Using Electronic Health Records to Measure Physician Performance for Acute Conditions in Primary Care Empirical Evaluation of the Community-Acquired Pneumonia Clinical Quality Measure Set

Background: Electronic health records (EHRs) have the potential to facilitate performance measurement for acute conditions. Objective: To evaluate the reliability and feasibility-of-use of a performance measure set for community-acquired pneumonia in an ambulatory EHR. Design: Retrospective, cross-sectional electronic chart review. Setting: Primary Care Clinics. Patients: Adults with an administrative claims diagnosis of pneumonia during a 14-month period. Measurements: Two reviewers independently examined data in the EHR to determine if (1) the encounter was a visit for acute pneumonia; (2) there was documentation for each of 12 performance measures; and (3) such information was in coded form. Results: Of 688 encounters with a claim diagnosis of pneumonia, 210 (31%) were identified by either reviewer as a primary care acute pneumonia visit. The 2 reviewers agreed that 198 encounters to 71 different clinicians were visits for acute pneumonia [kappa, 0.96-1 95% confidence interval (CI), 0.93-0.98]. Measure performance ranged from 10% for providing location of care rationale to 91% for documenting blood pressure, averaging 52% across all 12 measures. Inter-rater reliability ranged from 0.66 (95% CI, 0.47-0.84) for providing a location of care rationale to 0.97 (95% Cl, 0.91-1.0) for vital sign assessment. The proportion of data that was in coded form ranged from 0% for mental status, hydration status, chest x-ray performance, and location of care to 100% for medications and immunizations. Conclusions: Although EHRs offer potential advantages for performance measurement for acute conditions, accurate identification of pneumonia visits was challenging, performance generally appeared poor, and much of the data were not in coded form.