Assessing the completeness of periodontal disease documentation in the EHR: a first step in measuring the quality of care

Joanna Mullins,Aram Kim,Emily Sedlock,Alfa Yansane,Suhasini Bangar,Ana Neumann,Joel M White,Todd R Johnson,Shwetha V Kumar,Muhammad F Walji,Krishna Kumar Kookal,Elizabeth Mertz,Gregory W Olson,Elsbeth Kalenderian,Ryan Brandon,Kristen Simmons

doi:10.1186/s12903-021-01633-w

Abstract

BackgroundOur objective was to measure the proportion of patients for which comprehensive periodontal charting, periodontal disease risk factors (diabetes status, tobacco use, and oral home care compliance), and periodontal diagnoses were documented in the electronic health record (EHR). We developed an EHR-based quality measure to assess how well four dental institutions documented periodontal disease-related information. An automated database script was developed and implemented in the EHR at each institution. The measure was validated by comparing the findings from the measure with a manual review of charts.ResultsThe overall measure scores varied significantly across the four institutions (institution 1 = 20.47%, institution 2 = 0.97%, institution 3 = 22.27% institution 4 = 99.49%, p-value < 0.0001). The largest gaps in documentation were related to periodontal diagnoses and capturing oral homecare compliance. A random sample of 1224 charts were manually reviewed and showed excellent validity when compared with the data generated from the EHR-based measure (Sensitivity, Specificity, PPV, and NPV > 80%).ConclusionOur results demonstrate the feasibility of developing automated data extraction scripts using structured data from EHRs, and successfully implementing these to identify and measure the periodontal documentation completeness within and across different dental institutions.

Highlights

Modern-day healthcare places an increased emphasis on quality improvement to achieve better patient outcomes [1, 2]
Our objective was to measure the proportion of patients for which a comprehensive periodontal charting, periodontal disease risk factors [22, 30,31,32], and periodontal diagnoses were documented in the Electronic Health Record (EHR)
The validity of the measure score was established using standard diagnostics (sensitivity, specificity, positive predicted value (PPV), and negative predictive value (NPV)). 205 charts were manually reviewed at Institution 1, 323 charts at institution 2, 312 charts at institution 3, and 384 charts at institution 4

Summary

Introduction

Modern-day healthcare places an increased emphasis on quality improvement to achieve better patient outcomes [1, 2]. Mullins et al BMC Oral Health (2021) 21:282 harnessing Electronic Health Record (EHR) data to identify and report quality measures in dentistry [8, 9]. The passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act aimed to encourage adopting and promoting of "meaningful use" of EHRs and has paved the way to developing EHR-based quality measures [10], including dentistry [11]. Our objective was to measure the proportion of patients for which comprehensive periodontal charting, periodontal disease risk factors (diabetes status, tobacco use, and oral home care compliance), and periodontal diagnoses were documented in the electronic health record (EHR). We developed an EHR-based quality measure to assess how well four dental institutions documented periodontal disease-related information. The measure was validated by comparing the findings from the measure with a manual review of charts

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Discussion

Conclusion