Evaluating the Feasibility and Utility of Translating Choosing Wisely Recommendations Into E-Measures

Published in: Healthcare: the Journal of Delivery Science and Innovation, v. 3, no. 1, Mar. 2015, p. 24-37

Posted on RAND.org on February 10, 2015

by Kanaka Shetty, Daniella Meeker, Eric C. Schneider, Peter S. Hussey, Cheryl L. Damberg

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Research Question

  1. Can low-value services identified by the Choosing Wisely Campaign be translated into performance measures based on the electronic health record?

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.

Key Findings

  • Only six of the forty-five Choosing Wisely recommendations could be translated into e-Measures.
  • Thirty-two recommendations required data elements not usually found in the current EHR systems.
  • Eight did not use sufficiently precise terminology.


Translating these overuse concepts into e-measures will require better EHRs and more specific clinical terminology.

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