Health IT at the Agency for Healthcare Research & Quality ...s3.amazonaws.com/rdcms-himss/files/production/public/2015... · Health IT at the Agency for Healthcare Research & Quality

Health IT at the Agency for Healthcare Research & Quality

(AHRQ) April 14, 2015

Teresa Zayas Cabán, PhD/Chief, Health IT Research/AHRQ

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest

Teresa Zayas Cabán, PhD

Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Learning Objectives

• Describe AHRQ funded project and initiatives relevant to conference topics

• Synthesize findings from these projects

• Identify emerging health IT research opportunities

Today’s Agenda

• About AHRQ

• About Health IT at AHRQ

• AHRQ’s Role in Health IT and Approaches Used

• Selected Projects

• Knowledge Gained and Funding Priorities

Today’s Agenda

• About AHRQ





HHS Organizational Focus

Biomedical research

to prevent, diagnose,

and treat disease

Population health and

the role of

community-based

interventions to

improve health

Long-term and system-

wide improvement of

health care quality and

effectiveness

CDC NIH AHRQ

AHRQ’s Mission

To produce evidence to make health care

safer, higher quality, more accessible,

equitable, and affordable, and work within the

U.S. Department of Health and Human

Services and with other partners to make sure

that the evidence is understood and used.

Today’s Agenda

• About AHRQ





Health IT at HHS

ONC

Coordinating Health

IT Policy and

Programs

AHRQ CMS

Setting Rules for

Payment

Building Evidence

of Health IT Impact

on Health Care

Quality and Safety

AHRQ Health IT Funding

• Projects awarded to over 178 distinct institutions in 46 States and the District of Columbia

• FY15 Budget: $28M

AHRQ Health IT

Investment:

$450 million

Today’s Agenda

• About AHRQ


• AHRQ’s Role in Health IT and Approaches

Used



AHRQ’s Role in Health IT

• Demonstrate effectiveness of new health IT solutions

• Evaluate impact of health IT on quality and safety

• Work to ensure evidence is understood and used

Approaches to Reach Goals

•Research grants and contracts

•Partnering with other Federal agencies

•Sharing findings and lessons learned






• Research grants – Requests for applications

– Program announcements

– Small (R03, R21) and larger (R01, R18) grant projects

• Research contracts – Demonstration projects

– Rapid cycle, field-based research

– Systematic reviews of the literature

– Workshops/research agenda setting





A Robust Health Data Infrastructure

• Discusses technical challenges in the U.S. health IT system

• Proposes a future state for a health IT architecture

• Includes recommendations to develop national vision for an effective and efficient interoperable health IT “ecosystem”

http://healthit.ahrq.gov/RobustHealthDataInfrastructureReport







For more information: http://healthit.ahrq.gov/events

National Health IT Teleconferences

• Six to eight teleconferences per year

• Various topics related to health IT and quality

• 100–500 participants/ teleconference

Upcoming:

Web Conference on

Assessing Patient Health

Information Needs

Thursday, May 7, 2015

1:30 - 3:00 p.m. ET

http://healthit.ahrq.gov/events

United States Health Information Knowledgebase (USHIK)

http://ushik.ahrq.gov

http://ushik.ahrq.gov/

Children’s EHR Format

www.healthit.ahrq.gov/childehrformat

http://www.healthit.ahrq.gov/childehrformat

Today’s Agenda

• About AHRQ





Selected Projects

HIMSS 2015 Topics

Improving Outcomes

• Quality and Safety

Specific Health IT Applications or

Systems

• Consumer Health IT

• Electronic Health Records (EHRs)

• Health Information Exchange (HIE)

Health IT Design, Implementation,

and Use Issues

• Human Factors, Usability & Design

• IT Standards and Interoperability

• Process Improvement, Workflow,

Change Management/Clinician

Engagement

• Meaningful Use

Quality Improvement Activities

• Patient Engagement

• Quality Measurement

• Transitions of Care: Coordination

and Management

Sample Projects HIMSS 2015 Topics

Improving Outcomes



Systems





and Use Issues





Engagement

• Meaningful Use





and Management

Selected Projects

Computerized Provider Order Entry Reduces Medication Errors in Hospitals

• Estimates effect of computerized provider order entry (CPOE) systems on medication errors

