Arthritis quality indicators for the Veterans Administration: implications for electronic data collection, storage format, quality assessment, and clinical decision support.

The Veterans Administration (VA) uses information technology and performance measures to improve quality and efficiency. The VA stores all patient data electronically. Manual quality assessment audits are performed every three months. They are time consuming and expensive. Automated reviews would be more efficient. But the patient records are neither sufficiently coded nor structured to allow for full machine interpretability. Evidence-based rheumatology quality indicators have been proposed for inclusion in the quality data set. Automated reviews for some conditions would be possible with modification to some VA electronic data entry screens and to the underlying data repository. This effort would risk the imposition of untenable data entry and workflow burdens upon clinicians. This paper outlines some specific considerations for one disease, rheumatoid arthritis.

Usability of a computer-assisted interview system for the unaided self-entry of patient data in an urban rheumatology clinic.

OBJECTIVE: This study quantified the ease of use for patients and providers of a microcomputer-based, computer-assisted interview (CAI) system for the serial collection of the American College of Rheumatology Patient Assessment (ACRPA) questionnaire in routine outpatient clinical care in an urban rheumatology clinic. DESIGN: A cross-sectional survey was used. MEASUREMENTS: The answers of 93 respondents to a computer use questionnaire mailed to the 130 participants of a previous validation study of the CAI system were analyzed. For a 30-month period, the percentage of patient visits during which complete ACRPA questionnaire data were obtained with the system was determined. RESULTS: The computer system provided cost and labor savings in the collection of 2,476 questionnaires for 2,964 patients visits over 30 months for a capture rate of 83.5%. In the last 12 of those months, 1,035 questionnaires were collected for 1,062 patient visits (97.5% capture). There were no missing data. The prestudy capture rate was 13.5%, with 33% of surveys having complete data. Patients rated the overall usability of the system as good (mean = 1.34, standard deviation = 0.61) on a scale of 0-2, where 2 = good, but expressed difficulty with mouse manipulation and concerns about the privacy of the data entry environment. CONCLUSION The system proved easy to use and cost-effective for the (mostly) unaided self-entry of self-report data for each patient for each visit in routine outpatient clinical care in an urban rheumatology clinic.