1. EHR Quality Measurement In Its Infancy, Study Says
Johns Hopkins research describes some of the other electronic performance measures that could be
used with EHRs.
Quality performance measures based on data in electronic health records are still in their infancy and
have yet to tap many of the unique features of EHRs, according to a new study in the International
Journal for Quality in Health Care. The study, which was re-published in Medscape, provides a
conceptual framework for defining levels of electronic quality measures, or e-QMs.
The study proposes the following five-level typology for defining e-QMs:
--Translated e-QMs. Measures designed for use with paper records, such as whether patients with
diabetes have received HbA1c tests. These measures can use claims data or information from chart
abstraction, as well as EHRs.
--Health IT-assisted. Measures that could be derived from non-EHR data sources, such as blood pressure
or body mass index information, but that require EHRs for reporting on 100% of a patient population.
--Health IT-enabled. Metrics that take advantage of an EHR's features, such as the percentage of
abnormal test results read and acted upon by a clinician within 24 hours of receipt, or the percentage of
relevant clinical alerts that are acted upon.
--Health IT system management. Measures of how providers use health IT systems, such as the
percentage of all prescriptions ordered via electronic prescribing.
--E-iatrogenesis. Measures of patient harm caused at least in part by the health IT system, such as the
percentage of patients for whom the wrong drug was ordered because of an error in an e-prescribing
system, or the percentage of critical lab findings that did not lead to patient notification.
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Transforming Healthcare. ]
Although about half of U.S. doctors have some kind of EHR, less than a quarter of health care is
"substantially documented" in electronic records, the study said. As a result, many physicians with EHRs
are stuck at level 1 of e-QM capability.
Academic healthcare organizations and health IT pioneers such as Kaiser Permanente are capable of
collecting level 2 quality data, said Jonathan P. Weiner, the lead author of the study and a Johns Hopkins
professor of health policy and management, in an interview with InformationWeek Healthcare.
"Sophisticated systems have moved into stage 2. They wouldn't think about gathering data on blood

2. pressure or lab results on 100% of their sample with a paper chart audit, but it's not a big deal to do that
with an EHR."
Even the most advanced organizations, however, have just begun collecting level 3 data, Weiner said.
"I've been working with some of the leaders in health IT, and they're barely scratching the surface in
terms of new ways to measure performance. They've nailed the current ways of doing it. An EHR allows
one to get there more quickly, but I haven't seen many go beyond that."
Weiner noted that there are structural barriers to level 3 performance measures, including the
complexities of workflow and diagnosis. Moreover, he said, physicians don't want to go through a "click-
tree hell" in which they have to navigate multiple menus to perform simple actions. That's one reason
why much of the data in EHRs is in the form of free text, rather than structured data.
In the American Hospital Association's comments on the Meaningful Use Stage 2 proposals, the AHA
pointed out that many hospitals have had difficulty using their EHRs to collect quality data for two
reasons touched on in the Johns Hopkins study. First, the association noted, the underlying measures
themselves were developed for manual chart abstraction and had to be adapted to the EHR--in other
words, they were "translated e-QMs." And second, much of the requisite data is locked up in dictated or
written physician notes. In other words, the hospitals either haven't introduced electronic physician
documentation, or the doctors aren't using it.
Weiner agreed with AHA's critique. But as EHRs become more familiar to physicians, he said, their
documentation is bound to improve because it is the medico-legal basis of their records. Also, when EHR
quality data begins to matter in reimbursement, physicians will want to document what they've done in
a structured manner. Down the line, he added, natural language processing might make it easier for
doctors to enter structured data.
Weiner said the measurement of errors caused by EHRs is very important. "We don't want to build in
inefficiencies or safety problems or outright errors," he noted. But he also seconded the observation of
Dean Sittig, an expert at the University of Texas Health Sciences Center in Houston: The benefits of EHRs
in preventing medical errors far outweigh their potential to cause mistakes.
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Source: http://www.informationweek.com/news/healthcare/EMR/240001355

3. This is what we feel:
“Lack of uniformity won’t help”, Remarks Dr. Charu Chitalia – Director Operations, Acroseas Global
Solutions, while commenting on the current state of EMR implementation. “The doctors are at different
levels of their internal practices with reference to note-taking and documentation. This is somehow not
aligned with the levels of implementation outlined by the authorities. If there’s an absence of
synchronized implementation and adoption respectively, then the vast sums of investments done so far
would land meaningless”, remarks Dr. Chitalia.