AHRQ Official Defends Agencys HIT Improvement Work
The Agency for Healthcare Research and Quality might be on the congressional chopping block, but for now it is business as usual at the agency.
AHRQ continues to invest in research and evidence to understand how health IT can make healthcare safer and improve quality, while providing measures and datato track/improve performance and to evaluate progress in the use of HIT.
According to Arlene Bierman, M.D., director of AHRQ’s Center for Evidence and Practice Improvement, the agency has invested in research grants and contracts awarded to more than 180 institutions in 46 States and the District of Columbia. In her role since August, Bierman believes AHRQ has done some “foundational work” on the use of health IT and ensuring that evidence is understood and used in practice.
She argues that AHRQ’s research has expanded the evidence base for how HIT can improve quality of care and patient safety. In particular, Bierman says that more than ever there is a need to better understand which health IT designs can lead to higher adoption and use, and why some HIT has been shown to impact certain outcomes but not others.
“The overarching goal of our health IT portfolio is really aimed at getting evidence into practice and increasing uptake of evidence,” according to Bierman, who this week gave a presentation on the agency’s HIT portfolio to AHRQ’s National Advisory Council, whichprovides advice and recommendations to the AHRQ director.
AHRQ health IT research includes such technology areas as clinical decision support, e-prescribing, health information exchange, learning health systems, personal health records, and telehealth. For example, AHRQ-funded demonstration projects of clinical decision support have created processes and tools for translating clinical knowledge and narrative guidelines into formats that can be used by multiple electronic health record systems for implementing CDS across a range of healthcare settings, Bierman says.
She told the National Advisory Council that the tools, standards, and technology created by these demonstrations are being used by the Office of the National Coordinator for Health IT and have become the basis for HIT standards established by ONC to make it easier to share CDS between systems.
In addition, AHRQ’s Center for Evidence and Practice Improvement has launched an initiative to increase uptake of patient-centered outcomes research (PCOR) findings in clinical practice through clinical decision support. Bierman describes the AHRQ PCOR CDS Learning Network as an effort to “bring together groups of stakeholders, developers, researchers and health systems as a learning community to really advance the work in clinical decision support” by developing prototype tools and resources to make CDS shareable. An agency request for applications closes on November 14. “We’ve done CDS work before and this builds on it in a very targeted way,” she notes.
At the same time, one of the challenges is how to more routinely incorporate patient-reported outcomes and patient-generated data into medical practice, according to Bierman, as well as managing population health at the community and practice levels. A particularly vexing problem is the whole concept of care coordination and integration especially for patients who have complex needs or multiple conditions.
Another technology area touted by Bierman is an AHRQ-funded project that developed and evaluated the use of a personal health record to support preventive services management. Study results in Oklahoma showed that 84 percent of adults and 95 percent of children who had access to the PHR received all recommended preventive services and that it is now available to all primary care practices and wellness organizations in the state.
“Given all the work that we’ve done, the question is where can we most effectively target our work in the future and have a bigger impact on practice?” Bierman asks. Future AHRQ research, she concludes, will build on the body of evidence to support projects that develop, evaluate, and scale health IT interventions, with the aim of facilitating practice improvement and better patient outcomes.