JMIR Publications

ABSTRACT

Background:

Routine collection of disease activity (DA) and patient reported outcomes (PROs) in rheumatoid arthritis (RA) are critical components of a treat-to-target approach. However, little is known about the role electronic health record (EHR) systems play in facilitating their collection.

Objective:

Using the ACR’s RISE registry, we analyzed the relationship between EHR system and performance on DA and functional status (FS) quality measures.

Methods:

We analyzed data collected in 2018 from practices enrolled in RISE. We assessed practice-level performance on quality measures that require DA and FS documentation. Multivariable linear regression and zero-inflated negative binomial models were used to examine the independent effect of EHR system on practice-level quality measure performance, adjusting for practice characteristics and patient case-mix.

Results:

220 included practices cared for 314,793 RA patients. NextGen was the most commonly used EHR system (34.1%). We found wide variation in performance on DA and FS quality measures by EHR system (median (IQR) 30.1 (0, 74.8) and 9.0 (0, 74.2), respectively). Even after adjustment, NextGen practices performed significantly better than eMDs or Allscripts on the DA measure (55.5% vs. 28.2% and 5.2%, p<0.05) and significantly better than eClinicalWorks or eMDs on the FS measure (49.5% vs. 26.0% and 8.1%, p<0.05).

Conclusions:

Performance on national RA quality measures was associated with EHR system, even after adjusting for practice and patient characteristics. These findings suggest that future efforts to improve quality of care in RA should focus not only on provider performance reporting, but also on developing and implementing rheumatology-specific standards across EHRs.