Health Information Technology (IT)

Long-Term Objective 1: Most Americans will have access to and utilize a Personal Electronic Health Record (EHR)

#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	FY 2006 Target	FY 2006 Actual	FY 2007 Target	FY 2007 Actual	FY 2008 Target	FY 2009 Target	Out-Year Target
1.3.8	Most Americans will have access to and utilize a Personal Health Record (PHR)	NA	2 EHR Improvements Indian Health Service (IHS) and National Aeronautics and Space Administration (NASA) Health IT	Partner with one HHS Operating Division	Partnered with CMS on PHR technology	Partner with one HHS Operating Division	Partnered with CMS	Develop tool to assess consumer perspectives on the use of personal electronic health records	10 organization will use tools to assess consumer perspectives on the use of personal EHRs	2014
1.3.6	Increase physician adoption of Electronic Health Records (EHRs)	NA	10% Baseline	15%	21.9% of physician practices use e-prescribing	15% from baseline	24.9%	Increase 20% from Baseline	Increase 25% from Baseline	2012 40%
1.3.36	Increase the number of ambulatory clinicians using electronic prescribing to over 50%	N/A	N/A	Baseline	12%	15%	Ongoing	20%	25%	2012

 

#	Key Outputs	FY 2004 Actual	FY 2005 Actual	FY 2006 Target/Est.	FY 2006 Actual	FY 2007 Target/Est.	FY 2007 Actual	FY 2008 Target/Est.	FY 2009 Target/Est.	Out-Year Target/Est.
1.3.9	Engineered Clinical Knowledge will be routinely available to users of EHRs	NA	National summit with National Coordinator for Health IT and American Medical Informatics Association (AMIA)	Standards development and adoption	Initiated standards development and adoption of Engineered Clinical Knowledge	Standards development organizations will be in early development of tools enabling engineered clinical knowledge transfer	CCHIT certification criteria	Award 2 projects that will deliver best practice recommendations to key stakeholders to create engineered clinical knowledge	2 projects will deliver best practice recommendations to create engineered clinical knowledge	2010
	Appropriated Amount ($ Million)	$49.9M	$61.3M	$61.3M	$49.9M	$49.9M	$49.9M	$44.8M	$44.8M

As the Nation's lead research agency on health care quality, safety, efficiency, and effectiveness, AHRQ plays a critical role in the drive to adopt Health Information Technology (Health IT).  Established in 2004, the purpose of the Health IT portfolio at AHRQ is to develop evidence and inform policy and practice on how Health IT can improve the quality of American healthcare.  By making best evidence and consumer's health information available electronically when and where it is needed and developing secure and private electronic health records, Health IT can improve the quality of care, even as it makes health care more cost-effective.  This portfolio serves numerous healthcare stakeholders, including patients, providers, payers, purchasers, and policymakers.  The portfolio achieves these goals through research grants, demonstration, technical assistance and dissemination contracts, convening meetings, and staff activities.  Some recent achievements and research findings related to Health IT include:

• Advancement of electronic prescribing, through delivery of a report to Congress and subsequent proposed adoption of standards for Medicare Part D Beneficiaries.  As shown in the performance table below, AHRQ partnered with the Centers for Medicare & Medicaid Services (CMS) to award five pilot projects which tested several promising standards, and delivered the evidence on those standards through a rigorous evaluation.
• Demonstration of best practices for health information exchange, through projects like the Midsouth eHealth Alliance in Tennessee.  Currently entering its fourth year of existence, this data exchange serves all major emergency rooms in Memphis with over 50 million laboratory results and other encounter information available on nearly 1 million individuals.
• Developing secure and private health IT systems that are responsive to consumer's needs and desires.  AHRQ has funded the Health Information Security and Privacy Collaborative, a 35 State and territory effort which has defined the privacy and security landscape and has made concrete progress towards addressing inconsistencies and concerns.  AHRQ is also conducting focus groups to determine consumer's information needs to improve their healthcare.
• Leadership in measurement of quality using health IT, including funding of a pivotal report from the National Quality Forum on the readiness of health IT to measure widely adopted consensus measures of quality.

