Utilizing the Electronic Health Record to Improve Documentation Adherence With Performance Measures in Outpatient Inflammatory Bowel Disease Care

Abstract

Inflammatory bowel disease (IBD) is a chronic condition leading to significant health, lifestyle, and cost burdens to patients, their families, and society. Several health care organizations, including The Physician Quality Reporting System (PQRS), have created performance measures to aid in establishing evidence-based standards of care in attempts to improve the quality of IBD care, and ultimately health outcomes. When used effectively, the electronic health record (EHR) should improve adherence to, and documentation of, performance measures for outpatient IBD care. The aim of this study was to assess documentation adherence with selected PQRS performance measures at one academic medical center before and after the implementation of an IBD order set, note template, and patient education handout into the EHR. Fifty patient charts were randomly selected from consecutive outpatient IBD visits at our medical center from September 1, 2015 to June 30, 2016, prior to the availability of the EHR improvements. Another 50 patient charts were randomly selected from consecutive outpatient IBD visits at our medical center from September 1, 2016 to June 30, 2017, just after the addition of the EHR improvements. These charts were reviewed to assess documentation adherence with the pertinent PQRS performance measures for outpatient IBD care, which included the following: documentation of influenza and pneumonia vaccination, tobacco screening and cessation education, evaluation of latent tuberculosis and hepatitis B status prior to the initiation of anti–tumor necrosis factor therapy, and bone loss risk assessment. Documentation of administration, refusal, or prior receipt of both the influenza (19.4% before, 59.5% after; P < .05) and pneumonia (9% before, 63.6% after; P < .05) vaccines improved after the addition of the IBD-specific EHR resources. In addition, documentation of tobacco cessation intervention improved from 28.6% to 77.8% (P < .05). During both the pre- and post-intervention chart reviews, compliance with documentation of testing for latent tuberculosis (66.7% before, 100% after) and hepatitis B virus serology (100% before, 100% after) prior to the initiation of anti–tumor necrosis factor therapy and screening for tobacco use (100% before, 100% after) was high during both periods of time. Documentation of patients at risk for bone loss related to steroid use (0% before, 12.5% after) remained low both before and after the EHR improvements. None of these measures met statistical significance. The availability of customizable electronic resources in the EHR improves documentation compliance of PQRS measures for outpatient IBD care.