Health Record Systems Facilitators and health IT experts often found verifiable problems in clinical quality reports. For example, a represen- tative of cooperative 6 told us in an interview: “Doctors always look at our data and say it’s not [correct]…. Unless you put [information] in the exact spot, it doesn’t pull it [for the electronic clinical quality measures]…. They didn’t hit the little cog-radio button. It takes [you] to a tem- plate that you have to complete. In order to pull the data it has to be on there.” It was common for there to be specific locations (for example, checkboxes) where struc- tured data elements had to be recorded to be counted in a calculation of electronic clinical quality measures. The combination of vendor- standardized documentation requirements for themeasures, lack of alignment of these require- ments with clinical workflows, and clinical teams’ lack of awareness of documentation rules and the consequences of recording patterns on quality measurement led to many examples of unreliable reports of the measures. Challenges Developing Regional Data
Infrastructure For Quality Improvement Cooperatives that used data warehouses, hubs, or health information exchanges in their regions