The EMR-scan: assessing the quality of Electronic Medical Records in general practice.

Verheij, R., Jabaaij, L., Njoo, K., Hoogen, H. van den, Bakker, D. de. The EMR-scan: assessing the quality of Electronic Medical Records in general practice. Journal of Medical Internet Research: 2008, 10(3), p. 46-47. Abstract. Published as Multimedia Appendix in: Eysenbach G. Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness.
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Background: The use of electronic medical records (EMR) in general practice has spread rapidly in the last decade (more than 90% today). Traditionally, these records are primarily used for direct patient care and for administrative purposes by the practice involved. In recent years, further technical developments have made it possible to exchange EMRs or summaries of EMRs between health care providers. In the UK a 'spine' will provide summary information to other health care providers, to assist with diagnosis and care [1]. In the Netherlands a national health care information hub is being implemented, with the same objective [2]. In addition, routine primary care EMRs are increasingly used for public health monitoring in some countries [3]. The use of EMRs for the health care inspectorate are currently being considered and making EMRs accessible for individual patients is desired by many. In sum, theoretically, primary care EMRs can be used for many purposes. However, there is one condition that has to be fulfilled to make EMRs useful for all these purposes: it has to be certain that EMRs provide a true picture of the health status and treatment of all patients involved. Quality of record keeping is the key issue. Objective: To be able to assess the quality of recording by general practices in the Netherlands, we developed and tested the EMR-scan. Methods: The first step in doing this was to identify the most important items that have to be adequately recorded. This was done on the basis of guidelines issued by the Dutch College of General Practitioners [4], concerning the minimum dataset that has to be available at the out-of-hours service (e.g. current medication, clinical notes of last contacts, allergies). The second step was developing meaningful indicators on these items, without mixing up quality of treatment and case mix characteristics with quality of recording routines. This resulted in a set of indicators and data requirements. Examples of indicators are: % of contacts with diagnosis recorded; % patients with recorded allergies. Finally, indicators were tested on EMRs of 112,315 patients in 32 general practices (the third step). Results: Benchmark analysis on data from these 32 practices was performed. Controlling for demographic composition of practice populations, the performance of all practices on each separate indicator was plotted in order to assess the amount of between practice variation and to determine the reference value (benchmark). Reference values were generally defined as the average of the 32 practices analysed. Practices with unexplainable large deviations from this average were regarded as bad recorders. Conclusions: Given the increasing use of primary care EMRs for multiple purposes, there is a great need for an instrument to assess the quality of recording routines. The EMR-scan provides this instrument. The EMR-scan has been developed in order to improve recording routines of general practitioners and allied personnel. It can be applied by anyone who has access to the necessary data. It offers benchmark opportunities for groups of practices; a tool to evaluate differences between software systems; and a tool to evaluate the effects of education in recording routines. (aut. ref.)