Changes in performance after implementation of a multifaceted electronic-health-record-based quality improvement system

Med Care. 2011 Feb;49(2):117-25. doi: 10.1097/MLR.0b013e318202913d.


Background: Electronic health record (EHR) systems have the potential to revolutionize quality improvement (QI) methods by enhancing quality measurement and integrating multiple proven QI strategies.

Objectives: To implement and evaluate a multifaceted QI intervention using EHR tools to improve quality measurement (including capture of contraindications and patient refusals), make point-of-care reminders more accurate, and provide more valid and responsive clinician feedback (including lists of patients not receiving essential medications) for 16 chronic disease and preventive service measures.

Design: Time series analysis at a large internal medicine practice using a commercial EHR.

Subjects: All adult patients eligible for each measure (range approximately 100-7500).

Measures: The proportion of eligible patients who satisfied each measure after removing those with exceptions from the denominator.

Results: During the year before the intervention, performance improved significantly for 8 measures. During the year after the intervention, performance improved significantly for 14 measures. For 9 measures, the primary outcome improved more rapidly during the intervention year than during the previous year (P < 0.001 for 8 measures, P = 0.02 for 1). Four other measures improved at rates that were not significantly different from the previous year. Improvements resulted from increases in patients receiving the service, documentation of exceptions, or a combination of both. For 5 drug-prescribing measures, more than half of physicians achieved 100% performance.

Conclusions: Implementation of a multifaceted QI intervention using EHR tools to improve quality measurement and the accuracy and timeliness of clinician feedback improved performance and/or accelerated the rate of improvement for multiple measures simultaneously.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Chicago
  • Coronary Disease / drug therapy
  • Decision Support Systems, Clinical / organization & administration*
  • Diabetes Mellitus / drug therapy
  • Documentation
  • Drug Prescriptions / statistics & numerical data
  • Electronic Health Records / organization & administration*
  • Female
  • Heart Failure / drug therapy
  • Humans
  • Internal Medicine / organization & administration
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Point-of-Care Systems
  • Practice Patterns, Physicians' / organization & administration*
  • Program Evaluation
  • Quality Indicators, Health Care / organization & administration*
  • Reminder Systems
  • Total Quality Management / organization & administration*