title: Quality measurement of medication monitoring in the "meaningful use" era.
abstract: OBJECTIVE
  While the 2011 implementation of "meaningful use" legislation for certified electronic health records (EHRs) promises to change quality reporting by overcoming data capture issues affecting quality measurement, the magnitude of this effect is unclear. We compared the measured quality of laboratory monitoring of Healthcare Effectiveness Data and Information Set (HEDIS) medications based on specifications that (1) include and exclude patients hospitalized in the measurement year and (2) use physician test orders and patient test completion.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Among patients 18 years and older in a large multispecialty group practice utilizing a fully implemented EHR between January 1, 2008, and July 31, 2008, we measured the prevalence of ordering and completion of laboratory tests monitoring HEDIS medications (cardiovascular drugs [angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, digoxin, and diuretics] and anticonvulsants [carbamazepine, phenobarbital, phenytoin, and valproic acid]).
  
  
  RESULTS
  Measures excluding hospitalized patients were not statistically significantly different from measures including hospitalized patients, except for digoxin, but this difference was not clinically significant. The prevalence of appropriate monitoring based on test orders typically captured in the EHR was statistically significantly higher than the prevalence based on claims-based test completions for cardiovascular drugs.
  
  
  CONCLUSIONS
  HEDIS quality metrics based on data typically collected from claims undermeasured quality of medication monitoring compared to EHR data. The HEDIS optional specification excluding hospitalized patients from the monitoring measure does not have a significant impact on reported quality. Integration of EHR data into quality measurement may significantly change some organizations' reported quality of care.
authors: Division of Geriatric Medicine, University of Massachusetts Medical School, Biotech Four, 377 Plantation St, Ste 315, Worcester, MA 01605, USA. jennifer.tjia@umassmed.edu
authors: Jennifer
authors: J
authors: Tjia
authors: Terry S
authors: TS
authors: Field
authors: Shira H
authors: SH
authors: Fischer
authors: Shawn J
authors: SJ
authors: Gagne
authors: Daniel J
authors: DJ
authors: Peterson
authors: Lawrence D
authors: LD
authors: Garber
authors: Jerry H
authors: JH
authors: Gurwitz
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000295:instrumentation / Q000379:methods*; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs; D011785:Quality Assurance, Health Care / Q000379:methods*; D014481:United States
chemical_list: D055553:Prescription Drugs