title: Evaluating the feasibility and utility of translating Choosing Wisely recommendations into e-Measures.
abstract: BACKGROUND
  Efforts to reduce health care spending have focused on reducing use of low-value services, but relatively few performance measures address overuse of care. In 2012, the American Board of Internal Medicine Foundation's "Choosing Wisely" (CW) campaign identified 45 low-value services that clinicians and patients should avoid. Translating these overuse concepts into performance measures could assist in discouraging the use of these services. We assessed the feasibility and utility of converting these recommendations into e-Measures based on data from electronic health records [EHR]).
  
  
  METHODS
  We used four criteria to evaluate 45 CW recommendations for e-Measure development: (1) feasibility of extracting needed data from EHR systems meeting Meaningful Use Stage 2 standards; (2) whether the recommendation's terminology was sufficiently specific for translation into an e-Measure; (3) scientific evidence supporting the recommendation; and (4) impact on reducing resource use.
  
  
  RESULTS
  Only six of the 45 CW recommendations were deemed feasible for e-Measure development. Thirty-two recommendations require data elements unlikely to be found in current EHR systems; eight of 45 recommendations do not use sufficiently specific terminology.
  
  
  CONCLUSIONS
  Improved capture of clinical information in EHRs and greater specificity of clinical terminology are required to advance these overuse concepts into standardized e-measures.
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
authors.forename: Kanaka D
authors.initials: KD
authors.lastname: Shetty
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA; University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Daniella
authors.initials: D
authors.lastname: Meeker
authors.affiliation: The Commonwealth Fund, New York, NY, 10021, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
authors.affiliation: RAND Corporation, Boston, MA, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hussey
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA. Electronic address: damberg@rand.org.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Damberg
mesh_terms: D003695:Delivery of Health Care; D057286:Electronic Health Records; D006801:Humans; D007388:Internal Medicine; D016347:Medical Records Systems, Computerized; D014481:United States
keywords: Choosing Wisely; Efficiency measures; Health information technology; Overuse measures; e-Measures