the role of health it in comparative effectiveness · james scanlon, hhsjames scanlon, hhs...
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The Role of Health IT in The Role of Health IT in Comparative EffectivenessComparative Effectiveness
Carolyn M. Clancy, MDCarolyn M. Clancy, MDDirectorDirector
Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality
Health Information Technology Symposium Health Information Technology Symposium Massachusetts Institute of TechnologyMassachusetts Institute of Technology
Cambridge, MA Cambridge, MA –– July 2, 2009July 2, 2009
The Measure of ProgressThe Measure of Progress
Challenges and OpportunitiesChallenges and Opportunities
Growing concern about health spending; Growing concern about health spending; about $2.3 trillion per yearabout $2.3 trillion per yearLarge variation in clinical careLarge variation in clinical careUncertainty about best practices involving Uncertainty about best practices involving treatments and technologiestreatments and technologiesPervasive quality, safety, and equity issuesPervasive quality, safety, and equity issuesUsing health IT to improve research and careUsing health IT to improve research and careRewarding the Rewarding the ‘‘leading edgeleading edge’’ andand bringing bringing others alongothers along
The Role of Health IT inThe Role of Health IT in Comparative EffectivenessComparative Effectiveness
AHRQAHRQ’’s Roles & Resourcess Roles & Resources
AHRQ & Comparative AHRQ & Comparative Effectiveness ResearchEffectiveness Research
Health IT & Comparative Health IT & Comparative Effectiveness ResearchEffectiveness Research
A Look AheadA Look Ahead
Q&AQ&A
AHRQAHRQ’’s Missions Mission
Improve the quality, safety, Improve the quality, safety, efficiency and effectiveness of efficiency and effectiveness of health care for all Americanshealth care for all Americans
AHRQ PrioritiesAHRQ Priorities
Effective HealthEffective Health Care ProgramCare Program
Medical ExpenditureMedical Expenditure Panel SurveysPanel Surveys
AmbulatoryAmbulatory Patient SafetyPatient Safety
PatientPatient SafetySafetyHealth ITPatient SafetyOrganizationsNew PatientSafety Grants Comparative
Effectiveness ReviewsComparative Effectiveness Research Clear Findings for Multiple Audiences
Quality & Cost-Effectiveness, e.g.Prevention and PharmaceuticalOutcomesU.S. Preventive ServicesTask ForceMRSA/HAIs
Visit-Level Information onMedical ExpendituresAnnual Quality & Disparities Reports
Safety & Quality Measures,Drug Management andPatient-Centered CarePatient Safety ImprovementCorps
Other Research & Other Research & Dissemination ActivitiesDissemination Activities
AHRQ FY 2009 FundingAHRQ FY 2009 Funding
$372 million$372 million–– $37 million more than FY 2008$37 million more than FY 2008–– $46 million more than the president$46 million more than the president’’s s
requestrequest
FY 2009 appropriation includes:FY 2009 appropriation includes:–– $50 million for comparative effectiveness $50 million for comparative effectiveness
research, $20 million more than FY 2008 research, $20 million more than FY 2008 –– $45 million for health IT$45 million for health IT
Comparative Effectiveness Comparative Effectiveness and the Recovery Actand the Recovery Act
The American Recovery and Reinvestment The American Recovery and Reinvestment Act of 2009 includes $1.1 billion for Act of 2009 includes $1.1 billion for comparative effectiveness research:comparative effectiveness research:–– AHRQ: $300 millionAHRQ: $300 million
–– NIH: $400 million (appropriated to AHRQ and NIH: $400 million (appropriated to AHRQ and transferred to NIH)transferred to NIH)
–– Office of the Secretary: $400 million (allocated at Office of the Secretary: $400 million (allocated at the Secretarythe Secretary’’s discretion)s discretion)
Funding for health IT, prevention and other areas Funding for health IT, prevention and other areas could have implications for the Agency could have implications for the Agency
Meaningful UseMeaningful Use
