Availability and Quality of Electronic Health Record Data to Track Physical Function Across a Care Transition.

Introduction: Physical function (PF) is critical to quality of life and healthcare value, especially for older adults following hospitalization. Monitoring PF supports recovery, reduces adverse events, and improves care transitions. Despite the potential of electronic health records (EHRs) enabling systematic PF tracking, such data are rarely captured consistently. Here we examine the availability of PF-related data in EHRs for patients transitioning from hospital to homecare in a large health system, highlighting challenges and offering recommendations. Methods: We assessed availability of elements previously identified important to PF measurement from a single healthcare system. Working with Johns Hopkins Health System informatics and homecare leaders, we determined which recommended elements were captured in the EHR and which were feasible to extract within our resource constraints. We then requested an extraction of a refined data set for adult patients with a hospital admission between July 2016 and March 2021. After validation, data were securely transferred to University of Utah Health. Results: Data from 21 702 patients were included. Of 27 desired elements, 17 were available and successfully extracted. Individual elements were marked "present" if documented at least once during admission, or "missing" if absent. Administrative data had low missingness, although missingness for assessments of cognition and mobility performance in hospital was over 65%, and assessments of PF capacity in home health were missing in over 80% of patients. However, 81.7% of those receiving home health rehabilitation had the expected mobility measure. Overall, 73% of patients had at least 75% of the extracted data elements. Conclusions: Assembling a comprehensive view of PF across a care transition using EHR data proved highly challenging. Our recommendations address data element identification, generation and storage; data extraction, cleaning, and validation; interoperability across care settings; adequate resources to manage complex data; and prospective infrastructure development.