The Health IT program at AHRQ set several ambitious performance measures in 2004, and has seen steady progress on all of the measures and some notable achievements. To meet the President's goals of widespread adoption of electronic medical records, we partnered with CMS to test and recommend e-prescribing standards for national adoption, which was a requirement of the Medicare Modernization Act of 2003. This major achievement began in May 2005, and over two years several pilot projects were solicited, awarded and conducted, and a detailed evaluation was performed. The result has been a mandated Report to Congress in April 2007, and a Notice of Proposed Rulemaking from CMS to require use of the ready standards for Medicare beneficiaries. As this technology develops further we look forward to showing the Nation the best ways to use e-prescribing to improve the safety and quality of health care.

EHR adoption has slowly increased, and our 2007 goal of 15% of providers adopting was met. Our grants and contracts have produced significant insight into the best practices in implementation and use of EHRs, and continue to advance this field of knowledge. External barriers to adopt continue to pose a challenge, including the capital required from providers to purchase the system and uncertainty in the market for these products.

Similarly, hospitals have continued to steadily adopt computerized physician order entry, and in 2007 that technology is being utilized by 27% of providers across the Nation. We have developed evidence and tools that inform the best use of this technology, and will continue to disseminate those tools through our public and private partnerships.

Decision support is a critical next step beyond adoption of health IT, and represents significant potential for good information systems to help deliver high quality health care. Some of the basic building blocks are in place, as seen through Certification Commission for Health IT (CCHIT) certification criteria for health IT. Our programs will develop and demonstrate the most effective use of evidence-based information to inform the Nation's health care providers and policymakers.

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Patient Safety

Long-Term Objective 1: Within five years, providers that implement evidence-based tools, interventions, and best practices will progressively improve their patient safety scores on standard measures (e.g., HCAPS, HSOPS, ASOPS, PSIs).

#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	FY 2006 Target	FY 2006 Actual	FY 2007 Target	FY 2007 Actual	FY 2008 Target	FY 2009 Target	Out-Year Target
1.3.37	Increase the percentage of hospitals in the U.S. using computer-only patient safety event reporting systems (PSERS) (This replaces PART measure #2).			Baseline	12%	NA	NA	NA	24%	2017 48%
1.3.38	Increase the number of U.S. healthcare organizations using AHRQ-supported tools to improve patient safety from the 2007 baseline (new portfolio measure)					Baseline	382 hospitals	440	500	2017 1528
1.3.39	Increase the number of patient safety events reported to the Network of Patient Safety Databases (NPSD) from baseline. (This replaces measure #1)	NA	NA	NA	NA	NA	NA	NA	Baseline TBD	2017 increase to 200%
1.3.5	Reductions associated with reductions in hospitalizations with infections due to medical care. (Reductions are compared to previous year's results). Baseline 2003: $4,437.28 per capita					-2%	Ongoing 09/30/09	-2%	-2%	2017 TBD

 

#	Key Outputs	FY 2004 Actual	FY 2005 Actual	FY 2006 Target/Est.	FY 2006 Actual	FY 2007 Target/Est.	FY 2007 Actual	FY 2008 Target/Est.	FY 2009 Target/Est.	Out-Year Target/Est.
1.3.40	Patient Safety Organizations (PSOs) listed by HHS Secretary	N/A	N/A	N/A	N/A	N/A	N/A	Final Regulation published	PSOs listed by Secretary	2015 NPSD reports generated
1.3.41	Increase the number of tools that will be available in AHRQ's inventory of evidence-based tools to improve patient safety and reduce the risk of patient harm					Baseline	61	68	76	2017 200
	Appropriated Amount ($ Million)	$29.6M	$34.2M	$34.2M	$34.1M	$34.1M	$34.1M	$34.1M	$32.1M

The Patient Safety Program is comprised of two research components: Patient Safety Threats and Medical Errors and Patient Safety Organizations (PSOs) related to the Patient Safety and Quality Improvement Act (PSQIA) of 2005. The Patient Safety Program's goal as stated historically is to prevent, mitigate and decrease the number of medical errors, patient safety risks and hazards, and quality gaps associated with health care and their harmful impact on patients. The Program funds grants, contracts, and interagency agreements (IAAs) to support projects that identify the threats; identify and evaluate effective practices; educate, disseminate, and implement to enhance patient safety and quality; and maintain vigilance.

