Qual-IT - April 2006
New Reports Offer Guidelines, Assess HIT BenefitsOn April 10-11, the eHealth Initiative, joined by a large number of co-sponsors, hosted the Third Annual Connecting Communities Learning Forum. This year's sessions reflected the continued evolution of health information technology (HIT) and interoperability efforts throughout the country, with workshops profiling both fledgling and more advanced efforts of a number of state and regional collaborations. Rachel Block, director of the United Hospital Fund's Quality Strategies Initiative, and Bill Schroth, chair of the New York State Department of Health's HIT working group, gave a presentation on New York's HIT policy efforts. Adding a national perspective, the meeting also marked the release of new reports from Connecting for Health (CFH) and the federal Department of Health and Human Services' Agency for Health Care Quality and Research (AHRQ), both summarized below.
The new CFH report, noted Carol Diamond, director of health programs for the Markle Foundation, a co-sponsor of Connecting for Health, provides detailed policy and technical guidelines for the implementation of the CFH Common Framework for health information exchange. The framework reflects the premise that national implementation of health information exchange will occur through linkages among decentralized networks, and that a shared set of policies and technical standards should govern how those exchanges operate. Connecting for Health's primary policy focus is the protection of patient privacy across the full spectrum of information exchange activities, through:
· Limiting data collection and use;
· Developing model policies and procedures to protect privacy;
· Establishing procedures for notification and consent when data is accessed;
· Ensuring that patient data is correctly matched between discreet sources;
· Verifying the identity and scope of access for authorized system users; and
· Handling breaches of confidentiality.
In addition to these policy issues, CFH has developed detailed technical standards for health information exchange, addressing:
· The architecture of data exchange, including standards for messages (e.g., requests for data and responses to those requests);
· Standards for reporting of medication histories and laboratory results;
· Issues relating to data quality; and
· A technical prototype of the “record locator service”—the backbone of CFH's technical model for data exchange—as it is being implemented in Massachusetts.
All of Connecting for Health's technical standards are available on an open-source basis, free for use by health data exchange organizations. The CFH guide also covers model contract language, including detailed terms and conditions addressing all of the framework's key topics.
The new Agency for Health Care Quality and Research report, Costs and Benefits of Health Information Technology, introduced at the conference by agency director Carolyn Clancy, is based on research and analysis conducted by the RAND Corporation and its AHRQ-funded Southern California Evidence-Based Practice Center. The report focuses on a wide range of research literature that examines discrete HIT functions and systems within health care settings, and the extent to which these findings could be broadly applicable to health organizations in general.
While the report does not address the costs and benefits associated with interoperable health information exchange across multiple health care organizations, it does cite several areas in which evidence clearly points to the benefits of HIT within an organization:
· Clinical decision support and computerized prescription order entry systems have reduced incorrect dosing and other medication errors in pediatric inpatient settings.
· Decision support tools, such as guidelines and prompts to administer lab tests, have increased appropriate use of testing and reduced waste by decreasing over-ordering of certain tests.
· Computerized reminders on preventive care, as well as telemedicine, have directly benefited consumers.
Ultimately, HIT will result in cost savings, the report concludes—although studies differ as to when the break-even point might be achieved.
Nevertheless, the authors note important limitations in the current HIT research and evidence base. First, a large proportion of the extant research was conducted in a small number of academic medical centers that have been leaders in HIT implementation and research for many years. These institutions are atypical, and their research has tended to be geared toward specific issues arising within their respective operational environments. In addition, few of the studies were based on randomized controlled trials, the most widely accepted standard for research design. And few of the studies focused on a comprehensive set of health information system functions (RAND used a typology previously developed by the
It is particularly striking that the review found so few examples of research that looks at a comprehensive suite of electronic health information functions across a variety of provider settings. Additionally, the scope of the report and, very likely, the extent of the evidence does not cover conditions for large-scale interoperable data exchange. Dissemination of these findings about study design should provide guidance to future research efforts focusing on HIT.
As regional health information models—including those following Connecting for Health's recommended standards—move forward, future researchers will have a bigger and more complex landscape to assess. The New York State Department of Health is developing plans for evaluation and research based on the experience of its Health Care Efficiency and Affordability Law for New Yorkers (HEAL-NY) grantees. It will likely play a national leadership role in establishing the research protocols–and, it is hoped, documenting the results–that will influence clinical data exchange efforts across the country.
Agency for Health Care Quality and Research. The report, and additional information on the HIT benefits and costs database project that it summarizes, as well as other agency activities, can be accessed at http://healthit.ahrq.gov/portal/server.pt?open=512&objID=650&PageID=0&parentname=ObjMgr&parentid=106&mode=2&dummy=/index.html
Connecting for Health. CFH's report, procedures for accessing its technical code, and additional materials can be viewed at www.connectingforhealth.org