Evaluating the feasibility and utility of translating Choosing Wisely recommendations into e-Measures

Efforts to reduce health care spending have focused on reducing use of low-value services, but relatively few performance measures address overuse of care. In 2012, the American Board of Internal Medicine Foundation's "Choosing Wisely" (CW) campaign identified 45 low-value services that clinicians and patients should avoid. Translating these overuse concepts into performance measures could assist in discouraging the use of these services. We assessed the feasibility and utility of converting these recommendations into e-Measures based on data from electronic health records [EHR]).

We used four criteria to evaluate 45 CW recommendations for e-Measure development: (1) feasibility of extracting needed data from EHR systems meeting Meaningful Use Stage 2 standards; (2) whether the recommendation's terminology was sufficiently specific for translation into an e-Measure; (3) scientific evidence supporting the recommendation; and (4) impact on reducing resource use.

Only six of the 45 CW recommendations were deemed feasible for e-Measure development. Thirty-two recommendations require data elements unlikely to be found in current EHR systems; eight of 45 recommendations do not use sufficiently specific terminology.

Improved capture of clinical information in EHRs and greater specificity of clinical terminology are required to advance these overuse concepts into standardized e-measures.