The Patient Safety Program, which formally commenced in FY 2001, began with AHRQ awarding $50 million for 94 new projects aimed at reducing medical errors and improving patient safety.  Throughout the past six years, AHRQ has funded many additional projects and initiatives in a number of areas of patient safety and health care quality.  As a result, a large body of research is emerging, and numerous surveys, reporting and decision support systems, taxonomies, publications, tools, and presentations are available for general use.  AHRQ has addressed these patient safety issues independently and in collaboration with public and private sector organizations.  In June 2005, the Patient Safety and Quality Improvement Act (PSQIA) of 2005 became law.  The Act provided badly-needed protection (privilege) to providers throughout the country for quality and safety review activities. By fostering increased event reporting and peer review, through removal of the threat of disclosure in malpractice cases, this legislation should spur advancement of a culture of safety in healthcare organizations across the country.

Some recent research findings and projects related to Patient Safety include:

Research Grants

Through a study funded by AHRQ for which preliminary findings are currently available, it is estimated that 95% of hospitals have some type of reporting system.  This is based on a nationally representative sample of 2,000 hospitals with an 81% survey response rate.  Only about 12% of the respondents had a fully computerized system. (FY 2005 funding = $165,909)

In FY 2005, 17 Partnerships in Implementing Patient Safety two-year grants were awarded to assist health care institutions in implementing safe practice interventions that show evidence of eliminating or reducing medical errors, risks, hazards, and harms associated with the process of care.  The majority of these grants are completed and the resultant tool kits are in the process of being made available to the public and/or further tested in different environments to identify what easily works and what challenges are faced by "sharp-end" providers in implementing these safe practice intervention tool kits.  (FY 2005 and FY 2006 funds = $4.7 million)

Training Programs

In FY 2005, the Patient Safety Improvement Corps (PSIC) trained students from 19 States representing 35 hospitals/health care systems.  In FY 2006, the PSIC trained students from 16 States representing 19 hospitals/health care systems.  In FY 2007, the PSIC began its fourth and final class.  It is composed of 92 students representing 23 teams including 32 hospitals/hospital systems and 5 quality improvement organizations.  Each of these years exceeded the target number of organizations.  With the fourth class, the PSIC has trained a team in every State in the U.S.  Additionally, AHRQ produced a PSIC DVD which provides a self-paced, modular approach to training individuals involved in patient safety activities at the institutional level.  This interactive, 8-module DVD  provides information on the investigation of medical errors and their root causes; identification, implementation, and evaluation of system-level interventions to address patient safety concerns; and steps necessary to promote a culture of safety within a hospital or other health care facility. (FY 2009 funding for PSIC = $600,000)

It has been our expectation that "graduates" from the PSIC program will both use their PSIC training to become change agents in their home organizations and go on to implement as well as train others using the knowledge, skills, and patient safety improvement techniques delivered in their PSIC training.  For example, as a result of participating in the PSIC, the Connecticut Hospital Association and team members from the Connecticut Department of Public Health studied Connecticut's adverse event reporting system. This effort helped the Department of Public Health's Quality in Health Care Advisory Committee, which developed formal recommendations to enhance the effectiveness of the State's adverse event reporting system. The Committee's recommendations were incorporated in legislation enacted by the Connecticut legislature in May 2004.  In October 2005, the New York State Department of Health rolled out their PSIC-based training program including more than 700 people from the State's free-standing diagnostic and treatment centers (e.g., Ambulatory Surgery Centers, End Stage Renal Disease Dialysis Centers, Community Healthcare Centers) and selected Department of Health clinics.  In Georgia, the Georgia Hospital Association (GHA) developed their PSIC based on GHA's staff participation in our 2004-2005 PSIC program.  The GHA PSIC used 5 two-day face-to-face workshops, 8 Webinars, and 4 networking audio conferences.  This training enabled the GHA PSIC program attendees to go back to their organizations, train additional staff, and implement patient safety improvement programs.

