1028 — Measuring Performance Using the VA Electronic Medical Record: A Comparison with External Peer Review
Goulet JL (VA Connecticut Healthcare System, West Haven) , Erdos J
(VA Connecticut Healthcare System, West Haven), Kancir S
(VA Connecticut Healthcare System, West Haven), Levin FL
(VA Connecticut Healthcare System, West Haven), Wright SM
(Veterans Health Affairs Central Office (VACO), Washington, DC), Daniels SM
(Veterans Health Affairs Central Office (VACO), Washington, DC), Nilan L
(Veterans Health Affairs Central Office (VACO), Washington, DC), Justice AC
(VA Connecticut Healthcare System, West Haven)
Electronic medical records systems (EMR) contain many directly analyzable data fields that may reduce the need for extensive chart review, thus allowing performance measures that utilize those standard computable fields to be assessed on a larger proportion of patients in care.
We determined the extent to which selected chart review based clinical performance measures could be accurately replicated using readily available and directly analyzable EMR data.
A cross-sectional study using full chart-review results from the Veterans Health Administration’s External Peer Review Program (EPRP) merged to EMR data.
Over 80% of the data on these selected measures found in chart review was available in a directly analyzable form in the EMR. The extent of missing EMR data varied by site of care (p < 0.01). Among patients on whom both sources of data were available, we found a high degree of correlation between the two sources in the measures assessed (correlations of 0.89-0.98) and in the concordance between the measures using performance cut points (Kappa: 0.86-0.99). Further, there was little evidence of bias by source of information; the differences in values were not clinically meaningful (difference of 0.9 mg/dL for LDL cholesterol, 1.2 mmHg for systolic blood pressure, 0.3 mmHg for diastolic, and no difference for HgbA1c).
Directly analyzable data fields in the EMR can accurately reproduce selected EPRP measures on most patients. We found no evidence of systematic differences in performance values among those with and without directly analyzable data in the EMR.
Future research should address the applicability of EMR data that utilize those standard computable fields to other EPRP measures. Studies are needed to determine the degree of site variation in coding practices, and to assess whether the EMR data fields are useful for performance measures consistent across the entire system.