Improving the quality of morbidity indicators in electronic health records in Swiss primary care

A Busato,R Tandjung,M Zoller,C Chmiel,O Senn,H Bhend,T Rosemann

doi:10.4414/smw.2012.13611

Abstract

The FIRE Project established a standardised data collection to facilitate research and quality improvement projects in Swiss primary care. The project is based on the concept of merging clinical and administrative data. Since chronic conditions and multimorbidity are major challenges in primary care, in this study we investigated the agreement between different approaches to identify patients with chronic and multimorbid conditions in electronic medical records (EMRs). A total of 60 primary care physicians were included and data were collected between October 2008 and June 2011. In total, data from 509594 consultations derived from 98152 patients were analysed. Chronic and multimorbid conditions were identified either by ICPC-2 codes or by the type of prescribed medication. We compared these different approaches regarding the completeness of the data to describe chronic conditions and multimorbidity of patients in primary care practices. The data showed a high correlation between the two morbidity schemes and both indicators apparently provide reliable measures of morbidity within practices. There was considerable variability of patients with chronic conditions across practices, irrespective of whether ICPC-2-diagnoses or prescribed drugs were used to code clinical encounters. Obvious discrepancies between diagnoses and therapies across major disease categories existed. This study describes the current situation of EMRs in terms of the ability to measure the burden of chronic conditions in primary care practices. The results illustrate a need of action for this specific topic and the results of this study will be incorporated into the functional specification of EMRs of a planned eHealth project in Swiss primary care.

Highlights

In an earlier paper we described the FIRE Project, a data repository in the setting of Swiss primary care, and documented the implementation of a framework to collect data from electronic medical records (EMR) from individual practices [1]
The results illustrate a need of action for this specific topic and the results of this study will be incorporated into the functional specification of EMRs of a planned eHealth project in Swiss primary care
Chronic conditions were diagnosed in 31.7% and 46.1% of all consultations based on ICPC-2 and pharmaceutical cost groups (PCG) respectively

Summary

Introduction

In an earlier paper we described the FIRE Project, a data repository in the setting of Swiss primary care, and documented the implementation of a framework to collect data from electronic medical records (EMR) from individual practices [1]. There is a broad consensus that valid and reliable data are indispensable for quality initiatives, health services research and health policy decisions; such data, especially from primary care settings are lacking in most countries. Merging data in the EMR recorded for administrative purposes with clinical data gathered during patient encounters may provide an efficient way to build up a knowledge base regardless of whetherit will be used for quality issues, for example by calculating quality indicators, or for research purposes. We compared the agreement between different approaches to identify patients with chronic and mul-

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