the role of health it in comparative effectiveness · james scanlon, hhsjames scanlon, hhs...

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






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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






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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))






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.””






Q&AQ&A

the role of health it in comparative effectiveness · james scanlon, hhsjames scanlon, hhs...

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