Using Electronic Health Record Data to Achieve Quality: How Measuring Quality Reorganizes Care Delivery

• In Event: Emergent Technologies in Biomedicine and Healthcare: Boundaries, Tensions, and Possibilities - I

Abstract

Quality metrics in the healthcare sector have become a key component of ensuring improved health outcomes and care equity. With the emergence of electronic health records and widespread use of information technology in healthcare, measuring healthcare processes and outcomes as a form of accountability has become the primary method for achieving quality. However, definitions of quality and methods of achieving high quality care differs widely between organizations, and what these metrics mean for clinicians and patients remains unclear. This dissertation seeks to understand how quality measurement restructures the organization and delivery of care and to determine how it impacts care equity. As electronic health records, quality, and dashboard systems continue to gain momentum in their clinical utility, it is critical to investigate their implications for inequality. This paper presents theoretical framing and early data from an ongoing dissertation that investigates how quality is defined and measured in our current healthcare landscape. Using qualitative, constructivist grounded theory methodology, this study draws on in-depth interviews and ethnographic observation to examine the intersections and tensions that emerge as electronic quality measurement is implemented in clinical care. Data is currently being collected through a multi-level examination in two hospitals. It seeks to understand how definitions of quality vary between administrators and front-line providers and where potential misalignments occur. Finally, it examines how these metrics are restructuring care practices, and the implications they have for health disparities.

Author

• Rosalie Winslow, University of California, San Francisco