Development of Quality Indicators for the Correct Use of Electronic Medical Records in Primary Care: Modified Delphi Study

Abstract

Background: When used correctly, electronic medical records (EMRs) can support clinical decision-making, provide information for research, facilitate coordination of care, reduce medical errors, and generate patient health summaries. Studies have reported large differences in the quality of EMR data. Objective: Our study aimed to develop an evidence-based set of electronically extractable quality indicators (QIs) approved by expert consensus to assess the good use of EMRs by general practitioners (GPs) from a medical perspective. Methods: The RAND-modified Delphi method was used in this study. The TRIP and MEDLINE databases were searched, and a selection of recommendations was filtered using the specific, measurable, assignable, realistic, and time-bound principles. The panel comprised 12 GPs and 6 EMR developers. The selected recommendations were transformed into QIs as percentages. Results: A combined list of 20 indicators and 30 recommendations was created from 9 guidelines and 4 review articles. After the consensus round, 20 (100%) indicators and 20 (67%) recommendations were approved by the panel. All 20 recommendations were transformed into QIs. Most (16, 40%) QIs evaluated the completeness and adequacy of the problem list. Conclusions: This study provided a set of 40 EMR-extractable QIs for the correct use of EMRs in primary care. These QIs can be used to map the completeness of EMRs by setting up an audit and feedback system, and to develop specific (computer-based) training for GPs.