Quality improvement and practice-based research in neurology using the electronic medical record
Maraganore DM, Frigerio R, Kazmi N, Meyers SL, Sefa M, Walters SA, Silverstein JC. Quality improvement and practice-based research in neurology using the electronic medical record. Neurol Clin Pract. 2015 Oct;5(5):419–429. PMCID: PMC4634157
We describe quality improvement and practice-based research using the electronic medical record (EMR) in a community health system–based department of neurology. Our care transformation initiative targets 10 neurologic disorders (brain tumors, epilepsy, migraine, memory disorders, mild traumatic brain injury, multiple sclerosis, neuropathy, Parkinson disease, restless legs syndrome, and stroke) and brain health (risk assessments and interventions to prevent Alzheimer disease and related disorders in targeted populations). Our informatics methods include building and implementing structured clinical documentation support tools in the EMR; electronic data capture; enrollment, data quality, and descriptive reports; quality improvement projects; clinical decision support tools; subgroup-based adaptive assignments and pragmatic trials; and DNA biobanking. We are sharing EMR tools and deidentified data with other departments toward the creation of a Neurology Practice-Based Research Network. We discuss practical points to assist other clinical practices to make quality improvements and practice-based research in neurology using the EMR a reality.
The American Academy of Neurology (AAN) has proposed quality measures, but they have not been incorporated into electronic medical records (EMRs) by vendors.1,–5 Quality measures documented as unstructured text are not captured discretely, making it difficult to report performance. Neurology is also hampered by a lack of comparative effectiveness research. There are several approved treatments for common neurologic disorders, but it is unknown which are superior in efficacy and tolerability and for which patient subgroups. Traditional clinical trials enroll selected patients, use surrogate measures, follow patients for short periods, and generalize poorly to clinical practice.6,–9 Data captured in the EMR could be used to identify eligible patients, assign treatments, and measure outcomes at the point of care.10
To address these unmet needs, we created a quality improvement and practice-based research initiative in neurology using the EMR. We present a step-by-step description of our quality journey for 10 neurologic disorders (brain tumors, epilepsy, migraine, memory disorders, mild traumatic brain injury [mTBI], multiple sclerosis [MS], neuropathy, Parkinson disease [PD], restless legs syndrome, and stroke) and for brain health (risk assessments and interventions to prevent Alzheimer disease [AD] in targeted populations).