The Agency for Healthcare Research and Quality will spend time and money in 2016 on improving outcomes in one of the oldest use cases in health information technology: applying computers to support clinical decisionmaking.
“We have a grant out and we're reviewing applications now,” said Dr. Arlene Bierman, director of the AHRQ's Center for Evidence and Practice Improvement, in a recent interview. “We'll see what people propose.”
Bierman said one aim is to create “a learning network across the country,” focused on clinical decision support, using both existing systems and new ones where there is a demonstrated need.
A geriatrician, Berman previously served as a senior research physician AHRQ from 1997 to 2003 followed by 12 years as an assistant professor, full professor and researcher at the University of Toronto. She returned to the agency in August, just in time to sweat out an appropriations battle that might have either eliminated or eviscerated AHRQ.
Although the House had voted earlier to cut AHRQ's funding entirely and transfer its work to other agencies, and the Senate proposed a 35% reduction, the recently passed omnibus spending bill merely trimmed the AHRQ budget by 8%.
That leaves AHRQ, which has a substantial health information technology portfolio, $334 million to spend in fiscal year 2016, compared with $364 million in 2015. Bierman's center at AHRQ has five divisions – health information technology, decision science and patient engagement, practice improvement, the U.S. Preventative Services Task Force and the National Center for Excellence in Primary Care Research.
AHRQ “is reviewing the budget and all options as to next steps,” said an agency spokesman. “No decisions have been made,” on how the imposed cuts will be allocated.
Money for clinical decision support research is to come from the Patient-Centered Outcomes Research Trust Fund, so it was not subject to the recent budget machinations.
Computerized clinical decision support systems date back to the earliest days of the health IT industry.
Computerized physician order entry technology, to which many common CDS systems such as drug-drug and drug-allergy alerts are attached, is nearly ubiquitous today in hospitals and widely available to physician practices, thanks in large part to $31.7 billion in federal EHR incentive payments.
But the benefits of decision support are not uniformly distributed, Bierman said. For one thing, participation in the federal EHR program is lower for physicians than hospitals. And just because a hospital or practice has CDS doesn't mean it's always used or valued.
“Yes, we've been doing this for a long time, but there are barriers to use,” Bierman said. “There are some questions about acceptability to some physicians. We want to diffuse this to small to medium sized practices and small hospitals so it's available to every patient wherever you got to get care.”
Another health IT theme at AHRQ is incorporation of patient outcomes data, including patient-reported data, into a clinician's workflow.
Yet another is sharing patient care plans as needed across multiple providers, “making it easier to use EHRs for population management, whether at the practice level or the community level,” Bierman said.
“We got about 20 pages of things we're focusing on,” Bierman said. “We can only tackle a piece of it, but we feel the work that we do is very important. We're very open to get feedback from the community.”