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EHRs aren't ready for quality reporting, undermining reform efforts

Currently available electronic health record systems are not capable of accurately capturing and reporting clinical quality data, according to a new comment letter from the College of Healthcare Information Management Executives (CHIME). The letter states that it will be “impossible” for hospitals to automate quality reporting for meaningful use clinical quality measures and other programs through EHRs.

The letter was sent to the Centers for Medicare and Medicaid Services (CMS) in response to a request for comment issued by the agency as part of its Inpatient Quality Data Reporting program. CHIME officials noted that CMS is taking steps toward aligning the data reporting requirements of this program and meaningful use. But this alignment will do little to resolve the burden of quality reporting because available technology does not make automated reporting possible.

Specifically, the letter notes that a lot of the information hospitals need to report for quality initiatives is locked in free-text and other unstructured fields. Because text-recognition software is still relatively limited, this data cannot be used in any kind of systematic way.

This means that quality reports are either largely incomplete, or hospitals must task staff members with the laborious work of manually generating reports.

It’s hard to see either approach being tenable over the long term. So many of the nation’s health care reform efforts rely on clincal quality reporting. It’s obviously a central component of the meaningful use program, through the clinical quality measure requirements. Quality reporting also plays a major role in accountable care organizations.

But unless organizations are reporting accurate, complete data, these initiatives fall down like a house of cards. For example, how can an ACO prove that it is effectively and efficiency managing the health of its diabetic population when doctors are recording HbA1c test scores in free-text fields, the data from which is not included in quality reports?

The CHIME letter points to two possible solutions, both of which require significant changes to the current state of technology. Either electronic records must be entirely structured or text-recognition software must improve. Until either or both of those things happen, the letter states, quality reporting will continue to suffer.

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