Enabling Patient-Centered Care through Health Information Technology (Maryland)

Project Details - Ended

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Summary:

This project conducted a comprehensive literature review of the impact of health information technologies on patient-centered care (PCC). The project team looked at barriers and facilitators for the use of health information technology (IT) applications to deliver PCC, identified gaps in the literature, and recommended further areas for research. The impacts examined in the project included health care process outcomes; clinical outcomes; intermediate outcomes; responsiveness to the needs and preferences of individual patients; and shared decisionmaking between stakeholders, patient-clinician communication, and access to medical information. Several health IT applications were identified as being relevant to PCC including care management tools, telehealth, personal health records/patient portals, secure electronic messaging, and shared decisionmaking.

The main objectives of the project were to:

  • Conduct a comprehensive literature review regarding the impact of health IT that enables PCC.
  • Develop a final report on the impact of health IT that enables PCC.

The project team focused on four key questions: 1) Are health IT applications that address one or more components of PCC effective in improving specific outcomes, and how do the outcomes vary by type of health IT application?; 2) What are barriers or facilitators that clinicians, developers, patients, and their families or caregivers encounter that may impact implementation and use of health IT applications to enable PCC?; 3) What knowledge or evidence deficits exist regarding needed information to support estimates of cost, benefit, impact, sustainability, and net value with regard to enabling PCC through health IT?; and 4) What critical information regarding the impact of health IT applications implemented to enable PCC is needed to give consumers, their families, clinicians, and developers a clear understanding of the value proposition particular to them?

The team brought together a group of experts and advisors for the project, including a core team from Johns Hopkins University, representatives from AHRQ, and two external advisors. In addition, a Technical Expert Panel comprised of six external experts was brought together to serve as peer reviewers of the final report. Following the literature review, the research team concluded that significant evidence exists showing a positive impact of PCC-related health IT applications on health care outcomes, in particular in the following areas: health care process outcomes; clinical outcomes on diabetes, heart disease, cancer, and other health conditions; intermediate outcomes; improved responsiveness to the needs and preferences of patients; and improved shared decisionmaking, patient-clinician communication, and access to medical information. They did note, however, that there is not yet strong enough evidence to provide guidance to health care systems around the best use of these applications in promoting PCC system wide.

A number of barriers to PCC-related health IT applications were seen in the literature including the lack of usability; problems with access to the application due to older age, low income, low education, cognitive impairment, and other factors; low computer literacy in patients and clinicians; insufficient basic formal training in health IT applications; physicians’ concerns about more work; workflow issues; problems related to new system implementation, including concerns about confidentiality of patient information; depersonalization; incompatibility with current health care practices; lack of standardization; and problems with reimbursement. Facilitators noted in the literature included ease of use, perceived usefulness, efficiency of use, availability of support, comfort in use, and site location.

Areas identified as needing additional research included the need to determine the degree to which these interventions would be able to improve the delivery of PCC and improve outcomes for individuals with a variety of clinical conditions. More research is needed to improve the information available to health care providers so that this group is better able to weigh the benefits of these tools against the needed resources required to be invested to implement the tools. The project team recommended that future research and development in this area incorporate the principles of PCC in a more comprehensive and systematic manner.

Enabling Patient-Centered Care through Health Information Technology - 2010

Summary Highlights

  • Principal Investigator: 
  • Contract Number: 
    290-07-10061-I7
  • Project Period: 
    December 2008 – August 2010, Includes No-Cost Extension
  • AHRQ Funding Amount: 
    $330,000
  • PDF Version: 
    (PDF, 567.36 KB)


Target Population: General

Summary: The use of health information technology (IT) has been promoted as having tremendous promise for improving the efficiency, cost-effectiveness, quality, and safety of medical care delivery in our Nation's health care system. Health IT can support patient care-related activities such as order communications, results reporting, care planning, and clinical or health documentation. Customized integration of patients’ information in a health IT application delivered in an accessible, user-friendly format empowers patients and their family members to be active participants in care decisions and in the daily management of their health and illnesses. These are key components of patient-centered care (PCC), which the Institute of Medicine has identified as important to ensuring health care quality and patient safety.

Researchers at Johns Hopkins University drafted an evidence report that is part of a three-report series focused on the Agency for Healthcare Research and Quality (AHRQ) Health IT Portfolio’s strategic goals. This report focuses on the Portfolio’s goal of developing and disseminating evidence on the impact of health IT that enables PCC. Because of the diversity of health IT applications and the different ways to measure their impact, the review includes peer-reviewed scientific literature, as well as conference proceedings. The report explores the following three specific areas related to PCC:

  • Shared decisionmaking between the patient and/or family (or caregiver) and clinician.
  • Patient-clinician and/or family-clinician communication.
  • Access to medical information.

The review was guided by the conceptual framework based on current models of PCC and focuses on clinical outcomes and delivery process outcomes that impact systems, care providers, and patients. Barriers and facilitators of health IT-enabled PCC are presented from the perspective of clinicians, IT developers, consumers, and their families.

Project Objectives:
  • Conduct a comprehensive literature review regarding the impact of health IT that enables PCC. (Achieved)
  • Develop a final report on the impact of health IT that enables PCC. (Ongoing*)

2010 Activities: The activity throughout the year focused on drafting the final report. After conducting a literature review of over 300 articles, findings on the effectiveness of health IT applications in improving care processes, clinical outcomes, and intermediate outcomes were synthesized. The draft report was submitted to AHRQ and to a technical expert panel for review. The report is being revised to address reviewers’ comments.

Impact and Findings: The findings from this project will be available upon completion of the final report.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support PCC, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination

*Work on the report continued beyond the project end date of August 2010. .

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