Primary care practices' abilities and challenges in using electronic health record data for quality improvement

Deborah J. Cohen*, David A. Dorr, Kyle Knierim, C. Annette DuBard, Jennifer R. Hemler, Jennifer D. Hall, Miguel Marino, Leif I. Solberg, K. John McConnell, Len M. Nichols, Donald E. Nease, Samuel T. Edwards, Winfred Y. Wu, Hang Pham-Singer, Abel N. Kho, Robert L. Phillips, Luke V. Rasmussen, F. Daniel Duffy, Bijal A. Balasubramanian

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.

Original languageEnglish (US)
Pages (from-to)635-643
Number of pages9
JournalHealth Affairs
Issue number4
StatePublished - Apr 1 2018

ASJC Scopus subject areas

  • Health Policy


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