• Processing a prescription order through a CPOE system decreases the likelihood of error by 48 percent

• Approximately 17.4 million medication errors may be averted in one year in the United States by using CPOE, a 12.5 percent reduction

http://jamia.bmj.com/content/early/2013/01/27/amiajnl-2012-001241.full







E-Prescribing Systems Linked to Formulary Data Reduces Costs

• Doctors using e-prescribing with formulary decision support increased their use of generic prescriptions by 3.3 percent

• E-prescribing with formulary can save $845,000 per 100,000 patients per year

Available at:

http://archinte.jamanetwork.com/

article.aspx?articleid=773454

http://archinte.jamanetwork.com/article.aspx?articleid=773454





Tele-Consultation To Improve Access to Care in Rural Areas

• Developed capacity to treat chronic, common, complex diseases in rural, underserved areas

• Links community-based medical teams with university-based specialists

• Proven to be an effective way to treat hepatitis C virus infection in underserved communities

Evidence Report on Effectiveness of Clinical Decision Support and

Knowledge Management

• CDS improves health care process measures

• Successful implementation features named

• Clinical decision support impact on clinical and economic outcomes remains limited

Available at:

www.ahrq.gov/research/findings/evidence-

based-reports/services/health-it/index.html

http://www.ahrq.gov/research/findings/evidence-based-reports/services/health-it/index.html







Selected Projects

HIMSS 2015 Topics

Improving Outcomes



Systems





and Use Issues





Engagement

• Meaningful Use





and Management

Consumer Health IT

www.nap.edu/catalog.php?record_id=13149

Barriers and Drivers of Health IT Use for the

Elderly, Chronically Ill, and Underserved

http://www.ncbi.nlm.nih.gov/books/NBK38653/

http://www.nap.edu/catalog.php?record_id=13149



State and Regional Demonstrations of Health Information Exchange

• Building community trust

• Technical considerations

• Project planning and management

• Implementation

• Demonstrating Value

• Sustainability

http://healthit.ahrq.gov/stateandregionalhie



Guide to Evaluating HIE Projects

http://healthit.ahrq.gov/hieevaluationguide



Early, Foundational Work on CDS

Demonstration Videos

http://healthit.ahrq.gov/CDSCVideo

http://healthit.ahrq.gov/GLIDESVideo

http://healthit.ahrq.gov/CDSDemonstrationsReport

Demonstration Project Synthesis Report











Selected Projects

HIMSS 2015 Topics

Improving Outcomes



Systems





and Use Issues





Engagement

• Meaningful Use





and Management

Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT

• Objectives:

– Improve design of consumer health IT products

– Impact level of use

• Data collection methods:

– Environmental scan and grey literature review

– Key informant interviews

• Product: Designing Consumer Health IT: A Guide for Developers and Systems Designers

– Ten recommendations for designers, developers, and vendors of consumer health IT applications

http://healthit.ahrq.gov/developmentmethodsguide

http://healthit.ahrq.gov/developmentmethodsguide

Consumer Health IT in the Home: Design Considerations

• AHRQ-funded guide published

by National Research Council

– Rapid growth of home health

care has raised many issues

– Guide provides human factors

design considerations in health

IT applications

– Helps designers and developers

understand realities and complex

nature of managing health at

home

www.nap.edu/catalog.php?record_id=13205

http://www.nap.edu/catalog.php?record_id=13205

Basic Health IT Research

• Need to better understand – Clinical work and how it’s done

• Understanding Clinical Information Needs and Health Care Decision Making Processes in the Context of Health Information Technology (IT) (R01) (PA-11-198) - http://grants.nih.gov/grants/guide/pa-files/PA-11-198.html

– How individuals and families manage health information

• Understanding User Needs and Context to Inform Consumer Health Information Technology (IT) Design (R01) (PA-11-199)