Resources/Tools

AHRQ also supports the AHRQ Patient Safety Network (AHRQ PSNet).  It is a national Web-based resource featuring the latest news and essential resources on patient safety.  The site offers weekly updates of patient safety literature, news, tools, and meetings ("What's New"), and a vast set of carefully annotated links to important research and other information on patient safety ("The Collection").  Supported by a robust patient safety taxonomy and Web architecture, AHRQ PSNet provides powerful searching and browsing capabilities, as well as the ability for diverse users to customize the site around their interests (My PSNet).  Use of this site has also more than doubled over the last 30 months.  In addition, AHRQ funds the WebM&M (Morbidity and Mortality Rounds on the Web).  WebM&M is an online journal and forum on patient safety and health care quality.  This site features expert analysis of medical errors reported anonymously by our readers, interactive learning modules on patient safety ("Spotlight Cases"), Perspectives on Safety, and forums for online discussion.  (Funding for the PSNet and WebM&M total $1.3 million in FY 2009)

In the Institute of Medicine's 1999 report on medical errors, they suggested that systemic failures were important underlying factors in medical error and that better teamwork and coordination could prevent harm to patients.  The IOM recommended that health care organizations establish team training programs for personnel in critical care areas such as emergency departments, intensive care units, and operating rooms. As a follow up, we in partnership with the Department of Defense, developed a teamwork training program (TeamSTEPPS™).  It is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and other teamwork skills among health care professionals.  It includes a comprehensive set of ready-to-use materials and training curricula necessary to integrate teamwork principles successfully into an organization's health care system. TeamSTEPPS™ is presented in a multimedia format, with tools to help your health care organization plan, conduct, and evaluate its own team training program. It includes five components:  1. an instructor guide, 2. a multimedia resource kit including a CD-ROM and DVD with 9 video vignettes about how failures in teamwork and communication can place patients in jeopardy, and how successful teams can work to improve patient outcomes; 3. a spiral-bound pocket guide; 4. PowerPoint® presentations; and 5. a poster that tells staff that the organization is adopting TeamSTEPPS™.  In addition, we have a technical assistance contract in place to support those interested in implementing TeamSTEPPS™. (FY 2007 funding = $2.6 million; technical assistance in FY 2008 and FY 2009)

In FY 2007, we prepared and released a DVD (Transforming Hospitals: Designing for Safety and Quality).  The DVD reviews the case for evidence-based hospital design and how it increases patient and staff satisfaction, improves safety and quality of care, enhances employee retention, and results in a positive return on investment (ROI).  (FY 2006 funding = $400,295)

Historically, the Patient Safety Program has concentrated most of its resources on evidence generation.  While that activity continues to be important for AHRQ, increasingly, program support is moving more toward data development/reporting and dissemination/implementation as the Agency focuses on making demonstrable improvements in patient safety. This reporting and implementation focus has the advantage of providing a natural feedback loop regarding which areas of new evidence are most needed to address real quality and safety problems encountered by providers and patients.  Additionally, most of the measures for the patient safety program have been modified to better reflect our goals.  The new measures, effective in FY 2008, are provided in the Performance Table below.  The new measures better reflect our emphasis on implementation of evidence-based practices and reporting on their impact.  Two of the measures also enable us to capture information on two major new Agency initiatives (i.e., PSOs and HAIs).

The Patient Safety program received a PART review in 2003, and received an Adequate rating. The review cited improvements in the safety and quality of care as a strong attribute of the program. As a result of the PART review, the program continued to take actions to prevent, mitigate and decrease the number of medical errors, patient safety risks and hazards associated with health care and their harmful impact on patients. The program continues to develop decision support systems, taxonomies, publication, and tools.  For more information on programs that have been evaluated based on the PART process, go to: http://www.whitehouse.gov/omb/expectmore/.

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