Automating the assessment of quality indicators using a clinical data warehouse: a pilot study on door-to-imaging time in stroke management

Assessment of quality and safety indicators (QSIs) remains often based on time-consuming manual Electronic Health Record (EHR) review. As part of a pilot study to examine the feasibility of automating the calculation of French national QSIs using a Clinical Data Warehouse (CDW), we focused on the measure of door-to-imaging time (DTI time) in stroke management, i.e., the time interval between arrival at the hospital and the first stroke diagnostic imaging, through a retrospective observational study of patients hospitalized in the Greater Paris University Hospitals (AP-HP) for an acute stroke in 2022. We automatically computed the DTI time for more than 6,000 medical records in the CDW using a systematic approach and validated this method by matching the results against the manual AP-HP EHR review from the 2022 French national QSI audit. In this Matched population, CDW and manual EHR review methods agreed on estimating overall indicators, but showed discrepancies in the case-by-case analysis, mainly because of human variability both in EHR completion and manual reviewing. Automation looks promising in a context of limited professional resources but requires structured and validated data, interoperability in the case of inter-institutional stays, and validly measurable QSI.