Section 1: Health and Clinical Management: Leveraging Information Technology to Improve Quality and Safety

Summary

Objectives

To examine five areas that we will be central to informatics research in the years to come: changing provider behavior and improving outcomes, secondary uses of clinical data, using health information technology to improve patient safety, personal health records, and clinical data exchange.

Methods

Potential articles were identified through Medline and Internet searches and were selected for inclusion in this review by the authors.

Results

We review highlights from the literature in these areas over the past year, drawing attention to key points and opportunities for future work.

Conclusions

Informatics may be a key tool for helping to improve patient care quality, safety, and efficiency. However, questions remain about how best to use existing technologies, deploy new ones, and to evaluate the effects. A great deal of research has been done on changing provider behavior, but most work to date has shown that process benefits are easier to achieve than outcomes benefits, especially for chronic diseases. Use of secondary data (data warehouses and disease registries) has enormous potential, though published research is scarce. It is now clear in most nations that one of the key tools for improving patient safety will be information technology— many more studies of different approaches are needed in this area. Finally, both personal health records and clinical data exchange appear to be potentially transformative developments, but much of the published research to date on these topics appears to be taking place in the U.S.— more research from other nations is needed.

Keywords

Physicians’ practice patterns - patient safety - registries - personal health records - regional health information organizations

 

