Electronic health record data limited in publicly reported post-CABG mortality and readmission outcomes
Retooling paper-based measures to electronic format for the reporting of performance measures can help reduce hospitals’ reporting burden, reports The Joint Commission.
This is according to a recent study in Medical Care that evaluates whether electronic health records (EHRs) can eliminate the need for costly and time-consuming manual data abstraction of patient outcomes and risk factors necessary for risk adjustment. Outcome measures quantify the end result of healthcare and are sought after by patients to assess provider quality and payors to determine payment.
The study — “Retooling of Paper-based Outcome Measures to Electronic Format,” by researchers from The Joint Commission and the State University of New York — asked leading EHR vendors and hospital focus groups to review 28 risk factors in the New York State (NYS) coronary artery bypass graft (CABG) surgery statistical models for mortality and readmission, and to assess the feasibility of EHR data capture.
Simplified risk models based only on registry data elements that can be captured by EHRs (one for easily obtained data and one for data obtained with more difficulty) were developed and compared with the NYS models for different years.
Findings showed the simplified risk models using EHR data elements could not capture most risk factors in the NYS CABG surgery risk models. Only a low number of risk factor data elements – six out of 28 – could be obtained from the EHR. Risk factors included age, gender, creatinine level, height, weight and heart failure status.
Furthermore, outlier hospitals identified using the simplified models versus those identified using the NYS model differed substantially for readmission, but not for mortality. At the patient level, measures of fit and predictive ability indicated that the EHR models are inferior to the NYS CABG surgery risk models, although correlation of the predicted probabilities between the NYS and EHR models was high.
The data must be in a structured format in order to obtain accurate and reliable risk factor data from the EHR, the study authors note. Structured data refers to any data that resides in a fixed field within the EHR.
Most of the data currently used for risk adjustment for the cardiac surgery outcome measures studied were not currently in this format, precluding the reporting of these measures through the EHR in a form that would be acceptable to the medical community, even though the EHR risk models did surprisingly well at the hospital level given the small number of risk factors available in the EHR.
