Bringing Measurement to the Point of Care (New York)
This project assessed the impact and challenges of introducing health information technology tools to assist small primary care practices in measuring quality of care. In collaboration with an electronic health record (EHR) vendor, the Primary Care Information Project (PCIP) deployed new functionality that allowed clinicians to view 'real time' measures of the delivery of clinical preventive services. In addition, the EHR added patient specific alerts and 'one click' options to act on potentially missed opportunities for followup care or recommended preventive services. Providers using these systems were given substantial technical support and training to use these tools.
The primary objectives of this project were to:
- Design a simple and intuitive point of care quality measurement and decision support user interface.
- Validate a set of automated clinical quality measures that address priority public health issues.
- Characterize provider attitudes and measure provider satisfaction with performance indicators.
- Determine the impact of the quality dashboard on the accuracy of, and provider satisfaction with, EHR derived quality measures.
- Disseminate findings though national measurement consensus organizations (e.g., National Quality Forum's "Standardizing Ambulatory Care Performance Measures" project), through EHR vendors participating in this project, and through peer reviewed publications.
The study found that across the 56 practices involved, most did not have prior quality measurement experience or engage in quality improvement activities prior to the adoption of the EHR. Though most quality measures selected for this study showed post implementation improvement, a review of over 6,100 patient records showed that automated EHR-derived quality reports underreported many of the practices' performance. Providers found some documentation tasks within the EHR to be straight forward, while other data entry processes posed challenges that affect subsequent quality measurement and reporting.