• References

• 1 McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A. et al. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med 2003; 348: 2635-45.
• 2 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; May; 144 (10) 742-52.
• 3 Bates DW. The road to implementation of the electronic health record. Proc (Bayl Univ Med Cent) 2006; Oct; 19 (04) 311-2.
• 4 Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J. et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005; 293 (10) 1223-38.
• 5 Balas EA, Li ZR, Spencer DC, Jaffrey F, Brent E, Mitchell JA. An expert system for performancebased direct delivery of published clinical evidence. J Am Med Inform Assoc 1996; 03 (01) 56-65.
• 6 Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient out-comes: a systematic review. JAMA 1998; 280 (15) 1339-46.
• 7 Sequist TD, Gandhi TK, Karson AS, Fiskio JM, Bugbee D, Sperling M. et al. A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc 2005; 12 (04) 431-7.
• 8 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 (7494): 765.
• 9 Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ. et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 2006; 296 (04) 427-40.
• 10 Mangione CM, Gerzoff RB, Williamson DF, Steers WN, Kerr EA, Brown AF. et al. The association between quality of care and the intensity of diabetes disease management programs. Ann Intern Med 2006; 145 (02) 107-16.
• 11 Downs M, Turner S, Bryans M, Wilcock J, Keady J, Levin E. et al. Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study. BMJ 2006; 332 (7543) 692-6.
• 12 Palen TE, Raebel M, Lyons E, Magid DM. Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication orders. Am J Manag Care 2006; 12 (07) 389-95.
• 13 McGregor JC, Weekes E, Forrest GN, Standiford HC, Perencevich EN, Furuno JP. et al. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform Assoc 2006; 13 (04) 378-84.
• 14 Lorenzoni R, Ebert AG, Lattanzi F, Orsini E, Mazzoni A, Magnani M. et al. A computer protocol to evaluate subjects with chest pain in the emergency department: a multicenter study. J Cardiovasc Med 2006; 07 (03) 203-9.
• 15 Healthcare Data Warehousing Association (HDWA). www.hdwa.org Accessed 2/19/2007
• 16 Wan TT. Healthcare informatics research: from data to evidence-based management. J Med Syst 2006; Feb; 30 (01) 3-7.
• 17 Dewitt JG, Hampton PM. Development of a data warehouse at an academic health system: knowing a place for the first time. Acad Med 2005; Nov; 80 (11) 1019-25.
• 18 Grant A, Moshyk A, Diab H, Caron P, de Lorenzi F, Bisson G. et al. Integrating feedback from a clinical data warehouse into practice organisation. Int J Med Inf 2006; Mar-Apr; 75 3-4 232-9.
• 19 Persell SD, Wright JM, Thompson JA, Kmetik KS, Baker DW. Assessing the validity of national quality measures for coronary artery disease using an electronic health record. Arch Intern Med 2006; Nov 13; 166 (20) 2272-7.
• 20 Brown SH, Speroff T, Fielstein EM, Bauer BA, Wahner-Roedler DL, Greevy R. et al. eQuality: electronic quality assessment from narrative clinical reports. Mayo Clin Proc 2006; Nov; 81 (11) 1472-81.
• 21 Turchin A, Nikheel SK, Grant RW, Makhni EC, Pendergrass ML, Einbinder JS. Using Regular Expressions to Abstract Blood Pressure and Treatment Intensification Information from the Text of Physician Notes. J Am Med Inform Assoc 2006; 13: 691-5.
• 22 Steinbrook R. Facing the diabetes epidemic—mandatory reporting of glycosylated hemoglobin values in New York City. N Engl J Med 2006; Feb 9; 354 (06) 545-8.
• 23 Banerji MA, Stewart RB. A public health approach to the diabetes epidemic: NewYork City’s diabetes registry. Curr Diab Rep 2006; Jun; 06 (03) 169-71.
• 24 Clark AM, Findlay IN. Have a Heart Paisley IT Group. Improving evidence based cardiac care and policy implementation over the patient journey: the potential of coronary heart disease registers. Heart 2005; Sep; 91 (09) 1127-30.
• 25 Georgiou A, Burns J, McKenzie S, Penn D, Flack J, Harris MF. Monitoring change in diabetes care using diabetes registers—experience from divisions of general practice. Aust Fam Physician 2006; Jan-Feb; 35 1-2 77-80.
• 26 Levin-Scherz J, DeVita N, Timbie J. Impact of payfor-performance contracts and network registry on diabetes and asthma HEDIS measures in an integrated delivery network. Med Care Res Rev 2006; Feb; 63 (1 Suppl): 14S-28S.
• 27 Han YY, Carcillo JA, Venkataraman ST, Clark RSB, Watson RS, Nguyen TC. et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (06) 1506-12.
• 28 Phibbs CS, Milstein A, Delbanco SD, Bates DW. No proven link between CPOE and mortality. <http://pediatrics.aapublications.org/cgi/eletters/116/6/1506> 19 Dec 2005
• 29 Del Beccaro MA, Jeffries HE, Eisenberg MA. Harry Computerized provider order entry implementation: no association with increased mortality rates in an intensive care unit. Pediatrics 2006; 118 (01) 290-5.
• 30 Ammenwerth E, Talmon J, Ash JS, Bates DW, Beuscart-Zephir MC, Duhamel A. et al. Impact of CPOE on mortality rates—contradictory findings, important messages. Methods Inf Med 2006; 45 (06) 586-93.
• 31 Poon EG, Blumenfeld B, Hamann C, Turchin A, Graydon-Baker E, McCarthy PC. et al. Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network. J Am Med Inform Assoc 2006; 13 (06) 581-92.
• 32 Berner ES, Houston TK, Ray MN, Allison JJ, Heudebert GR, Chatham WW. et al. Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial. JAMA 2006; 13 (02) 171-9.
• 33 Simon SR, Smith DH, Feldstein AC, Perrin N, Yang X, Zhou Y. et al. Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people. J Am Geriatr Soc 2006; 54 (06) 963-8.
• 34 Judge J, Field TS, DeFlorio M, Laprino J, Auger J, Rochon P. et al. Prescribers’ responses to alerts during medication ordering in the long term care setting. JAMA 2006; 13 (04) 385-90.
• 35 Casey MM, Wakefield M, Coburn AF, Moscovice IS, Loux S. Prioritizing patient safety interventions in small and rural hospitals. J Comm J Qual Patient Saf 2006; 32 (12) 693-702.
• 36 Sims SA, Snow LA, Porucznik CA. Surveillance of methadone-related adverse drug events using multiple public health data sources. J Biomed Inform. In press 2007
• 37 Wagner EH. Chronic disease management: What will it take to improve care for chronic illness?. Eff Clin Pract 1998; 01: 2-4.
• 38 Connecting for Health. The personal health working group final report. Markle Foundation. 2003 Jul 1
• 39 Lowes R. Personal health records: What’s the status now?. Med Econ. 2006 Feb 17;83(4):TCP13-4, TCP16
• 40 Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006; Mar-Apr; 13 (02) 121-6.
• 41 Raths D. Gateway to success. With consumers becoming more responsible for their healthcare choices, portals can help separate tech-savvy providers and payers from the competition. Healthc Inform 2006; Apr; 23 (04) 30-2. 34, 36..
• 42 Grant RW, Wald JS, Poon EG, Schnipper JL, Gandhi TK, Volk LA. et al. Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care. Diabetes Technol Ther 2006; Oct; 08 (05) 576-86.
• 43 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Affairs. 2005 Suppl:W5-10-W5-18
• 44 Carvel J. GPs revolt over patient files privacy. The Guardian. November 21, 2006 http://society.guardian.co.uk/health/story/0,1953212,00.html Accessed 2/25/2007
• 45 Debor G, Diamond C, Grodecki D, Halamka J, Overhage JM, Shirky C. A tale of three cities— where the RHIOS meet the NHIN. J Healthc Inf Manag 2006; 20 (03) 63-70.
• 46 E-HIM Work Group on Patient Identification in RHIOs. “Surveying the RHIO Landscape: A Description of Current RHIO Models, with a Focus on Patient Identif ication.”. J AHIMA 2006; Jan; 77 (01) 64A-D.
• 47 Raths D. Real solutions for RHIO problems. Pioneering data exchange groups seek sustainability by solving business problems for members. Healthc Inform 2006; Aug; 23 (08) 26-9.
• 48 The Connecting for Health Common Framework: Resources for Implementing Private and Secure Health Information Exchange. http://www.connectingforhealth.org/commonframework/