The Recovery Act calls for establishment of The Recovery Act calls for establishment of an incentive for providers who become an incentive for providers who become ““meaningful usersmeaningful users”” of electronic health of electronic health records records A Federal Health IT Policy Committee A Federal Health IT Policy Committee workgroup is developing criteria for a workgroup is developing criteria for a definition of meaningful usedefinition of meaningful useThe focus: quality outcomes, health status The focus: quality outcomes, health status and cost controland cost control
http://http://healthit.hhs.govhealthit.hhs.gov
Meaningful Use: Meaningful Use: AHRQAHRQ’’ss RoleRole
AHRQ provides Federal partners with the AHRQ provides Federal partners with the best available evidence on how proposed best available evidence on how proposed criteria for meaningful use might help to criteria for meaningful use might help to achieve the ultimate goal of high quality, achieve the ultimate goal of high quality, high value health carehigh value health care–– AHRQ grantees and contractors have been AHRQ grantees and contractors have been
significant contributors to the public significant contributors to the public discussion on meaningful usediscussion on meaningful use
–– The Agency also participates in internal The Agency also participates in internal Federal discussions about meaningful useFederal discussions about meaningful use
Recovery Act Timeline: AHRQRecovery Act Timeline: AHRQ
20092009
March 19: The March 19: The Federal Federal
Coordinating Coordinating Council for Council for
Comparative Comparative Effectiveness Effectiveness Research is Research is establishedestablished
February 17: February 17: The American The American Recovery and Recovery and Reinvestment Reinvestment Act of 2009 is Act of 2009 is
signed into lawsigned into law
JanuaryJanuary AprilApril JulyJuly
June 30: Due June 30: Due date for IOM date for IOM
submission of a submission of a list of national list of national
priority priority conditionsconditions**
May 1: Due May 1: Due date for Agency date for Agency
wide and wide and programprogram-- specific specific
Recovery Act Recovery Act plansplans
OctoberOctober
November 1: November 1: AHRQ AHRQ FY FY ‘‘10 10
operations operations plan dueplan due
July 30: July 30: AHRQ to AHRQ to submit submit FY FY ’’09 09
Operations Operations PlanPlan
20102010
December December 31, 2010: All 31, 2010: All
Recovery Recovery Act funding Act funding
to be to be obligatedobligated
* * Stakeholder input requiredStakeholder input required
Federal Coordinating Council Federal Coordinating Council MembersMembers
Anne Anne HaddixHaddix, CDC, CDCThomas Thomas ValuckValuck, CMS, CMSPeter Delany, SAMHSAPeter Delany, SAMHSACarolyn Clancy, AHRQCarolyn Clancy, AHRQDeborah Hopson, HRSADeborah Hopson, HRSADavid Hunt, ONCDavid Hunt, ONCJames Scanlon, HHSJames Scanlon, HHSElizabeth Elizabeth NabelNabel, NIH, NIH
Garth Graham, Office of Garth Graham, Office of Minority HealthMinority HealthJesse Goodman, FDAJesse Goodman, FDAMichael Marge, Office on Michael Marge, Office on DisabilityDisabilityNeeraNeera TandenTanden, HHS, HHSJoel Joel KupersmithKupersmith, VA, VAMichael Kilpatrick, Michael Kilpatrick, DoDDoDEzekiel Emanuel, OMBEzekiel Emanuel, OMB
The Role of Health IT inThe Role of Health IT in Comparative EffectivenessComparative Effectiveness
AHRQAHRQ’’s Roles & Resourcess Roles & Resources
AHRQ & Comparative AHRQ & Comparative Effectiveness ResearchEffectiveness Research
Health IT & Comparative Health IT & Comparative Effectiveness ResearchEffectiveness Research
A Look AheadA Look Ahead
Q&AQ&A
AHRQ Comparative AHRQ Comparative Effectiveness ResearchEffectiveness Research
http//:http//:effectivehealthcare.ahrq.goveffectivehealthcare.ahrq.gov
Effective Health Care ProgramEffective Health Care Program
A.A. Evidence synthesis (EPC program)Evidence synthesis (EPC program)–– Systematically reviewing, synthesizing, comparing existing Systematically reviewing, synthesizing, comparing existing
evidence on treatment effectivenessevidence on treatment effectiveness–– Identifying relevant knowledge gapsIdentifying relevant knowledge gaps
