Rheumatoid Arthritis Electronic Clinical Quality Measures by American College of Rheumatology
An electronic health record (EHR) is a digital version of a patient's paper chart. EHRs are real-time, patient centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient's care.
Electronic clinical quality measures (eCQMs) rely on computer algorithms to extract data from electronic health records (EHRS). On behalf of the American College of Rheumatology (ACR), we sought to develop and test eCQMs for Rheumatoid Arthritis (RA).
A working group developed candidate RA process measures and subsequently assessed face validity through an interdisciplinary panel of health care stakeholders. A public comment period followed. Measures that passed these levels of review were electronically specified using the Quality Data Model, which provides standard nomenclature for data elements (category, datatype, value sets) obtained through an EHR. For each eCQM, 3 clinical sites using different EHR systems tested the scientific feasibility and validity of measures. Measures appropriate for accountability were presented for national endorsement.
Expert panel validity ratings were high for all measures (median 8-9 out of 9). Health system performance on eCQMs was 53.6% for RA disease activity assessment, 69.1% for functional status assessment, 93.1% for disease modifying drug (DMARD) use and 72.8% for tuberculosis screening. Kappa statistics, evaluating whether the eCQM validity captured data obtained from manual EHR chart review demonstrated moderate to substantial agreement.
Four eCQMs for RA have achieved national endorsement and are recommended for use in federal quality reporting programs. Implementation and further refinement of these measures is ongoing in the ACR's registry, the Rheumatology Informatics System for Effectiveness (RISE).