Keyser DJD et al. 2009 "Using health information technology-related performance measures and tool to improve chronic care."

Keyser DJ, Dembosky JW, Kmetik K, et al. Using health information technology-related performance measures and tools to improve chronic care. Jt Comm J Qual Patient Saf 2009;35(5):248-255.
"Background: The American Medical Association led a collaborative initiative to explore opportunities for improving the quality of outpatient chronic care through the use of nationally endorsed clinical performance measures and tools. The measures and tools focused on adult diabetes, major depressive disorder, chronic stable coronary artery disease, heart failure, hypertension, and asthma. Methods: The RAND Corporation conducted an independent, formative assessment of the initiative's four pilot activities using the Context-Input-Process-Product evaluation model. Results: Pilots 1 and 2 demonstrated the feasibility and value of implementing performance measures and tools in practices with electronic health information systems, while highlighting the difficulty of using them in practices with paper-based systems and in community-based models, where multiple stakeholders are expected to share patient data. Pilot 3 illustrated the usefulness of validating performance measures before their use for internal quality improvement or external reporting. Pilot 4 documented the challenges involved in exporting clinical performance data from a physician practice to external entities for multiple potential uses. Discussion: Improving the quality of chronic care through clinical performance measurement, data aggregation, and reporting will require expanded use of clinical performance measures for both internal quality improvement and pay-for-performance; integrating electronic health records (EHRs) or electronic-based registries into more physician offices; more accurate measurement and documentation of diagnoses and care procedures; EHR products that make it easier to capture certain types of information; and simplified, standardized processes for performance data extraction and exporting."
To evaluate the impact of electronic health record (EHR) systems, clinical decision support systems, and computerized provider order entry (CPOE) systems on data collection for performance measures, integrating evidence-based clinical guidelines with patient data, and quality improvement.
Tools Used
Type Clinic
Primary care
not applicable
Urban, suburban, and rural
Other Information
Organizations which played leading roles in the study included: Pittsburgh Regional Healthcare Initiative, Iowa Foundation for Medical Care, Ambulatory and Community Health Network of the Cook County Bureau of Health Services, Northwestern Medical Faculty Foundation, and Midwest Heart Specialists.
Type of Health IT
Electronic health records (EHR)
Disease registry
Context or other IT in place
The context varied across practices.
Workflow-Related Findings
Clinical staff "now have access to both patient- and group-level reports that integrate clinical data from several sources ... and can generate lists of patients who have missed a visit or who need a specific test or service ... Physicians are also able to create electronic progress notes, which enable them to view the record of a particular patient," including medications and treatment plans.
"Inputting the requisite data into the registry posed considerable challenges, particularly because some of the information had to be entered manually."
"The [EHR], like many other off-the-shelf EHRs, was not automatically able to produce the heart failure and [coronary artery disease] CAD performance measures. Rather, staff had to develop search terms and programs for querying the data system for relevant patient data."
"[S]taff found that extracting...performance data from the [EHR] was both time-consuming and resource-intensive, requiring considerable collaboration with staff at the QI organization."
"Although no additional physician time was required for data entry, issues related to operationalizing specific elements...were problematic."
Physicians in one practice "now report data on the measures as part of their routine office visits and receive feedback reports that use the measures...The use of the reports has spurred healthy competition among teams of physicians to improve care."
The results "demonstrate the feasibility and value of implementing [clinical data performance measurement, data aggregation and reporting tools] in office-based settings supported by well-established EHRs or electronic-based disease registries while highlighting the difficulty of using them in practices with paper-based systems."
"Physicians across all practice types spent more time than anticipated dealing with the edits, prompts and pop-ups that are built into the performance measures and tools ... In addition, because the measures and tools are currently designed to address only one condition each, physicians had to use multiple measures and tools when caring for patients with multiple conditions."
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included providers, staff, and their patients not otherwise specified.