Chasm Between Cancer Quality Measures and Electronic Health Record Data Quality.
Chasm Between Cancer Quality Measures and Electronic Health Record Data Quality.
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DOI：
10.1200/cci.21.00128
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发表时间：
2022-01
影响因子：
4.2
通讯作者：
Chen, James L.
中科院分区：
文献类型：
--
作者：
Schorer, Anna E.;Moldwin, Richard;Koskimaki, Jacob;Bernstam, Elmer, V;Venepalli, Neeta K.;Miller, Robert S.;Chen, James L.
《2015年医疗保险准入和芯片再授权法案》（MACRA）要求符合条件的临床医生在基于绩效的激励支付系统（MIPS）中报告临床质量指标（CQM），以最大限度地提高报销率。为了确定电子健康记录（EHR）中的结构化数据是否足以报告MIPS CQM，分析了ASCO CancerLinQ平台汇总的EHR数据。使用CancerLinQ健康技术平台，对19个肿瘤MIPS（oMIPS）CQM进行了评价，以确定是否存在满足每个CQM所需的数据元素（DE）和具有患者数据的DE百分比人群（填充率）。在进行这项分析时，CancerLinQ网络包括63个活跃的实践，代表8个不同的EHR供应商，包含超过163万名患有一种或多种恶性肿瘤的独特患者的记录（173万例癌症病例）。63个oMIPS相关DE的填写率在实践中差异很大。对于52%的DE，平均研究中心至少有一个填充的DE。在95%的实践中，只有35%的DE填充了至少一个患者记录。然而，所有实践的平均DE填充率为23%。在任何实践中，22%的DE都没有发现数据。由于具有未填充DE分量的任何oMIPS CQM导致无法计算测量值，因此19个oMIPS CQM中只有2个（10.5%）可计算超过1%的患者。尽管EHR系统对于某些DE具有相对较高的DE填充率，但EHR中DE的填充不足和不一致性使得自动肿瘤MIPS CQM计算不切实际。
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires eligible clinicians to report clinical quality measures (CQMs) in the Merit-Based Incentive Payment System (MIPS) to maximize reimbursement. To determine whether structured data in electronic health records (EHRs) were adequate to report MIPS CQMs, EHR data aggregated by ASCO's CancerLinQ platform were analyzed. Using the CancerLinQ health technology platform, 19 Oncology MIPS (oMIPS) CQMs were evaluated to determine the presence of data elements (DEs) necessary to satisfy each CQM and the DE percent population with patient data (fill rates). At the time of this analysis, the CancerLinQ network comprised 63 active practices, representing eight different EHR vendors and containing records for more than 1.63 million unique patients with one or more malignant neoplasms (1.73 million cancer cases). Fill rates for the 63 oMIPS-associated DEs varied widely among the practices. The average site had at least one filled DE for 52% of the DEs. Only 35% of the DEs were populated for at least one patient record in 95% of the practices. However, the average DE fill rate of all practices was 23%. No data were found at any practice for 22% of the DEs. Since any oMIPS CQM with an unpopulated DE component resulted in an inability to compute the measure, only two (10.5%) of the 19 oMIPS CQMs were computable for more than 1% of the patients. Although EHR systems had relatively high DE fill rates for some DEs, underfilling and inconsistency of DEs in EHRs render automated oncology MIPS CQM calculations impractical.