| Description |
Clinical decision support (CDS) and electronic clinical quality measurement (eCQM) are 2 important computerized strategies aimed at improving the quality of healthcare. Unfortunately, computer-facilitated quality improvement faces many barriers. One problem area is the lack of integration of CDS and eCQM, which leads to duplicative efforts, inefficiencies, misalignment of CDS and eCQM implementations, and lack of appropriate automated feedback on clinicians' performance. Another obstacle in the acceptance of electronic interventions can be the inadequate accuracy of electronic phenotyping, which leads to alert fatigue and clinicians' mistrust of eCQM results. To address these 2 problems, the research pursued 3 primary aims: Aim 1. Explore beliefs and perceptions regarding the integration of CDS and eCQM functionality and activities within a healthcare organization. Aim 2. Evaluate and demonstrate feasibility of implementing quality measures using a CDS infrastructure. Aim 3. Assess and improve strategies for human validation of electronic phenotype evaluation results. To address Aim 1, a qualitative study based on interviews with domain experts was performed. Through semistructured in-depth and critical incident interviews, stakeholders' insights about CDS and eCQM integration were obtained. The experts identified multiple barriers to the integration of CDS and eCQM and offered advice for addressing those barriers, which the research team synthesized into 10 recommendations. To address Aim 2, the feasibility of using a standards-based CDS framework aligned with anticipated electronic health record (EHR) certification criteria to implement electronic quality measurement (QM) was evaluated. The CDS-QM framework was used to automate a complex national quality measure at an academic healthcare system which had previously relied on time-consuming manual chart abstractions. To address Aim 3, a randomized controlled study was conducted to evaluate whether electronic phenotyping results should be used to support manual chart review during single-reviewer electronic phenotyping validation. The accuracy, duration, and cost of manual chart review were evaluated with and without the availability of electronic phenotyping results, including relevant patient-specific details. Providing electronic phenotyping results was associated with improved overall accuracy of manual chart review and decreased review duration per test case. Overall, the findings informed new strategies for enhancing efficiency and accuracy of computer-facilitated quality improvement. |