B.B. Evidence generation (DEcIDE, CERTs)Evidence generation (DEcIDE, CERTs)–– Development of new scientific knowledge to address Development of new scientific knowledge to address
knowledge gaps. knowledge gaps. –– Accelerate practical studiesAccelerate practical studies
C.C. Evidence communication/translation Evidence communication/translation (Eisenberg Center)(Eisenberg Center)–– Translate evidence into improvements Translate evidence into improvements –– Communication of scientific information in plain language Communication of scientific information in plain language
to policymakers, patients, and providersto policymakers, patients, and providers
New Priority Conditions for the New Priority Conditions for the Effective Health Care ProgramEffective Health Care Program
Arthritis and nonArthritis and non--traumatic joint disorderstraumatic joint disordersCancerCancerCardiovascular disease, Cardiovascular disease, including stroke and including stroke and hypertensionhypertensionDementia, including Dementia, including Alzheimer DiseaseAlzheimer DiseaseDepression and other Depression and other mental health disordersmental health disordersDevelopmental delays, Developmental delays, attentionattention--deficit deficit hyperactivity disorder hyperactivity disorder and autism and autism Diabetes MellitusDiabetes Mellitus
Functional limitations Functional limitations and disabilityand disabilityInfectious diseases Infectious diseases including HIV/AIDSincluding HIV/AIDSObesityObesityPeptic ulcer disease Peptic ulcer disease and dyspepsiaand dyspepsiaPregnancy including Pregnancy including prepre--term birthterm birthPulmonary Pulmonary disease/Asthmadisease/AsthmaSubstance abuseSubstance abuse
Brigham and WomenBrigham and Women’’s Hospitals Hospital Health IT Health IT
ChildrenChildren’’s Hospital s Hospital -- CincinnatiCincinnati Pediatric carePediatric careDuke University Medical CenterDuke University Medical Center Therapies for heart and blood vessel disordersTherapies for heart and blood vessel disorders
HMO Research NetworkHMO Research Network Multiple populationMultiple population--based delivery systems based delivery systems
Houston Area CERTHouston Area CERT Consumer education and patient adherenceConsumer education and patient adherence
KP KP CtrCtr for Health Research, Portlandfor Health Research, Portland Coordinating CenterCoordinating Center
Rutgers UniversityRutgers University Mental health therapeuticsMental health therapeutics
University of Alabama University of Alabama -- BirminghamBirmingham Musculoskeletal disordersMusculoskeletal disorders
University of Arizona & CUniversity of Arizona & C--PathPath Drug interactions/WomenDrug interactions/Women’’s healths health
University of Chicago (New 9/07)University of Chicago (New 9/07) Clinical/economic issues in hospital settingsClinical/economic issues in hospital settings
University of Illinois University of Illinois -- ChicagoChicago Prescribing tools, including formulariesPrescribing tools, including formularies
University of IowaUniversity of Iowa Elderly and agingElderly and aging
University of PennsylvaniaUniversity of Pennsylvania AntiAnti--infective use and resistanceinfective use and resistance
Vanderbilt UniversityVanderbilt University Therapeutic issues in Medicaid and VA systemTherapeutic issues in Medicaid and VA system
Weill Medical College Weill Medical College -- CornellCornell Therapeutic medical devicesTherapeutic medical devices
CERTs CentersCERTs Centers
EvidenceEvidence--Based Practice CentersBased Practice Centers
Created in 1997; Created in 1997; promotes evidencepromotes evidence--based practice and based practice and decisiondecision--makingmakingGenerate comparative Generate comparative effectiveness reviews effectiveness reviews on medications, devices on medications, devices and other interventionsand other interventionsUserUser--driven, with public driven, with public and privateand private--sector sector partnerspartners
• Blue Cross and Blue Shield Association, Technology Evaluation Center (TEC), Chicago, IL
• Duke University, Durham, NC• ECRI, Plymouth Meeting, PA• Johns Hopkins University, Baltimore, MD• McMaster University, Hamilton, Ontario• Oregon Evidence-Based Practice Center• RTI International-University of North
