February 20, 2007Annals of Internal Medicine
Automated Review of Electronic Health Records to Assess Quality of Care for Outpatients with Heart Failure
Key result
Automated review of EHR data yielded similar performance to hybrid review for LVEF measurement (94.6% vs 97.3%) but underestimated warfarin prescription for atrial fibrillation (70.4% vs 93.6%).
Why the study?
Does automated review of EHR data accurately measure quality of care compared to hybrid review in outpatients with heart failure?
Population
517 adults with a qualifying International Classification of Diseases, Ninth Revision, diagnosis of heart…
Comparison
Automated review of EHR data to measure quality… vs Automated review followed by manual review of…
Design
Cohort
Authors
Discussion
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Implication
Automated EHR review should not yet replace hybrid methods for medication quality metrics in HF; leaves open validation against note-documented exclusions.
Study Design
Type
Observational (n=517)
Multicenter
No
Structured PICO
Does automated review of EHR data accurately measure quality of care compared to hybrid review in outpatients with heart failure?
P
Population
517 adults with a qualifying International Classification of Diseases, Ninth Revision, diagnosis of heart failure in their EHR data and 2 or more clinic visits over the past 18 months at an academic general internal medicine clinic.
I
Intervention
Automated review of EHR data to measure quality of care
C
Comparator
Automated review followed by manual review of electronic notes for patients with apparent quality deficits (hybrid review)
O
Outcome
Accuracy of assessing quality measures including LVEF measurement, prescription of beta-blockers, ACE inhibitors or ARBs, and warfarin
Main Result
Absolute Event Rate: 94.6% vs 97.3%
Automated review of EHR data accurately assesses some heart failure quality measures but underestimates performance on medication measures like warfarin due to missed exclusion criteria documented only in clinical notes.
Limitations
- The findings may not be applicable to other practices and other EHRs.
- Used EHR data to identify eligible patients, so the study may have excluded some patients with heart failure.
- Patient charts were manually reviewed only if a provider appeared to fail a quality measure on automated review.
- Did not determine the sensitivity and specificity of automated review according to standard definitions.
- Findings may not be applicable to other practices and other EHRs
- Used EHR data to identify eligible patients, potentially excluding some patients with heart failure
- Patient charts were manually reviewed only if a provider appeared to fail a quality measure on automated review
- Did not determine the sensitivity and specificity of automated review according to standard definitions
Cite This Study
Baker et al. (2007) conducted an observational in Heart failure (n=517). Automated review of EHR data vs. Hybrid review (automated review followed by manual review) was evaluated on LVEF measurement assessment. Automated review of EHR data yielded similar performance to hybrid review for LVEF measurement (94.6% vs 97.3%) but underestimated warfarin prescription for atrial fibrillation (70.4% vs 93.6%).