Keith Kanel, Pittsburgh Regional Health Initiative
14 April 2012
The study by Jaffe (Israel J Health Policy Res 2012:1:3) provides an answer to a question that vexes American healthcare planners; once electronic health records are pervasive, will automatic forcing functions and decision support lead to complete population health data sets, and ensuing leaps in measured performance? From these authors, the answer may be ¿no¿, or more appropriately, ¿not yet¿.
It is stated that Israel has over 99% of its population tracked through EHRs ¿ a remarkable achievement. But 1 in 6 patients did not have a recorded blood pressure in this study, and 4 in 10 had insufficient data to calculate a BMI.
The good news is that documentation improvement was robust ¿ particularly in BMI measurement which rose over 50% in 3 years. Almost all of the QICH markers moved in a positive direction. But it is sobering that some of the more important process metrics, such as effective control of blood pressure and cholesterol, improved minimally between 2007 and 2009 (67.0% to 68.6%, and 60.3% to 65.6%, respectively). Effective control of blood sugar actually fell (from 49.4% to 48%).
The message may be that good measurement alone does not create quality. The authors do not state whether these data are publically reported to inspire rapid improvement, particularly in the closed Israeli single-payer insurance market. Whereas they do lament the absence of pay-for-performance, this method has not been proven to meaningfully drive quality improvement in the United States. Perhaps the message is that creating a culture of quality improvement is a long battle, and transparency of reliable and trusted data is but a first step.
Keith T. Kanel, MD
Chief Medical Officer
Pittsburgh Regional Health Initiative
Jewish Healthcare Foundation
Pittsburgh, PA USA
Israel Journal of Health Policy Research
A Long Battle, But a Great First Step
14 April 2012
The study by Jaffe (Israel J Health Policy Res 2012:1:3) provides an answer to a question that vexes American healthcare planners; once electronic health records are pervasive, will automatic forcing functions and decision support lead to complete population health data sets, and ensuing leaps in measured performance? From these authors, the answer may be ¿no¿, or more appropriately, ¿not yet¿.
It is stated that Israel has over 99% of its population tracked through EHRs ¿ a remarkable achievement. But 1 in 6 patients did not have a recorded blood pressure in this study, and 4 in 10 had insufficient data to calculate a BMI.
The good news is that documentation improvement was robust ¿ particularly in BMI measurement which rose over 50% in 3 years. Almost all of the QICH markers moved in a positive direction. But it is sobering that some of the more important process metrics, such as effective control of blood pressure and cholesterol, improved minimally between 2007 and 2009 (67.0% to 68.6%, and 60.3% to 65.6%, respectively). Effective control of blood sugar actually fell (from 49.4% to 48%).
The message may be that good measurement alone does not create quality. The authors do not state whether these data are publically reported to inspire rapid improvement, particularly in the closed Israeli single-payer insurance market. Whereas they do lament the absence of pay-for-performance, this method has not been proven to meaningfully drive quality improvement in the United States. Perhaps the message is that creating a culture of quality improvement is a long battle, and transparency of reliable and trusted data is but a first step.
Keith T. Kanel, MD
Chief Medical Officer
Pittsburgh Regional Health Initiative
Jewish Healthcare Foundation
Pittsburgh, PA USA
Competing interests
None declared