Health IT Brings Research Breakthroughs Into PracticeHealth IT Brings Research Breakthroughs Into Practice

8 Accountable Care Organizations Worth Closer Examination

With all the talk about how evidence-based medicine will transform healthcare, it still takes an average of 17 years for new medical evidence to become an integral part of clinical practice, according to the Institute of Medicine. This troubles quality-improvement leaders like Dr. Carolyn Clancy, director of the U.S. Agency for Healthcare Research and Quality (AHRQ), the federal entity tasked with improving the quality, safety, efficiency, and effectiveness of healthcare for all Americans.

"If there's one thing we've learned," said Clancy, who has run AHRQ since 2003, "it's that good evidence is necessary but not sufficient."

Part of her job is to decide on making research investments that will produce a return on investment. One AHRQ grant to researchers at Duke University School of Medicine and the University of Utah School of Medicine, for instance, turned into a paper on clinical decision support and knowledge management that appeared in the Annals of Internal Medicine in April. That study showed some of the clinical, economic, workload, and efficiency benefits of clinical decision support outside of academic medical centers that have an extensive health IT infrastructure.

"I think of clinical decision support as almost like any therapeutic intervention," Clancy told information Healthcare. Ideally, it gives clinicians and patients information they want. However, said Clancy, "it needs to be timely and not intrusive." The latter point remains a challenge for vendors, hospital CIOs, and clinical leaders alike.

Another AHRQ concern is clinical workflow. This year, the agency published a toolkit to help providers assess both clinical and administrative workflow in the context of health IT and two more toolkits on e-prescribing for physicians and pharmacies. The former is a series of case studies of primary care physicians that AHRQ identified as "exemplars," Clancy said.

[ For more on the role of IT in clinical research, see Health IT's Next Challenge: Comparative Effectiveness Research. ]

Likewise, electronic prescribing is not as straightforward as some in the technology community might believe. "It requires a lot of attention to work process redesign," said Clancy. She noted that her own physician has been "struggling to get e-prescribing right" because there are different standards to choose from.

AHRQ also is playing a major role in healthcare reform. The bulk of the public's attention has been on the insurance aspects of the Patient Protection and Affordable Care Act--a.k.a. "Obamacare"--and on the "Meaningful Use" electronic health records (EHR) incentive program, but AHRQ is deeply involved in changes in the realm of patient safety.

In fact, other than the $27 billion allocated for Meaningful Use, no healthcare program authorized by the 2009 American Recovery and Reinvestment Act received more funding than the $1.1 billion given to AHRQ for comparative effectiveness research. AHRQ has rebranded it "patient-centered outcomes research" after critics linked those studies with nonexistent government "death panels" that allegedly would decide whether Medicare patients could receive specific treatments.

As previously reported, AHRQ has been using some of the money to support research into data infrastructure to help clinicians sort through massive Medicare databases in search of more effective treatments. AHRQ also has sponsored research with other funding on how to create an all-payer database of insurance claims, with the same goal in mind.

"We're doing a lot of work with people who are sponsoring patient-centered medical homes," Clancy said, encouraging them to experiment with delivery models, as long as they use common methods to evaluate learning.

To this end, AHRQ has been collaborating with the National Quality Forum for the last four years to develop what Clancy called "highly technical" common methods of measuring patient safety reports. "We are working with IT vendors to include these formats," Clancy added.

information Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)