Evaluating the feasibility and utility of translating Choosing Wisely recommendations into e-Measures Kanaka D. Shetty a , Daniella Meeker a,b,1 , Eric C. Schneider c,1 , Peter S. Hussey d,1 , Cheryl L. Damberg a,n a RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA b University of Southern California, Los Angeles, CA 90033, USA c The Commonwealth Fund, New York, NY, 10021, USA d RAND Corporation, Boston, MA, USA article info Article history: Received 6 April 2014 Received in revised form 8 November 2014 Accepted 16 December 2014 Available online 31 January 2015 Keywords: Overuse measures Efficiency measures e-Measures Choosing Wisely Health information technology abstract Background: 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]). Materials and methods: 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. Results: 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. Conclusions: Improved capture of clinical information in EHRs and greater specificity of clinical terminology are required to advance these overuse concepts into standardized e-measures. & 2015 Elsevier Inc. All rights reserved. 1. Introduction Hundreds of billions of dollars may be spent on services with little clinical benefit. 1,2 To address this problem, efforts to identify and encourage physicians to reduce the use of low-value services are beginning to emerge. 3–5 Professional practice recommenda- tions, performance measures, and clinical decision support tools are various approaches being considered to discourage the deliv- ery of overused services, such as imaging in non-specific lower back pain. 5–7 Prior experience with professional practice guideline generation has revealed that expert consensus is just one step in the difficult process of changing clinical practice. 8 Converting professional practice recommendations into performance mea- sures that are tied to audit and feedback, public reporting, or financial incentives may be an effective complement to profes- sional practice guidelines for discouraging the use of low-value services. 3,9 However, the development and deployment of overuse measures have faced a number of challenges, most notably that their construction often depends on complex clinical information, including patient behaviors and physical exam findings, to define circumstances under which some commonly overused procedures might have substantial value. 10 Although a variety of organizations including the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) seek to advance the development and use of measures of overuse con- structed using EHR data, 12 few valid, evidence-based measures of overuse of services have been developed. e-Measures—perfor- mance measures specified using data from electronic health record [EHR] systems—may facilitate measurement of overuse of services because of the potential for capturing detailed clinical information during the patient encounter which could be used to construct Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/hjdsi Healthcare http://dx.doi.org/10.1016/j.hjdsi.2014.12.002 2213-0764/& 2015 Elsevier Inc. All rights reserved. n Corresponding author. Tel.: þ1 310 393 0411; fax: þ1 310 451 7085. E-mail address: damberg@rand.org (C.L. Damberg). 1 Tel.: þ1 310 393 0411. Healthcare 3 (2015) 24–37