title: Is the quality of data in an electronic medical record sufficient for assessing the quality of primary care?
abstract: OBJECTIVE
  Quality indicators for the treatment of type 2 diabetes are often retrieved from a chronic disease registry (CDR). This study investigates the quality of recording in a general practitioner's (GP) electronic medical record (EMR) compared to a simple, web-based CDR.
  
  
  METHODS
  The GPs entered data directly in the CDR and in their own EMR during the study period (2011). We extracted data from 58 general practices (8235 patients) with type 2 diabetes and compared the occurrence and value of seven process indicators and 12 outcome indicators in both systems. The CDR, specifically designed for monitoring type 2 diabetes and reporting to health insurers, was used as the reference standard. For process indicators we examined the presence or absence of recordings on the patient level in both systems, for outcome indicators we examined the number of compliant or non-compliant values of recordings present in both systems. The diagnostic OR (DOR) was calculated for all indicators.
  
  
  RESULTS
  We found less concordance for process indicators than for outcome indicators. HbA1c testing was the process indicator with the highest DOR. Blood pressure measurement, urine albumin test, BMI recorded and eye assessment showed low DOR. For outcome indicators, the highest DOR was creatinine clearance <30 mL/min or mL/min/1.73 m(2) and the lowest DOR was systolic blood pressure <140 mm Hg.
  
  
  CONCLUSIONS
  Clinical items are not always adequately recorded in an EMR for retrieving indicators, but there is good concordance for the values of these items. If the quality of recording improves, indicators can be reported from the EMR, which will reduce the workload of GPs and enable GPs to maintain a good patient overview.
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands.
authors.forename: Pashiera
authors.initials: P
authors.lastname: Barkhuysen
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: de Grauw
authors.affiliation: Department of Primary and Community Care/Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands.
authors.forename: Reinier
authors.initials: R
authors.lastname: Akkermans
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands.
authors.forename: José
authors.initials: J
authors.lastname: Donkers
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Schers
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands.
authors.forename: Marion
authors.initials: M
authors.lastname: Biermans
mesh_terms: D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D057286:Electronic Health Records / Q000592:standards*; D058006:General Practice / Q000592:standards; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012042:Registries
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Data Quality; Electronic Medical Record; Quality Indicators; Quality of Care; Type 2 Diabetes Mellitus