Meaningful Use Not Correlated With Quality in Study

Ken Terry

April 14, 2014

Showing meaningful use (MU) of electronic health records (EHRs) was not correlated with performance on clinical quality measures, according to a new study published online April 14 in JAMA Internal Medicine.

The study, one of the first of its kind, was performed at clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts. It compared the quality scores of 540 physicians who achieved MU with those of 318 physicians who did not. The healthcare organization computed quality scores on MU measures for all of the 858 physicians, but only some of these physicians met all of the criteria for the government incentive program during the 3-month study period.

Lipika Samal, MD, MPH, from the Division of General Medicine and Primary Care, Brigham and Women’s Hospital, and colleagues looked at 7 metrics for 5 conditions: hypertension, diabetes, coronary artery disease, asthma, and depression. "[MU] was associated with marginally better quality for 2 measures, worse quality for 2 measures, and not associated with better or worse quality for 3 measures," the authors state.

The study found that MU was correlated with better control of cholesterol in patients with diabetes and of blood pressure in hypertensive patients. The MU group provided worse treatment of asthma and depression than the non-MU group did.

In an accompanying commentary, Lisa M. Kern, MD, MPH, from the Department of Healthcare Policy and Research, the Department of Medicine, and the Center for Healthcare Informatics and Policy, Weill Cornell Medical College, and the Health Information Technology Evaluation Collaborative, New York City, and Rainu Kaushal, MD, MPH, from the Department of Healthcare Policy and Research, the Department of Medicine, the Department of Pediatrics, and the Center for Healthcare Informatics and Policy, Weill Cornell Medical College; the Health Information Technology Evaluation Collaborative; and New York-Presbyterian Hospital, New York City, note: "The effects of MU on quality are not yet well understood." Although some studies have shown a positive correlation between the use of EHRs and quality, it is not known whether MU is associated with higher quality than EHR use alone, they point out.

They indicate several factors that make it difficult to evaluate the validity and applicability of the study. First, "The Brigham and Women's Hospital is a national leader in the use of EHRs to improve quality and safety," so its experience may not be relevant to more typical care settings. It was also not clear how long the physicians in the study had used the EHR or how some of them had used the system to achieve MU. In addition, the reliability of the data collection in the study is doubtful, the reviewers say, because automated algorithms for extracting quality data capture only data entered in structured fields.

Dr. Samal told Medscape Medical News that the integrity of the data "wasn't much of an issue for us. The issue of not having structured data doesn't apply to our health system as much as to other health systems. You can trust the data we have."

The bigger challenge, in her view, is that the MU quality metrics are so specific that they exclude a lot of patients with a particular condition. "The problem is not that the data is suspect, but there's so little data that matches specific questions."

The study showed the numbers of physicians in 3 groups of specialties who had achieved MU. Seventy-eight percent of primary care physicians, 62% of medical specialists, and 43% of surgeons had met all of the MU criteria. However, the researchers did not break down the percentages of physicians in these categories who had scored higher than non-MU on the quality measures.

Dr. Samal said she and her colleagues had decided not to do that because the government's regulations for quality reporting apply equally to all specialties. However, she acknowledged that the MU metrics are skewed toward primary care.

Eric C. Schneider, MD, chair in healthcare quality for the RAND Corporation and director of its Boston office, commented, "We don't have good [MU] metrics for specialists, other than cardiologists and endocrinologists. For the vast majority of specialists, we're looking at the primary care aspects of the care they're delivering."

The MU quality metrics are "fairly crude" in understanding nuances of clinical care, he noted. Moreover, not enough structured data are being entered into EHRs yet to do good quality measurement.

As a primary care physician who practices part time in Brigham and Women's network, Dr. Schneider said he was not sure how reliably the data is being collected. "But in this smaller dataset [used in the study], they're probably getting more reliable data."

Overall, he said, "It's an interesting exploratory study and was done well. It's a good start."

Dr. Samal and colleagues have disclosed no relevant financial relationships. Dr. Schneider practices part-time in the Brigham and Women's network but was unaware of the study.

JAMA Intern Med. Published online April 14, 2014.

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