In an interview, Nancy Foster, the American Hospital Association's quality and patient safety vice president, explains the problem in capturing, for example, whether a patient received a pneumococcal vaccine:
"It seems that it would be easy. But while pharmacy data is usually captured electronically (the vaccine was provided), nursing notes are often not (the vaccine was given); they're in text. So you have to search through the text...'I gave Mrs. Jones her pneumococcal vaccine today at 3:45,' which is written out in different ways by different nurses. Imagine the difficulty of doing that in medicalese, the way nurses and doctors write things in charts. And there are medical issues."
Here's a synopsis of what's happened.
On January 4, Janet Corrigan, president of the National Quality Forum, received a sharp letter from the AHA's Foster. The NQF has a $10 million annual contract to assure that measures used for EHR and other incentive payments can adapt to an electronic format.
The AHA "strongly supports the move toward automated quality reporting to ease burden and provide real-time information," Foster began.
"To be useable, however, automated quality measurement must be feasible, generate valid and reliable results, and have benefits that outweigh costs," Foster wrote. "Early experience from the hospital field in implementing Stage 1 of meaningful use calls into question whether e-measures will deliver on that promise. NQF has a key role to play in ensuring that they do."
Unfortunately, Foster wrote, these e-specifications never underwent appropriate field or feasibility review. A GAO report subsequently concurred.