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.