EHR problem lists aren't accurate enough for risk adjustment, study suggests

Problem lists held in EHRs often do not accurately reflect a patient's comorbidities, leading researchers to dissuade hospitals from using these lists to determine risk adjustments, according to a study published in The American Journal of Managed Care.

For the study, the researchers compared EHR problem lists and EHR free-text notes of 1,596 men diagnosed with prostate cancer to determine the accuracy of comorbidity information held in the problem lists. All of the men received diagnoses and long-term follow-up care at two Southern California Veterans Affairs Medical Centers between 1998 and 2004.

The researchers determined EHR problem lists had poor sensitivity for detecting comorbidities like cerebrovascular disease, diabetes, congestive heart failure and liver disease, among others. The free-text notes were predictive of other long-term mortality outside of the prostate cancer diagnosis, whereas the EHR problem lists were not.

"Inaccuracies in EHR problem list-based comorbidity data can lead to incorrect determinations of case mix," the study authors concluded. "Such data should be validated prior to application to risk adjustment."

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