Using electronic health records to measure physician performance for acute conditions in primary care: empirical evaluation of the community-acquired pneumonia clinical quality measure set

This study evaluated the reliability and feasibility-of-use of a performance measure for pneumonia in an ambulatory electronic health record (EHR) in primary care clinics. Two reviewers independently examined data in the EHR to determine if (1) encounter was a visit for acute pneumonia; (2) documentation existed for each of 12 performance measures; and (3) such information was in coded form. Of 688 encounters with a claim diagnosis of pneumonia, 210 (31%) were identified. The 2 reviewers agreed that 198 encounters to 71 different clinicians were visits for acute pneumonia. Measure performance ranged from 10% to 91%, averaging 52% across all 12 measures. The proportion of data that was in coded form ranged from 0% for mental and hydration status to 100% for medications and immunizations. Although EHRs offer potential advantages for performance measurement for acute conditions, accurate identification of pneumonia visits was challenging, performance generally appeared poor, and much of the data were not in coded form.