Family physicians provide nearly 20% of all clinical outpatient visits, translating to 200 million visits in the U.S. annually. Despite widespread adoption of EHRs and federal policies about their support of care quality, we remain far from EHRs making clinical quality reporting a by-product of care.  In a study published in Annals of Family Medicine, researchers from the American Board of Family Medicine, Colorado Permanente Medical Group-Institute for Health Research, OCHIN, and Kaiser Permanente of Washington Health Research Institute report on the Trial of Aggregate Data Exchange for Maintenance of certification and Raising Quality (TRADEMaRQ), a randomized controlled trial, to assess whether quality measure reporting could be made a byproduct of clinical care and quality improvement.

Family physicians were recruited and randomized before choosing improvement activities for continuous certification to test whether seeing quality measures before choosing would modify their choices. A necessary step in this was for their clinic network to regularly share their quality data for loading into physician certification portfolio. The goal was understanding if health systems could routinely report physician quality measures to support improvement. The study found that health systems only used a handful of measures in common and that efforts to automate sharing them was confounded by dozens of measure transmission errors including breaks in data delivery, changes in measures, and measure results that made no sense.  Kaiser Permanente Colorado (KPCO) found 17 different ways that their process was interrupted, failed, or needed revision. These errors often required human intervention and manual repair, preventing fully automated file transfers.  Southeast Texas Medical Association (SETMA) was the only health system to have no identified errors.

Despite continued growth in heath information technology and calls for interoperability, clinical practices are still struggling to produce and use quality measures from their clinical data. There is valid concern, as the researchers note, that although quality reporting is unlikely to disappear, the reliability of what is reported is unclear, meaningfulness is uncertain, and the cost is high.