Carolina at Chapel Hill, NC• Southern California Evidence-based
Practice Center-RAND, Santa Monica, CA• Tufts University-New England Medical
Center, Boston, MA• University of Alberta• University of Connecticut• Minnesota Evidence-based Practice
Center• University of Ottawa• Vanderbilt University
DEcIDE Research Network*DEcIDE Research Network*
Outcome Science Cambridge, MA
Brigham & Women’s Hospital Boston, MA
U of Colorado Aurora, CO
U of Pennsylvania Philadelphia, PA
Harvard Pilgrim Boston, MA
Acumen, LLC Palo Alto, CA
U of Illinois Chicago
Duke University Durham, NC
U of Maryland Baltimore, MD
Vanderbilt U Nashville, TN
U of North Carolina Chapel Hill, NC
RTI International RTP, NC
Johns Hopkins Baltimore, MD
**Network of institutions and partner Network of institutions and partner organizations with access to deorganizations with access to de--identified identified data of 50 million patients; generates data of 50 million patients; generates evidence and analytic tools in practical, evidence and analytic tools in practical, accelerated formataccelerated format
AHRQ Evidence Translation/ AHRQ Evidence Translation/ Communication (Eisenberg Center)Communication (Eisenberg Center)
Translates knowledge about Translates knowledge about effective health care into clear, effective health care into clear, actionable summaries to assess:actionable summaries to assess:–– TreatmentsTreatments–– MedicationsMedications–– TechnologiesTechnologies
Develops information summaries Develops information summaries for 3 key audience groups:for 3 key audience groups:–– ConsumersConsumers–– Health care providersHealth care providers–– PolicymakersPolicymakers
The Role of Health IT inThe Role of Health IT in Comparative EffectivenessComparative Effectiveness
AHRQAHRQ’’s Roles & Resourcess Roles & Resources
AHRQ & Comparative AHRQ & Comparative Effectiveness ResearchEffectiveness Research
Health IT & Comparative Health IT & Comparative Effectiveness ResearchEffectiveness Research
A Look AheadA Look Ahead
Q&AQ&A
Health IT and Comparative Health IT and Comparative Effectiveness ResearchEffectiveness Research
As with comparative effectiveness research, As with comparative effectiveness research, health IT is a useful tool in a much larger health IT is a useful tool in a much larger toolkit toolkit –– it is necessary, but not it is necessary, but not thethe solution. solution. With regards to comparative effectiveness With regards to comparative effectiveness research, health IT can play pivotal roles. For research, health IT can play pivotal roles. For example:example:–– Information gathering Information gathering –– technology has the technology has the
potential to enable studies to be potential to enable studies to be completed much, much fastercompleted much, much faster
–– Dissemination Dissemination –– Results about Results about new findings can be widely new findings can be widely distributed very quicklydistributed very quickly
AHRQ Health IT AHRQ Health IT Research FundingResearch Funding
LongLong--term agency priorityterm agency priorityAHRQ has invested more AHRQ has invested more than $260 million in than $260 million in contracts and grants contracts and grants More than 150 More than 150 communities, hospitals, communities, hospitals, providers, and health care providers, and health care systems in 48 statessystems in 48 states
AHRQ Health IT AHRQ Health IT Investment: $260 Investment: $260
MillionMillion
AHRQ Health IT InitiativeAHRQ Health IT Initiative
State and regional State and regional demonstrationsdemonstrationsGrantsGrantsPrivacy and security solutions Privacy and security solutions for Interoperable Health for Interoperable Health Information ExchangeInformation ExchangeASQ initiativeASQ initiativeEE--prescribing pilotsprescribing pilotsClinical decision support Clinical decision support demonstrationsdemonstrationsTechnical assistance for Technical assistance for Medicaid and CHIP agenciesMedicaid and CHIP agencies
National Resource Center National Resource Center for Health ITfor Health IT
