Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults
The documentation rates for 11 adult preventative care services were evaluated using electronic health record (EHR) agreement data and Medicaid claims data. The goal of this study was to measure the patient-level agreement for documentation of each adult preventative care service across the EHRs and Medicaid at Oregon Community Health Centers (CHCs). 
EHR data was obtained from OCHIN’s EHR data repository for 43 Oregon CHCs and Medicaid enrollment and claims data was obtained for all Oregon Medicaid recipients in 2011.The OCHIN EHR data contained information from the electronic medical record that included demographic, utilization and clinical data. Information was extracted from the EHR with the help of automated queries of structured data.The enrollment data focused on patients between the ages of 19 to 64 who were covered by Medicaid throughout 2011. The study included 13,101 patients who were Medicaid recipients that had data in both the OCHIN EHR and Medicaid data.
The evaluation found Medicaid data documented a greater number of services than EHR data, specifically: cervical and breast cancer screening, colonoscopy, chlamydia screening, and cholesterol screening. EHR data identified more patients with documented services than Medicaid claims data did for the following services: total colorectal cancer screening, FOBT, influenza vaccine, BMI, and smoking assessment.
The study found that EHR data and Medicaid data were comparable. Of the 11 adult preventative care services that were reviewed, the services that were performed in a primary care setting were more likely to be found in EHR data and services that were referred were least likely to be found in the EHR data.
EHR data paired with Medicaid data provides the most comprehensive view of a quality reporting documentation, however, it is not a long-term solution, so EHRs (alone) can provide data that can lead to improved quality of care reporting. In order to improve the EHR data quality and datasets, methods such as standardization and electronic data exchanges should be employed.
The finding that the best short-term method for quality reporting documentation was a hybrid between EHR and Medicaid data was interesting. If the goal is to truly evaluate preventative care, by including only Medicaid recipients’ data, a large portion of the population’s health data is excluded from the study. The focus on one sector of the population may likely skew results. I am glad the authors concluded that the best method in obtaining quality healthcare data for preventative care was from EHRs solely, albeit these EHRs need to employ additional strategies to accomplish this.
[https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/basics.html Medicare and Medicaid EHR Incentive Program Basics e]
- Heintzman 2014. Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/?term=Agreement+of+Medicaid+claims+and+electronic+health+records+for+assessing+preventive+care+quality+among+adults