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From the August 2003 Issue Stanching Hospitals' Financial Hemorrhage With Information Technology |
AHRQ: A Tradition of Evidence Federal agency carries a rich history of involvement in today’s evidence-based medicine movement, focusing on the “evidence inside” healthcare IT. By Carolyn M. Clancy, M.D. Over the past decade, the importance of applying scientific evidence to improving clinical care has become increasingly apparent to clinicians and healthcare organizations. The recognition that information technology can bring this evidence to the point of care in a timely fashion has inspired enormous enthusiasm. IT has the potential to make the right thing to do, the easy thing to do. This is exciting news for us at the Agency for Healthcare Research and Quality (AHRQ). Not only have we sponsored much of the science-based clinical research now being used, but we have also developed the evidence for harnessing IT in delivering that research. We have been building this evidence since the late 1960s. Today, we work directly with IT vendors to show how AHRQ-sponsored work can be customized for use in their products. Through our clinical information systems outreach project, we are partnering with companies large and small to bring our science-based research, quality indicators, databases, consumer publications and other materials directly to the point of care. Table 1 (see below) represents a snapshot of our many resources.
Many readers know us by our former name, the Agency for Healthcare Policy and Research, which Congress changed to AHRQ in 1999. We are one of several public health service agencies within the Department of Health and Human Services; sister agencies include the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration. Based in Rockville, Md., with a staff of approximately 280, we are the nation’s lead government agency for sponsoring evidence-based research on healthcare quality, costs, outcomes and patient safety. Our mission is to not only sponsor and develop science-based research, but also to ensure that research is used in everyday clinical practice. Putting Evidence to Work Researcher E. Andrew Balas discovered that, on average, it takes as long as 17 years for research to be used for patient care. This finding has been substantiated by several AHRQ-funded studies. For example, our research found that elderly patients who received beta-blockers following a heart attack were 43 percent less likely to die in the first two years following such an attack than were patients who did not receive this drug. Despite this finding, however, only 21 percent of eligible patients were receiving such therapy. One reason for the lag between publication of research and actual implementation is obvious: With so many studies and journal articles published daily, physicians cannot keep pace with the amount of information available, much less perform the necessary comparison and analysis needed to assess the evidence. Even if they could keep pace, it would be impossible to carry so many studies to the bedside. But when research is assessed and brought together in the form of evidence-based recommendations, it can be downloaded, uplinked, incorporated into software or sent out as alerts. The lag between publication and implementation can be significantly shortened. More than 30 years ago, AHRQ sponsored much of the initial work in medical informatics and information technology. As early as 1968, agency-funded research looked at the efficacy of COSTAR (Computer Stored Ambulatory Record), one of the earliest electronic patient record systems, in reminding physicians to perform specific screening and preventive measures. From there, our work expanded to include computerized physician order entry, computer generated alerts, and now includes more than 150 studies in informatics and information technology. It is this vision—to build the evidence for using IT in delivering other evidence—that is the unique contribution of AHRQ. Diverse Partnerships Partnership has been the cornerstone of numerous AHRQ initiatives. In fact, many of the content resources listed in Table 1 are themselves the products of partnerships (e.g., the National Guideline Clearinghouse is a partnership with the American Medical Association and the American Association of Health Plans). Developing partnerships with technology vendors in bringing science to the point of care was the logical next step in putting research into practice. Our first partnership was established when ePocrates, a handheld physician network, agreed to publish ePocrates DocAlert messages featuring recommendations from the U.S. Preventive Services Task Force (USPSTF)—an independent panel of experts based at AHRQ—and other AHRQ research. DocAlert messages deliver clinical news such as medication safety alerts, customized information on medical specialties and USPSTF recommendations directly to clinicians’ PDAs. To receive these messages, clinicians download the ePocrates software to their PDAs. Each time they synchronize their devices, they receive three new alerts, one of which might be a USPSTF recommendation. If clinicians want more information on the recommendation, they simply check the “Email More Info” button, and the next time they synchronize their handhelds, additional information is sent to their e-mail accounts. They can also view additional information directly on their PDAs in the form of a Doc Memo, which can be saved directly to their devices. To date, nine USPSTF recommendations have been announced through alert messages. Of nearly 500,000 clinicians who have seen DocAlerts with Task Force recommendations, more than 40 percent have requested or viewed additional information. Clinical Content Consultants LLC Another of our CIS partners is Clinical Content Consultants LLC, a small physician-owned company based in Concord, N.H., that develops evidence-based clinical decision-support software applications that help healthcare providers improve the quality of care. One of CCC’s product lines is the Clinical Guideline Encounter Form, an electronic face sheet that clinicians use with an electronic medical record to capture and record patient information. The form also provides evidence-based treatment recommendations based on the data entered. Through a partnership with AHRQ, CCC is incorporating the latest Task Force recommendations in its Prevention Encounter Form software. The software provides clinical decision support prompts that automatically alert the provider when preventive services are due and allows for easy documentation and tracking. It also enables clinicians to view the latest recommendation and link to it on the USPSTF and AHRQ Web sites for further information. InfoPOEMs In another example, AHRQ is partnering with InfoPOEMs Inc. (Patient-Oriented Evidence that Matters), which produces daily e-mails to healthcare professionals, alerting them to the latest development in clinical medicine research. A group of editors reviews more than 1,000 studies monthly from more than 100 journals. These InfoPOEMs can also be accessed through Inforetriever, an online database system that provides a full scope of information from decision-support tools to diagnostic calculators, and from clinical practice guidelines to Cochrane Systematic Review abstracts. The entire system is built on the idea that evidence-based information must be available for healthcare professionals to use at the bedside. To this end, Inforetriever is also available as a PDA application, allowing doctors to access relevant information quickly and efficiently. InfoPOEMs now provides many of the clinical practice guideline summaries housed in the National Guideline Clearinghouse as well as USPSTF recommendations in its Inforetriever system. In addition, the pneumonia severity index, developed by AHRQ’s Pneumonia Patient Outcomes Research Team, is included as a decision-support tool to help physicians determine the most appropriate care for newly diagnosed cases of community-acquired pneumonia by predicting patient risk of mortality within 30 days of initial diagnosis. As new technologies continue to emerge, AHRQ will continue identifying ways to put science directly into clinicians’ hands and improve the quality of everyday care. Discussions are now under way with 20 more companies, and we expect to announce several additional partnerships in the coming months. As the penetration of IT in healthcare organizations reaches a critical mass, it will be essential to ensure that information delivery systems are based on the best possible evidence, and that the evidence reflects the most current scientific knowledge. AHRQ’s mission is to ensure that the “evidence inside” IT is current and is effectively deployed to improve the quality and safety of healthcare. Carolyn M. Clancy, M.D., is the director of the Agency for Healthcare Research and Quality, Rockville, Md. For more information about AHRQ’s CIS Partnership program, For more information about ePocrates’ DocAlerts, www.rsleads.com/308ht-206 For more information about Clinical Guidelines Encounter Forms from Clinical Content Consultants LLC, www.rsleads.com/308ht-207 For more information about InfoPOEMs Inc., www.rsleads.com/308ht-208 © 2003 Nelson Publishing, Inc |
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