– http://grants.nih.gov/grants/guide/pa-files/PA-11-199.html

http://grants.nih.gov/grants/guide/pa-files/PA-11-198.html
















Improving the Safety of Health IT: Health IT Hazard Manager

http://healthit.ahrq.gov/HealthITHazardManagerFinalReport



IT Standards and Interoperability

• Medicare Modernization Act

– E-prescribing (eRx) Pilots

– Administrated by AHRQ & CMS

• Test eRx systems of data standards for how efficiently and effectively eRx information can be transmitted to and from providers and pharmacies

• Initial standards + 3 eRx foundation standards

http://healthit.ahrq.gov/erxpilots



Electronic Prescribing of Controlled Substances

• Developed electronic system to create and securely transmit prescriptions for controlled substances

• Participants reported that the system improved workflow and efficiency

For more information:

http://healthit.ahrq.gov/CarrowSuccess

Story.pdf

Project Video:

http://healthit.ahrq.gov/AHRQHealthIT

SuccessStoriesCarrowVideo

http://healthit.ahrq.gov/CarrowSuccessStory.pdf



http://healthit.ahrq.gov/AHRQHealthITSuccessStoriesCarrowVideo




Using Health IT in Workflow Redesign: Impact of Health IT on Workflow

• Request for task order to

– Study implementation of health IT to support practice redesign in ambulatory care settings

– Further understand causal relationships between health IT and workflow processes

• Three task orders with different foci – Health IT-supported diabetes care coordination program

– Different redesign efforts, focus on interruptions and exceptions

– Capture and use of patient reported health information via health IT

• Results expected late spring/early summer and Web conference being planned

Workflow Assessment for Health IT Toolkit

http://healthit.ahrq.gov/workflow



Evaluation of Stage 3 Meaningful Use (MU) Objectives

• Awarded 12 grants and contracts

– Rapid cycle evaluations of implementation of Stage 3 MU proposed objectives

• Evaluations were to yield

– Proposed strategies for improving the objectives at the policy level

– Proposed EHR innovations that would better enable providers to meet the proposed objectives

– Suggestions for hospitals and/or ambulatory practices on how to increase the value to them of MU objectives

http://healthit.ahrq.gov/ahrq-funded-projects/evaluation-of-meaningful-use













Selected Projects

HIMSS 2015 Topics

Improving Outcomes



Systems





and Use Issues





Engagement

• Meaningful Use





and Management

Enabling Patient-Centered Care Through Health IT Grant Initiative

• Developed and tested approaches to delivering patient-centered care in

• Providing access to medical information

• Supporting patient-clinician communication

• Patient self-management

• Shared decisionmaking

• Highlighted barriers and facilitators to the use of health IT to deliver patient-centered care

• Found positive impact on outcomes for health IT applications that support patient-centered care

http://healthit.ahrq.gov/asqpccreport


My Wellness Portal Enhances Patient-Centered Preventive Care


http://healthit.ahrq.gov/MoldSuccess

Story2013.pdf

Project Video:

http://healthit.ahrq.gov/AHRQHealthIT

SuccessStoriesMoldVideo

• Personal health

record (PHR) to

support preventive

service management

• 84 percent of adults

and 95 percent of

children received all

recommended

preventive services

http://healthit.ahrq.gov/MoldSuccess Story2013.pdf



http://healthit.ahrq.gov/AHRQHealthITSuccessStoriesMoldVideo




Enabling Quality Measurement Through Health IT Grant Initiative

• Projects integrated patient safety and quality measurement with health IT

– Measure development across episodes of care

– Clinical data needs for quality measurement export and reporting

– Reporting of quality data for improvement

http://healthit.ahrq.gov/asqeqmreport



Health IT-Enabled Quality Measurement

• Identified:

– strategies,

– a health services infrastructure, and

– research issues

related to health IT- enabled quality measures

http://healthit.ahrq.gov/HealthITEnabledQualityMeasurement

http://healthit.ahrq.gov/ahrq-funded-projects/health-it-enabled-quality-measurement

http://healthit.ahrq.gov/ahrq-funded-projects/health-it-enabled-quality-measurement



