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Health IT at AHRQ

AHRQ's health information technology (health IT) initiative is part of the Nation's strategy to put information technology to work in health care. By developing secure and private electronic health records for most Americans and making health information available electronically when and where it is needed, health IT can improve the quality of care, even as it makes health care more cost-effective.

The broad mission of AHRQ's health IT initiative is to improve the quality of health care for all Americans. The Agency has focused its health IT activities on the following three goals:

• Improve health care decisionmaking.
• Support patient-centered care.
• Improve the quality and safety of medication management.

To address the mission, AHRQ has invested over $260 million in contracts and grants to over 150 communities, hospitals, providers, and health care systems in 48 States to promote access to and encourage the adoption of health IT. These projects constitute a real-world laboratory for examining health IT at work and aim to achieve the following:

• Help clinicians provide higher quality, safer health care.
• Put the patient at the center of health care.
• Stimulate the implementation of health IT, especially in rural and underserved areas.
• Identify the most successful approaches and barriers to health IT implementation.
• Make the business case for health IT by evaluating costs and benefits.

Transforming Health Care Quality Through Health IT (2004-2008)

AHRQ has awarded over 100 grants totaling $118 million to promote access to health IT by helping communities, hospitals, providers, and health care systems to plan, implement, and demonstrate the value of health IT:

Planning grants to develop health IT infrastructure and data-sharing capacity among clinical provider organizations in their communities by:

• Creating multidisciplinary collaboratives and coalitions of health care providers.
• Conducting needs assessments and feasibility studies.
• Developing plans to implement electronic health records.

Implementation grants to support community-wide and regional health IT systems by:

• Developing shared registries, electronic health record systems, and telemedicine networks.
• Integrating clinical data from a variety of health IT systems, including pharmacy, laboratory, and public health organizations.
• Redesigning clinical workflow to improve patient care and provider access to information.
• Creating novel methods for delivering information to providers.

Value demonstration grants to evaluate how the adoption of health IT will:

• Impact quality, safety, and resource use in large, integrated delivery systems.
• Advance the effectiveness of Web-based, patient education tools.
• Improve patient transitions between health care facilities and their homes.

State and Regional Demonstrations in Health IT (2004-2009)

AHRQ has awarded contracts totaling $30 million to the States of Colorado, Delaware, Indiana, Rhode Island, Tennessee, and Utah to develop statewide and regional networks allowing health care providers, laboratories, pharmacies, major public and private purchasers of health care, hospitals, ambulatory care facilities, home health care providers, and long-term care providers to use health IT to communicate and share information. The goals of these projects are to:

• Identify and support State and regional data sharing and interoperability activities.
• Demonstrate measurable improvements in the quality, safety, efficiency, and/or effectiveness of care resulting from clinical data exchange.
• Identify successful strategies for the sustainability of health information exchange.
• Identify programmatic linkages to other key regional and national health IT initiatives.

Ambulatory Safety and Quality Program (2007-2011)

Through its Ambulatory Safety and Quality program, AHRQ is funding a variety of projects that are focused on improving ambulatory care through the use of health IT. Specifically, this program seeks to:

• Enable the evaluation or development of new health IT strategies in ambulatory care settings that assist clinicians, practices, and systems to measure the quality and safety of care.
• Improve outcomes through more effective clinical decision support, medication management, or care delivery.
• Investigate approaches for using health IT to create or enhance patient-centered care.

Enabling Quality Measurement Through Health IT. Funded at approximately $15 million, these 17 grants support the development of health IT to assist in measuring the quality and safety of care in ambulatory care settings. Grantees develop, refine, and evaluate quality of care measures for a variety of diseases and examine decision support systems, system integrations, electronic reminders, and health information exchanges across care settings.

Improving Quality Through Clinician Use of Health IT. Funded at approximately $27 million, these 24 projects support using health IT to improve quality and safety in health care delivery and medication management. Grantees focus on clinical reminders, rules, or triggers for decision support; electronic prescribing; and electronic medical records, often within the primary care setting. Other focus areas include quality improvement through mechanisms such as reporting and reminders, management of chronic diseases, and quality improvement during transitions between care settings.

Enabling Patient-Centered Care Through Health IT. Funded at about $18 million, these 16 grants explore using health IT to support patient-centered care in ambulatory settings. Most target the primary care or home environment, with technologies such as personal health records, patient-focused telehealth, and clinical/medication reminders. Their focus is on patient self-management of chronic conditions, patient-clinician communication, shared decisionmaking and patient and/or clinician access to medical information.

