Study: EHRs not able to capture accurate risk, case mix data

Electronic health records (EHR) may not be able to accurately determine case mix, according to a study published January 18 in the American Journal of Managed Care.

EHR problem list-based comorbidity assessment data can be used to detect comorbidities or major comorbidities and Charlson Comorbidity Index (CCI) scores. The study compared EHR problem list-based scores for specific major comorbidities to scores based on data entered in the EHR free-text field. The EHR problem list-based assessment was, in general, inaccurate and not able to capture major comorbidities although specificity was above 94% for all documented comorbidities, the study authors concluded. The EHR problem-list based assessment was able to detect chronic obstructive pulmonary disease in only 42% of records and was able to correctly identify liver disease in only 1%. In contrast, manual review of free-text field data was able to capture more detailed, accurate CCI scores that were also predictive of long-term other-cause mortality.

As reimbursement continues to move from fee-for-service to quality-based and risk-adjusted methodologies, capturing accurate comorbidity and major comorbidity will be increasingly vital. Relying on EHR problem lists to capture risk data may seem like a simple method to save time and resources while improving documentation, but the study authors conclude that case mix data based on EHR problem lists should be validated before it is applied to risk scores.