title: Validity of electronic health record-derived quality measurement for performance monitoring.
abstract: BACKGROUND
  Since 2007, New York City's primary care information project has assisted over 3000 providers to adopt and use a prevention-oriented electronic health record (EHR). Participating practices were taught to re-adjust their workflows to use the EHR built-in population health monitoring tools, including automated quality measures, patient registries and a clinical decision support system. Practices received a comprehensive suite of technical assistance, which included quality improvement, EHR customization and configuration, privacy and security training, and revenue cycle optimization. These services were aimed at helping providers understand how to use their EHR to track and improve the quality of care delivered to patients.
  
  
  METHODS
  Retrospective electronic chart reviews of 4081 patient records across 57 practices were analyzed to determine the validity of EHR-derived quality measures and documented preventive services.
  
  
  RESULTS
  Results from this study show that workflow and documentation habits have a profound impact on EHR-derived quality measures. Compared with the manual review of electronic charts, EHR-derived measures can undercount practice performance, with a disproportionately negative impact on the number of patients captured as receiving a clinical preventive service or meeting a recommended treatment goal.
  
  
  CONCLUSIONS
  This study provides a cautionary note in using EHR-derived measurement for public reporting of provider performance or use for payment.
authors.affiliation: Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, New York, USA. aparsons@health.nyc.gov
authors.forename: Amanda
authors.initials: A
authors.lastname: Parsons
authors.forename: Colleen
authors.initials: C
authors.lastname: McCullough
authors.forename: Jason
authors.initials: J
authors.lastname: Wang
authors.forename: Sarah
authors.initials: S
authors.lastname: Shih
mesh_terms: D000328:Adult; D019985:Benchmarking; D004282:Documentation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009519:New York City; D011320:Primary Health Care; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive; D015203:Reproducibility of Results; D012189:Retrospective Studies; D057188:Workflow