Research and Projects: AHRQ THQIT and SRD Portfolio

Massachusetts

Evaluating Smart Forms and Quality Dashboards in an EHR

Description:  Assesses the value of health IT to clinicians through creation of CDSS tools integrated with clinical documentation workflow and physician performance feedback, its impact on clinical decision support and quality assessment, and its cost-effectiveness.

Abstract:  DESCRIPTION (provided by the applicant): Electronic health records (EHR) have come of age. Modern clinical practice requires a clinician to be mindful of best practices, and wary of excess utilization and cost. However, abundant data show that gaps exist between best evidence and practice, wide variations persist in clinical practice patterns, and escalation of healthcare costs continues largely unabated. The fundamental value proposition of IT in health care has come under increased scrutiny while it is increasingly accepted that the effective application of IT is critical for improved patient safety and quality. This application aims to better demonstrate the value of IT to the end-user clinician through creation of clinical decision support tools integrated with clinical documentation workflow, and through provision of physician performance feedback on quality and benchmarks in the EHR. We aim to demonstrate value to the clinician, as well as to the goals of patient safety and quality, and address the combined needs of clinical workflow support and decision support with innovative EHR technology. We hypothesize that two EHR-based interventions: the first focusing on the impact of a forms-based, clinical documentation-centric, approach to decision support, and the second on providing clinician specific performance reports regarding guideline compliance and quality benchmark achievement at the point of care, will significantly increase the perceived value of EHR to the end-user clinician. We propose to address three related research questions to illuminate this area of inquiry: 1) can a usable EHR intervention be developed which provides clinical decision support in the context of clinical documentation workflow, and which integrates population-based performance feedback to the physician; 2) do such tools improve the capture of key data for clinical decision support and quality assessment, compliance with best practice guidelines, and the quality of clinical documentation, and 3) is the use of such tools cost-effective - is there an impact utilization of medications, tests, and procedures in the setting of either care provided for patients with acute respiratory illness (ARI), or coronary artery disease (CAD)? We believe these are fundamental value questions which are critical to the broad adoption of IT in practice. If the end-user does not perceive the value of these tools primarily in the clinical workflow, healthcare IT will never be adopted, and secondary gains in patient safety, quality, and costs will never be achieved.

Year 1 Funding:  $378,525

Estimated Total Funding:  $1,153,892

Principal Investigator:  Blackford Middleton

Applicant Institution:  Brigham and Women's Hospital

City/Town:  Boston, Massachusetts

State:  Massachusetts

Grant Number:  R01 HS15169

Category:  Value Grants (THQIT)

Thesaurus Terms:  automated medical record system, computer assisted medical decision making, computer system design /evaluation, electronic recording system, health care service evaluation, medical record, questionnaire, bioinformatics, computer assisted patient care, coronary artery, health care personnel, physician, respiratory infection, health services research tag

Project Start Date:  Sep 30, 2004

Project End Date:  Sep 29, 2007