Established in 2004Established in 2004Central national source of Central national source of information and assistance information and assistance for advancing health IT for advancing health IT goalsgoalsMaintains operation of Maintains operation of health IT Web sitehealth IT Web siteDirect technical assistance Direct technical assistance to AHRQ granteesto AHRQ granteesRepository for lessons Repository for lessons learnedlearned
http://http://healthit.ahrq.govhealthit.ahrq.gov
Health IT EPC ReportHealth IT EPC Report
First synthesis of existing First synthesis of existing evidence on factors evidence on factors influencing the usefulness, influencing the usefulness, usability, barriers and drivers usability, barriers and drivers to use, and effectiveness of to use, and effectiveness of consumer applicationsconsumer applicationsThe top factor associated The top factor associated with use by patients was the with use by patients was the perception of a health benefitperception of a health benefitPatients prefer systems Patients prefer systems tailored to them that tailored to them that incorporate familiar devicesincorporate familiar devices
Issue PapersIssue Papers
Substantive reports of issues, challenges and lessons learned from granteesExecutive summaries list the grantees being evaluated and describe key points and challenges faced during implementationTopics include Bar-Coded Medication Administration, Regional Health Information Organizations, Long-term Care, and the Rural Underserved
AHRQAHRQ’’s Patient Safety and s Patient Safety and Health IT EHealth IT E--NewsletterNewsletter
FreeMonthly Highlights news and information on health IT research, funding opportunities, data, events, publications23,000 subscribers
Support for Clinical DecisionSupport for Clinical Decision-- Making at the Point of CareMaking at the Point of Care
A quick handsA quick hands--on tool designed to on tool designed to help primary care clinicians identify help primary care clinicians identify screening, counseling and screening, counseling and preventive medication services preventive medication services appropriate for patientsappropriate for patients
Available both as a PDA application Available both as a PDA application and Weband Web--based toolbased tool
Based on current USPSTF Based on current USPSTF recommendations, can be searched recommendations, can be searched by specific patient characteristicsby specific patient characteristics
www.ePSS.ahrq.govwww.ePSS.ahrq.gov
Electronic Preventive Electronic Preventive Services Selector (Services Selector (ePSSePSS))
The Role of Health IT inThe Role of Health IT in Comparative EffectivenessComparative Effectiveness
AHRQAHRQ’’s Roles & Resourcess Roles & Resources
AHRQ & Comparative AHRQ & Comparative Effectiveness ResearchEffectiveness Research
Health IT & Comparative Health IT & Comparative Effectiveness ResearchEffectiveness Research
A Look AheadA Look Ahead
Q&AQ&A
Evidence of ProgressEvidence of Progress
WalWal--MartMart–– Plans to sell Plans to sell EMRsEMRs to to
doctorsdoctorsGeisingerGeisinger Health SystemsHealth Systems–– Building the capability to Building the capability to
push specific types of push specific types of information to select patient information to select patient populationspopulations
MarriottMarriott–– Launched a preventive Launched a preventive
health campaign to help health campaign to help address multiple languages address multiple languages and diverse backgrounds of and diverse backgrounds of employeesemployees
Distributed Network Prototypes* Distributed Network Prototypes* for Populationfor Population--Based StudiesBased Studies
Aim: to develop a federated network prototype that Aim: to develop a federated network prototype that supports secure analyses of electronic information supports secure analyses of electronic information across multiple organizations to study risks, effects across multiple organizations to study risks, effects and outcomes of various medical therapiesand outcomes of various medical therapiesThe longThe long--term goal is a coordinated partnership of term goal is a coordinated partnership of multiple research networks that provide information multiple research networks that provide information that can be quickly queried and analyzed: that can be quickly queried and analyzed: –– Model 1Model 1: Colorado DEcIDE center with American Academy of : Colorado DEcIDE center with American Academy of
