title: Formalization and computation of quality measures based on electronic medical records.
abstract: OBJECTIVE
  Ambiguous definitions of quality measures in natural language impede their automated computability and also the reproducibility, validity, timeliness, traceability, comparability, and interpretability of computed results. Therefore, quality measures should be formalized before their release. We have previously developed and successfully applied a method for clinical indicator formalization (CLIF). The objective of our present study is to test whether CLIF is generalizable--that is, applicable to a large set of heterogeneous measures of different types and from various domains.
  
  
  METHODS
  We formalized the entire set of 159 Dutch quality measures for general practice, which contains structure, process, and outcome measures and covers seven domains. We relied on a web-based tool to facilitate the application of our method. Subsequently, we computed the measures on the basis of a large database of real patient data.
  
  
  RESULTS
  Our CLIF method enabled us to fully formalize 100% of the measures. Owing to missing functionality, the accompanying tool could support full formalization of only 86% of the quality measures into Structured Query Language (SQL) queries. The remaining 14% of the measures required manual application of our CLIF method by directly translating the respective criteria into SQL. The results obtained by computing the measures show a strong correlation with results computed independently by two other parties.
  
  
  CONCLUSIONS
  The CLIF method covers all quality measures after having been extended by an additional step. Our web tool requires further refinement for CLIF to be applied completely automatically. We therefore conclude that CLIF is sufficiently generalizable to be able to formalize the entire set of Dutch quality measures for general practice.
authors.affiliation: Department of Computer Science, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Dentler
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.forename: Annette
authors.initials: A
authors.lastname: ten Teije
authors.forename: Ronald
authors.initials: R
authors.lastname: Cornet
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
mesh_terms: D057286:Electronic Health Records; D058006:General Practice / Q000592:standards*; D006801:Humans; D009323:Natural Language Processing; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011381:Programming Languages; D019984:Quality Indicators, Health Care
keywords: EMR-driven Phenotyping; Electronic Medical Record; Identification of Patient Cohorts; Quality Indicators; Quality Measures; Secondary Use of Patient Data