Mandatory vs Optional Fields for PC Quality Metrics in EMRs

Topic: Measuring Impact and Value

To improve documentation of quality metrics a multidisciplinary team of clinicians designed new documentation templates in our electronic medical record (EMR) to capture key palliative care (PC) quality metrics. We sought to determine what proportion of initial inpatient PC consults included quality metric data when the note fields were mandatory versus optional in three southeastern academic hospitals.

 We compared documentation percentages from January-April (mandatory fields) with June-July 2015 (optional fields). There were 1,428 initial consults and 2,636 follow-up visits during the “mandatory period” and 576 and 1,340 during the “optional period.” Documentation rates were 100% when mandatory. During the optional period, the documentation rates were: dyspnea screen, 82%; nausea screen, 73%; offers of spiritual support, 80%; and surrogate name and phone documentation 89% and 80%, respectively. Opioid use was documented in 59% of initial consults when optional; clinicians reported positive opioid use in 45% of consults when mandatory but only 29% when optional. Dyspnea and nausea were “unable to be assessed” in ~30% of mandatory versus ~20% of optional consults. 5% of mandatory phone numbers were invalid entries.

Although the notes were designed with multidisciplinary clinician input to optimize workflow, some objected to the mandatory fields. Making these optional reduced documentation by 11-27%.


  • Zachary Binney
  • Emory Palliative Care Center, Emory University
  • 1518 Clifton Rd
  • Atlanta, GA 30322
  • (404) 803-6877

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