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Taking Issue   |    
Quality of Medical Information: A Meaty Topic
Samuel G. Siris, M.D.
Psychiatric Services 2009; doi: 10.1176/appi.ps.60.11.1417
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According to federal regulations, there are several quality categories for meat. These include Prime, Choice, and Utility grades. Prime is the best and, not surprisingly, the most expensive. Choice is next—pretty good quality but not as excellent, or as expensive, as Prime. And then there is Utility grade, which is suitable for dog food. (Although dogs generally discriminate keenly as to whether or not they have been fed, beyond that, most don't seem to be particularly fussy.)

Medical information in psychiatry also comes in different quality grades, and it particularly behooves us to be mindful of this fact as the nation contemplates the creation of universally shared computerized medical records. The highest grade of medical information is Research grade. This is the quality of information necessary to produce new knowledge. Research-grade information includes such exacting features as the precise explication of diagnostic criteria and of rating scale reliability measures. The next highest information quality level is Clinical grade. Practitioners require this level to give competent treatment. It incorporates such attributes as diagnostic accuracy; a correct list of medications, dosages, and their starting and stopping dates; and comprehensive assessments of the effects of medications.

A less exacting level of medical information is Administrative grade, which mostly involves data relevant to the financial aspects of care—what is needed for billing purposes and the like. It emphasizes accuracy in regard to such features as the spelling of a patient's name. Notably, although Administrative-grade information is crucial for ensuring payment, much of its precision is focused on domains irrelevant to research or clinical tasks—just as Research- and Clinical-grade information is often not necessary to complete administrative tasks. For example, the requirement of a diagnosis for billing purposes simply means that the item cannot be left blank—diagnostic correctness, while desirable, is seldom necessary.

To stay properly "on task," functional components of a medical organization need to be fed information diets of the appropriate quality grade. This facilitates successful digestion and utilization of the information. When business-oriented leadership controls a health care organization and takes a top-down approach to data management (a not infrequent occurrence these days), there is a serious risk that the system will consider itself satisfied with Administrative-grade information alone. Clinical performance will then be imperiled. Clinical success requires the user-friendly availability of Clinical-grade information at clinical decision points—a pivotal principle to keep in mind as our medical information systems evolve. Otherwise, the prospect of a burgeoning menu of informational "dog food" is unsavory food for thought indeed.

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