Qual Saf Health Care 14:99-106 doi:10.1136/qshc.2004.011049
  • Original Article

Pursuing integration of performance measures into electronic medical records: beta-adrenergic receptor antagonist medications

  1. M Weiner1,2,3,
  2. T E Stump1,2,
  3. C M Callahan1,2,3,
  4. J N Lewis4,
  5. C J McDonald2,3
  1. 1Indiana University Center for Aging Research, Indianapolis, Indiana, USA
  2. 2Regenstrief Institute Inc, Indianapolis, Indiana, USA
  3. 3Department of Medicine, Indiana University, Indianapolis, Indiana, USA
  4. 4Health Care Excel Inc, Medicare Quality Improvement Organization, Indianapolis, Indiana, USA
  1. Correspondence to:
 Dr M Weiner
 Indiana University Center for Aging Research, Regenstrief Institute Inc, 1050 Wishard Blvd, Indianapolis, Indiana 46202-2872, USA;
  • Accepted 25 November 2004


Objective: Electronic medical records seldom integrate performance indicators into daily operations. Assessing quality indicators traditionally requires resource intensive chart reviews of small samples. We sought to use an electronic medical record to assess use of β-adrenergic antagonist medications (β-blockers) following myocardial infarction, to compare a standardized manual assessment with assessment using electronic medical records, and to discuss potential for future integration of performance indicators into electronic records.

Design: Cross-sectional data analysis.

Setting: An urban academic medical center.

Participants: US Medicare beneficiaries 65 years of age or older, admitted to hospital with myocardial infarction between 1995 and 1999.

Measurements and main results: Manual chart review was compared with a computer driven assessment of electronic records. Administration of β-blockers and cases excluded from use of β-blockers were measured, based on Medicare criteria. Among 4490 older adults, 391 (4%) of 9018 hospital admissions contained codes for myocardial infarction. In 323 (83%) of the 391 hospital admissions, criteria for excluding β-blockers were met; 235 (60%) were excluded due to heart failure. Of 68 hospital admissions for myocardial infarction that did not meet exclusion criteria, physicians prescribed β-blockers in 49 (72%) on admission and 42 (62%) at discharge. Compared with manual chart review, electronic review had a sensitivity of 83–100% and led to fewer false negative findings.

Conclusions: An electronic medical records system can be used instead of chart review to measure use of β-blockers after myocardial infarction. This should lead to integration of real time automated performance measurement into electronic medical records.


  • This work has been supported by Regenstrief Institute Inc, Health Care Excel Inc, and Centers for Medicare and Medicaid Services. Dr Weiner is supported by grant number 5K23AG020088-02 from the National Institute on Aging (US). Dr Callahan is supported by NIA grant number AG 00868.

  • The authors have no conflicts of interest in this work.

  • The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.