was collected from an Agency for Healthcare Research and Quality (AHRQ)-funded initiative that compiled survey data across 1,492 practices from 2015 to 2017. Online diary data, interviews, meeting notes, and field notes from practice site visits were deidentified for individual participants and reviewed for accuracy by the researchers.

The results showed that practices and quality improvement facilitators experienced significant challenges using EHRs to generate tailored reports of electronic clinical quality measures for quality improvement, which led to substantial delays in reporting quality measures and engaging in measurement-informed quality improvement activities.

Once such specific problem that was identified was that “ONC-certified EHRs for meaningful use do not provide customizable measure specifications, date ranges, and frequency of reports. Vendors are resistant to making changes to EHRs beyond what is required for ONC certification and meaningful use, and any changes are expensive and take too much time to deliver.”

Other problem areas were around practices lacking technical expertise and resources, EHR design features, delays in software upgrades, and high vendor fees for connecting to a data warehouse, hub or HIE, the researchers found.

The study also showed that practices participating in Stages 1 and 2 of meaningful use were more likely to report being able to generate reports of electronic clinical quality measures at the practice and clinician levels, compared to practices not participating in the MU program.

What’s more, practices owned by health/hospital systems had higher odds of reporting the ability to generate reports of electronic clinical quality measures, compared to clinician-owned practices, while solo and rural practices were less likely than practices with six or more physicians and those in urban areas to report being able to generate such reports.

The researchers concluded, “To improve EHRs’ ability to achieve their potential and support sustainable payment reforms, policy makers should consider empowering the ONC and CMS to expand their standards and requirements for, and monitoring of, EHR vendors.” They added that, “EHR data are ‘locked up,’ which prevents even a well-resourced initiative from being able to use data for quality measurement across diverse practice settings.”

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