Essays academic service

Improvement of technology in healthcare delivery system

AHRQ is responding to this mandate by utilizing the full spectrum of funding mechanisms to support projects that will generate knowledge and evidence on the use of IT in health care. Specific IT components; Application of IT in AHRQ's clinical research networks; IT as an essential component of translating research into practice; and, IT as the backbone of efforts to assure an effective health system response to bioterrorism.

Accordingly, the Agency developed a series of research solicitations RFAs to: Design and test best practices for reducing errors in multiple health care settings; Develop the science base to inform these efforts; Improve provider education to reduce errors; Capitalize on IT advances to translate effective strategies into widespread practice; and Build capacity to further reduce errors.

This represents the single largest investment the federal government has ever made to address the problem of medical errors.

  1. This is where The Cloud comes in. Technological advancements in healthcare have contributed to services being taken out of the confines of hospital walls and integrating them with user-friendly, accessible devices.
  2. We might do that by distinguishing infrastructure, which is provided about once, with consumables that are provided regularly.
  3. In fact, healthcare apps are one of the fastest-growing markets in mobile application development. The PBRNs were established in September 2000, when 19 networks from across the country were funded with planning grants.
  4. That's one of the reasons we see varied care all over the country.
  5. Technical solutions to this problem include providing accredited high-quality information; cultural solutions include improving education.

The CLIPS RFA generated enthusiasm among patient safety and informatics researchers and resulted in a large number of competitive proposals from a wide range of public and private sector organizations. Many proposals involved research using handheld wireless devices, electronic medical record systems, computerized decision support tools, or electronic prescribing applications. Other areas of proposed research included simulation models for education and training, automated error alerting mechanisms, structured electronic data sets, digital eye technology, database applications, computerized patient self-monitoring and communication tools, wearable mini computers, biometric technology, Internet and intranet applications, cognitive science and human factors engineering, data mining, and barriers to electronic prescribing.

Examples of currently funded projects are summarized in Table 2. This project examines the acceptance, benefits, and barriers in the use of stand-alone, handheld decision support systems DSSs in an ambulatory setting, and the clinical impact and cost-effectiveness of point-of-care, handheld ambulatory DSSs on medical errors.

Use of Information Technology to Improve the Quality of Health Care in the United States

Researchers are developing an infrastructure to support automated surveillance of errors by applying a natural language processor to code the information contained in patients' electronic medical records to detect and characterize medical errors.

This research project will determine whether preventable adverse outcomes for the frail elderly population in long-term care settings can be avoided by using computers that alert nursing and other staff to the likelihood of problems such as falls, pressure ulcers, and urinary tract infections. This project explores the relationship between human, machine, and environmental factors associated with the operation of infusion devices in clinical settings.

The project will identify and characterize properties of infusion devices, environmental conditions, and operator cognition that promote user errors. For example, one group of investigators developed a web-based communication and disease management system that provides clinical information and facilitates communication between patients with asthma and their providers.

The Impact of Technology in Healthcare

They are currently assessing the impact of their program on compliance with asthma management guidelines and overall quality of care. Another group of researchers is developing a prototype information exchange system that provides immediate access to patient information and facilitates communication during emergency response situations by integrating Internet resources, fingerprint technology, and smart cards.

Finally, a third group of investigators is developing a computerized medical monitoring device that is enabled with a Bluetooth wireless network. The device automatically collects, analyzes and transmits patient data, and also alerts patients and providers to potential problems.

The group is currently developing working prototypes of a weight scale, glucose monitor, and thermometer. The network includes nine partners that encompass a wide variety of organizational care settings and provide health care services to more than 55 million people.

These IDSRN partners are well suited for conducting relevant research due to 1 their improvement of technology in healthcare delivery system to collect and maintain administrative, claims, clinical, and other data on large populations that are clinically, demographically, and geographically diverse; 2 their access to many of the country's leading clinicians, health services researchers, and health care facilities; 3 their expertise in quantitative and qualitative methodologies, including emerging areas with important policy or managerial implications; and their leadership and improvement of technology in healthcare delivery system authority to implement and evaluate various interventions, including financial and organizational changes.

For example, two network partners are studying how automated electronic reminders affect compliance with recommended guidelines for the management of patients with diabetes. Another network partner is studying how different integrated delivery systems in California, Washington, Oregon, Alaska, North Carolina, Utah, and Idaho transfer medication information within each system. Finally, two partners are studying how electronic communication can be used by patients and providers to improve quality of care.

The PBRNs are made up of community-based, primary care clinicians working together with experienced health services researchers to address clinically relevant health care issues and translate research findings into practice to improve quality of care.