Clinical Decision Support Demonstrations (2008-2012)

AHRQ awarded $5 million for two contracts that will focus on the development, adoption, implementation, and evaluation of best practices using clinical decision support (CDS). The Brigham and Women's Hospital in Boston, MA, and Yale University School of Medicine in New Haven, CT, have each been awarded 2-year contracts to conduct CDS demonstration projects that will:

• Incorporate CDS into electronic medical records that have been certified by the Certification Commission for Health IT.
• Demonstrate that CDS can operate on multiple computer systems.
• Establish lessons learned for CDS implementation relevant to important stakeholder health care communities.
• Assess potential benefits and drawbacks of CDS, including effects on patient satisfaction, measures of efficiency, cost, and risk.
• Evaluate methods for creating, storing, and replicating CDS elements across multiple clinical sites and ambulatory practices.

Electronic Prescribing Pilots (2005-2007)

In partnership with the Centers for Medicare & Medicaid Services (CMS), AHRQ funded five pilot projects that implemented and tested initial electronic prescribing standards proposed by the Department of Health and Human Services (HHS). These projects also tested e-prescribing interoperability with HHS-endorsed standards as well as clinical and economic outcomes.

• RAND focused on physicians in an e-prescribing program sponsored by Horizon Blue Cross Blue Shield of New Jersey. The pilot also involved Caremark's mail-order pharmacy and Walgreens' retail pharmacy, so that it could include end-to-end testing of the standards.
• The Brigham and Women's Hospital worked with physicians from the CareGroup Health System in Boston who were already using well-established outpatient electronic medical record and computerized physician order entry systems. This enabled them to isolate the effects of the standards on the operation of existing e-prescribing practices.
• Achieve, the largest information technology vendor for the long-term care industry, partnered with a nonprofit long-term care system in the Midwest that also owns the pharmacies that serve its facilities and RNA, a pharmacy management system software vendor. This pilot study implemented e-prescribing in facilities that had never used the technology.
• University Hospitals Health System and Ohio KePRO, the Quality Improvement Organization, teamed to study the implementation of the standards in some of the primary and specialty care offices that make up the University Hospitals Medical Practices. These physicians are generally in small practices of two to three doctors.
• SureScripts, the Nation's largest provider of e-prescribing networking and certification services, worked with physician offices in Florida, Massachusetts, Nevada, New Jersey, and Tennessee using a variety of software systems to send prescriptions to an assortment of chain and independent pharmacies.

AHRQ and CMS plan to work together again to address unfinished issues in the initial standards.

Health Information Privacy and Security Collaboration (2005-2009)

The privacy and security of health information is important to patients whose information is electronically exchanged during care delivery. To better protect patient privacy, AHRQ, in conjunction with the Office of the National Coordinator for Health IT, provided $26 million to fund the Health Information Privacy and Security Collaboration. The collaboration includes 33 States and one U.S. territory and is managed by RTI International. The collaborative is working to examine how health care organizations and public agencies currently protect the privacy and security of health information.

The collaborative is also examining areas where State and Federal law may need to be updated to enable greater exchange of health information while ensuring privacy and security, especially when information is shared across State lines. The activities and outcomes of the collaborative will support improvements to State and Federal policy as well as organizational practices related to privacy and security.

AHRQ's National Resource Center for Health Information Technology (2004-present)

AHRQ established the National Resource Center for Health Information Technology and a Web site (www.healthit.ahrq.gov) to support the Agency's health IT initiative. The National Resource Center serves as the link between the health care community at large and the researchers and experts who are on the front lines of health IT. As the central repository for lessons learned from AHRQ's health IT initiative, the National Resource Center encourages adoption of health IT by disseminating the latest tools, best practices, and research results from this unique real-world laboratory.

For More Information

For additional information on AHRQ projects on health information technology, please visit www.healthit.ahrq.gov and click on the red envelope in the upper right corner to sign up for e-mail updates or to subscribe to AHRQ's free monthly Patient Safety and Health Information Technology E-Newsletter. For specific questions, please contact the health IT staff at NRC-healthit@ahrq.hhs.gov.

AHRQ Publication No: 08-M064
August 2008