Electronically-Mediated Care Coordination

• Research grants and contracts

– At different scales

• Focus: – Specifically focused on

care coordination

– Care coordination included

• Topics Explored – Processes of care

– Integrating care and services

– Transitions in care

– Measurement

Enhancing Complex Care through an Integrated Care Coordination

Information System

• Complex redesign to support coordination of care using health IT

• Health IT provides a means to monitor and enroll high risk patients

• Shown to improve care coordination activities

Today’s Agenda

• About AHRQ





What we Know so Far

• Studies have shown health IT

– Improves quality of care

– Can improve efficiency and even save time

– Has increased patient, caregiver, and provider satisfaction

– Is associated with improvement in patient safety and improved cost-effectiveness

• Some evidence regarding health IT attributes that can impact use and effectiveness

• Evidence of facilitators best practices in design and implementation

Gaps

• Findings cannot be generalized to all types of heath IT applications or systems, all care settings, all user groups, or all care processes

• Evidence not as strong for some clinical outcomes

• Issues in systems design and implementation that can impact the use and effectiveness of health IT

What’s Needed

• Additional user involvement in health IT design and evaluation

• Research in settings/with user groups for which adoption and use lag

• Demonstrated best practices in design and implementation of health IT

• Which effective health IT designs can lead to higher adoption and use, and improved outcomes

• Inclusion of sociotechnical context as part of health IT design and evaluation

• Understand why impact varies across outcomes

• Understand impact on workflow and workload, efficiency, economic, and clinical outcomes

Moving Forward

• Areas of Interest

– Continuous quality improvement cycle

– Research on:

• Health IT design

• Health IT implementation

• Health IT use

• Impact of health IT on outcomes

• Use of health IT to support quality measurement

Ongoing Funding Opportunities

• Special Emphasis Notice (SEN): Interest in Career Development (K08) and Dissertation (R36) Grants Focused on Health Information Technology (IT)

– NOT-HS-13-011: http://grants.nih.gov/grants/guide/notice-files/NOT-HS-13-011.html

• Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (IT) (R21)

– PA-14-001: http://grants.nih.gov/grants/guide/pa-files/PA-14-001.html

www.healthit.arhq.gov/funding

http://grants.nih.gov/grants/guide/notice-files/NOT-HS-13-011.html

















http://www.healthit.arhq.gov/funding

























– Support next generation of health IT researchers by funding health IT-focused training grant applications

– Mechanisms

• AHRQ Mentored Clinical Scientist Research Career Development Award (K08)

• AHRQ Grants for Health Services Research Dissertation Program (R36)

























– Fund exploratory and developmental research grants that will contribute to the evidence base of how health IT improves health care quality

– Three study types:

1. Pilot and feasibility or self-contained health IT research projects;

2. Secondary data analysis of health IT research; and

3. Economic (prospective or retrospective) analyses of a health IT project

Recent Funding Opportunities

• SENs: Call for Applications to Address Health IT Safety

– R01: NOT-HS-14-007 (http://grants.nih.gov/grants/guide/notice-

files/NOT-HS-14-007.html)

– R21: NOT-HS-14-008 (http://grants.nih.gov/grants/guide/notice-

files/NOT-HS-14-008.html)

• SEN: Interest in Research on Health IT Safety

– NOT-HS-15-005: http://grants.nih.gov/grants/guide/notice-

files/NOT-HS-15-005.html

– Also R01s and R21s






























Upcoming Funding Opportunity

• Dissemination of patient-centered outcomes research (PCOR) findings through clinical decision support

– For more information http://grants.nih.gov/grants/guide/notice-files/NOT-HS-15-002.html












Other AHRQ Funding Opportunities

• AHRQ Small Research Grant Program (R03)

– PA-15-147: http://grants.nih.gov/grants/guide/pa-files/PA-15-

147.html

• AHRQ Health Services Research Projects (R01)


291.html

• AHRQ Health Services Research Demonstration and Dissemination Grants (R18)


290.html

http://www.ahrq.gov/funding/fund-opps/index.html






























Questions?


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Health IT at the Agency for Healthcare Research & Quality ...s3.amazonaws.com/rdcms-himss/files/production/public/2015... · Health IT at the Agency for Healthcare Research & Quality