QNOTE

An instrument for measuring the quality of EHR clinical notes

Harry B. Burke, Albert Hoang, Dorothy Becher, Paul Fontelo, Fang Liu, Mark Stephens, Louis N. Pangaro, Laura L. Sessums, Patrick O'Malley, Nancy S. Baxi, Christopher W. Bunt, Vincent F. Capaldi, Julie M. Chen M., Barbara A. Cooper, David A. Djuric, Joshua A. Hodge, Shawn Kane, Charles Magee, Zizette R. Makary, Renee M. Mallory & 4 others Thomas Miller, Adam Saperstein, Jessica Servey, Ronald W. Gimbel

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background and objective: The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole. Materials and methods: Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss k. Results: The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04). Conclusions: We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument.

Original languageEnglish (US)
Pages (from-to)910-916
Number of pages7
JournalJournal of the American Medical Informatics Association
Volume21
Issue number5
DOIs
StatePublished - Jan 1 2014

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Outpatients
Internal Medicine
Type 2 Diabetes Mellitus
Multicenter Studies
Medicine
Physicians

All Science Journal Classification (ASJC) codes

  • Health Informatics

Cite this

Burke, Harry B. ; Hoang, Albert ; Becher, Dorothy ; Fontelo, Paul ; Liu, Fang ; Stephens, Mark ; Pangaro, Louis N. ; Sessums, Laura L. ; O'Malley, Patrick ; Baxi, Nancy S. ; Bunt, Christopher W. ; Capaldi, Vincent F. ; Chen M., Julie M. ; Cooper, Barbara A. ; Djuric, David A. ; Hodge, Joshua A. ; Kane, Shawn ; Magee, Charles ; Makary, Zizette R. ; Mallory, Renee M. ; Miller, Thomas ; Saperstein, Adam ; Servey, Jessica ; Gimbel, Ronald W. / QNOTE : An instrument for measuring the quality of EHR clinical notes. In: Journal of the American Medical Informatics Association. 2014 ; Vol. 21, No. 5. pp. 910-916.
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abstract = "Background and objective: The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole. Materials and methods: Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss k. Results: The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04). Conclusions: We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument.",
author = "Burke, {Harry B.} and Albert Hoang and Dorothy Becher and Paul Fontelo and Fang Liu and Mark Stephens and Pangaro, {Louis N.} and Sessums, {Laura L.} and Patrick O'Malley and Baxi, {Nancy S.} and Bunt, {Christopher W.} and Capaldi, {Vincent F.} and {Chen M.}, {Julie M.} and Cooper, {Barbara A.} and Djuric, {David A.} and Hodge, {Joshua A.} and Shawn Kane and Charles Magee and Makary, {Zizette R.} and Mallory, {Renee M.} and Thomas Miller and Adam Saperstein and Jessica Servey and Gimbel, {Ronald W.}",
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Burke, HB, Hoang, A, Becher, D, Fontelo, P, Liu, F, Stephens, M, Pangaro, LN, Sessums, LL, O'Malley, P, Baxi, NS, Bunt, CW, Capaldi, VF, Chen M., JM, Cooper, BA, Djuric, DA, Hodge, JA, Kane, S, Magee, C, Makary, ZR, Mallory, RM, Miller, T, Saperstein, A, Servey, J & Gimbel, RW 2014, 'QNOTE: An instrument for measuring the quality of EHR clinical notes', Journal of the American Medical Informatics Association, vol. 21, no. 5, pp. 910-916. https://doi.org/10.1136/amiajnl-2013-002321

QNOTE : An instrument for measuring the quality of EHR clinical notes. / Burke, Harry B.; Hoang, Albert; Becher, Dorothy; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N.; Sessums, Laura L.; O'Malley, Patrick; Baxi, Nancy S.; Bunt, Christopher W.; Capaldi, Vincent F.; Chen M., Julie M.; Cooper, Barbara A.; Djuric, David A.; Hodge, Joshua A.; Kane, Shawn; Magee, Charles; Makary, Zizette R.; Mallory, Renee M.; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W.

In: Journal of the American Medical Informatics Association, Vol. 21, No. 5, 01.01.2014, p. 910-916.

Research output: Contribution to journalArticle

TY - JOUR

T1 - QNOTE

T2 - An instrument for measuring the quality of EHR clinical notes

AU - Burke, Harry B.

AU - Hoang, Albert

AU - Becher, Dorothy

AU - Fontelo, Paul

AU - Liu, Fang

AU - Stephens, Mark

AU - Pangaro, Louis N.

AU - Sessums, Laura L.

AU - O'Malley, Patrick

AU - Baxi, Nancy S.

AU - Bunt, Christopher W.

AU - Capaldi, Vincent F.

AU - Chen M., Julie M.

AU - Cooper, Barbara A.

AU - Djuric, David A.

AU - Hodge, Joshua A.

AU - Kane, Shawn

AU - Magee, Charles

AU - Makary, Zizette R.

AU - Mallory, Renee M.

AU - Miller, Thomas

AU - Saperstein, Adam

AU - Servey, Jessica

AU - Gimbel, Ronald W.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background and objective: The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole. Materials and methods: Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss k. Results: The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04). Conclusions: We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument.

AB - Background and objective: The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole. Materials and methods: Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss k. Results: The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04). Conclusions: We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument.

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U2 - 10.1136/amiajnl-2013-002321

DO - 10.1136/amiajnl-2013-002321

M3 - Article

VL - 21

SP - 910

EP - 916

JO - Journal of the American Medical Informatics Association : JAMIA

JF - Journal of the American Medical Informatics Association : JAMIA

SN - 1067-5027

IS - 5

ER -