Family Practice will develop the Family Practice will develop the ““Distributed Ambulatory Distributed Ambulatory Research NetworkResearch Network”” ((DARTNetDARTNet) using electronic health record ) using electronic health record (EHR) data from eight organizations representing over 200 (EHR) data from eight organizations representing over 200 clinicians and over 350,000 patientsclinicians and over 350,000 patients
–– Model 2Model 2: HMO Research Network (HMORN) DEcIDE will develop : HMO Research Network (HMORN) DEcIDE will develop the the ““Virtual Data WarehouseVirtual Data Warehouse”” to assess the effectiveness and to assess the effectiveness and safety of different antisafety of different anti--hypertensive 5.5 to 6 million individuals hypertensive 5.5 to 6 million individuals cared for by six health planscared for by six health plans
**AHRQ Centers for Outcomes and EvidenceAHRQ Centers for Outcomes and Evidence
The The ““3T3T’’ss”” Road Map to Road Map to Transforming U.S. Health CareTransforming U.S. Health Care
Key T1 activity to testKey T1 activity to testwhat care workswhat care works
Clinical efficacy researchClinical efficacy research
Key T2 activities to testKey T2 activities to testwho benefits from who benefits from
promising carepromising care
Outcomes researchOutcomes researchComparative effectivenessComparative effectiveness
ResearchResearch
Health services researchHealth services research
Key T3 activities to testKey T3 activities to testhow to deliver highhow to deliver high--qualityquality
care reliably and incare reliably and inall settingsall settings
Measurement and Measurement and accountability of healthaccountability of health
care quality and costcare quality and cost
Implementation of Implementation of Interventions and healthInterventions and health
care system redesigncare system redesign
Scaling and spread of Scaling and spread of effective interventionseffective interventions
Research in above domainsResearch in above domains
T1 T2 T3Basic biomedicalscience
Clinical efficacy knowledge
Clinical effectivenessknowledge
Improved healthcare quality and
value andpopulation health
Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 23Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp. 231919--2321. The 2321. The ““3T3T’’s Roadmap to Transform U.S. Health Care: The s Roadmap to Transform U.S. Health Care: The ‘‘HowHow’’ of Highof High--Quality Care.Quality Care.””
2121stst Century Health CareCentury Health CareImproving quality by promoting a culture of safety Improving quality by promoting a culture of safety
through Valuethrough Value--Driven Health CareDriven Health Care
21st Century Health Care
InformationInformation--rich, patientrich, patient-- focused enterprisesfocused enterprises
Information and Information and evidence transform evidence transform
interactions from interactions from reactive to reactive to
proactive (benefits proactive (benefits and harms)and harms)
Evidence is Evidence is continually refined continually refined as a byas a by--product of product of
care deliverycare delivery
Actionable information available Actionable information available –– to to clinicians AND patients clinicians AND patients –– ““just in timejust in time””
According to Yogi BerraAccording to Yogi Berra
““If you don't know If you don't know where you are where you are going, you might going, you might wind up someplace wind up someplace else.else.””
The Role of Health IT inThe Role of Health IT in Comparative EffectivenessComparative Effectiveness
AHRQAHRQ’’s Roles & Resourcess Roles & Resources
AHRQ & Comparative AHRQ & Comparative Effectiveness ResearchEffectiveness Research
Health IT & Comparative Health IT & Comparative Effectiveness ResearchEffectiveness Research
A Look AheadA Look Ahead
Q&AQ&A