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Editor's Correspondence
May 14, 2007

Beware the Burden of Measurement—Reply

Arch Intern Med. 2007;167(9):972. doi:10.1001/archinte.167.9.972

In reply

We agree with Sinsky that clinicians should not be burdened with documenting clinical information solely for the purpose of quality measurement for external reporting. However, collecting standardized data in electronic health records (EHRs) can also be used to improve quality and safety within a practice. Clear examples are computerized clinical decision support for drug-allergy, drug-drug, or drug-condition interactions. In addition, better structured data will improve physician alerts and feedback indicating when important quality goals are not met for preventive services and therapies for patients with chronic disease, such as coronary heart disease. Better decision support becomes possible with better data. Unstructured data cannot be used for practice-wide assessment and improvement. Which of the 5000 patients does not have up-to-date breast, colon, or cervical cancer screening? Who has medical reasons for which the test is not indicated? If the answers to these questions are stored as standardized data rather than being lost in a sea of free text, a practice can systematically notify patients who may benefit from a service and avoid those who have already received it or have a medical reason not to do it.

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