The PBRNs were established in September 2000, when 19 networks from across the country were funded with planning grants. The PBRNs represent a wide variety of practice settings located in 50 states and the District of Columbia, providing access to more than 5,000 primary care providers and almost seven million patients.

For example, one PBRN is testing the feasibility of clinicians using handheld devices with computerized algorithms for assessing and counseling patients who smoke. Another network is testing an Internet-based communication, surveillance, and data management system to enhance linkages between community practices, state health departments, and the State Epidemiological and Bioterrorism Surveillance System. A third network is testing the use of a computerized automated reminder system for lipid management within an electronic medical record.

The system integrates a patient's clinical information with current research findings, calculates the risk of cardiovascular disease for an individual patient, and generates reminders to the clinician. Finally, three PBRNs are developing interactive surveillance systems to recognize bioterrorism events.

Translating Research into Practice TRIP Research on Translation and Implementation In health care, many clinical practices are not based on good scientific evidence regarding an intervention's impact on important outcomes or quality of care. Sometimes this occurs because evidence from well conducted, randomized controlled trials is not available.

  1. For example, passwords may not work very well, so nurses find ways to get on with their jobs regardless. The bad apple theory is very appealing.
  2. Conclusion Health care has lagged far behind many other industries in harnessing the capabilities of IT to improve services, knowledge, communication, outcomes, quality, and efficiency.
  3. Electronic medical records allow all patient histories, test results, diagnoses and relevant information to be stored centrally in an online location. They catch errors," he says.
  4. They can also draw from existing studies for comprehensive meta-analyses. The device automatically collects, analyzes and transmits patient data, and also alerts patients and providers to potential problems.
  5. The implementation of these telemedicine options means less crowded waiting rooms and easing the pressure on front desk teams. This article has been cited by other articles in PMC.

However, even when good evidence is available and there is strong consensus regarding the effects of an intervention, there is often inappropriate utilization of the intervention, resulting in suboptimal care. Studies suggest that it takes an average of 17 years for research evidence to be incorporated into standard clinical practice. The use of IT can help overcome this gap in knowledge management and application through tools to enhance the translation, implementation, and dissemination of important research findings in clinical practice.

With this in mind, AHRQ launched its Translating Research into Practice TRIP-I program in 1999, funding 14 projects to generate new knowledge about facilitating the use of rigorously derived evidence to improve patient care. Building on the success of TRIP-I, AHRQ launched TRIP-II in September 2000, funding 13 projects that focused on implementation issues, such as organizational and clinical characteristics, that are associated with successfully translating research findings into clinical practice in diverse settings.

One group of investigators is using an interactive, multi-media computer program to improve diabetes-related knowledge, attitudes, self-efficacy, and compliance with self-care recommendations in clinics serving predominantly African American and Hispanic patients. Another group of investigators is assessing a computerized decision support system that provides automated reminders, alerts, and guidelines in the outpatient setting. A third group of investigators is evaluating Internet-based learning modules designed to increase screening of female patients who are at risk for chlamydia infection and to decrease the incidence of pelvic inflammatory disease in primary care practices.


Finally, investigators are evaluating the impact of a quality improvement model using electronic medical records and academic detailing on adherence to clinical practice guidelines for prevention of cardiovascular disease and stroke in 22 primary care settings across the United States. The 27 projects funded under TRIP-I and TRIP-II will provide important information that can help narrow the gap between knowledge and practice—between what we know and what we do—to improve the quality of the nation's health care.

Strategic Partnerships The Agency is developing strategic partnerships to generate and disseminate research findings, facilitate use of its resources, and promote evidence-based medicine at the point of care among large and diverse audiences. AHRQ is spearheading a federal initiative to integrate and simplify the collection and reporting of patient safety data from the Department of Health and Human Services.

Over the next two years, AHRQ will develop and pilot-test a Web-based reporting system featuring a common user interface.

The Impact of Technology on Healthcare

The Agency is also working with the National Committee on Vital and Health Statistics, the eHealth initiative, the Markle Foundation, and other federal, state, local, and private sector partners to improve health care quality and public health through the use of IT, including the development and adoption of national standards and the development of a national electronic health information infrastructure.

Bioterrorism Preparedness Even before the events of September 11, 2001 and the subsequent anthrax attacks, AHRQ was supporting research initiatives to improve the nation's ability to respond to bioterrorism. The Agency's bioterrorism efforts have focused on assisting clinicians, hospitals, and health care systems in the following areas: Emergency preparedness of hospitals and health care systems for bioterrorism and rare public health events; Technologies and methods to improve the linkages between clinical health care systems, emergency response networks, and public health agencies; and Training and information needed to prepare community clinicians to recognize the manifestations of bioterrorism and manage patients appropriately.

3 Ways Technology has Changed Healthcare

The Agency's bioterrorism research is a natural outgrowth of its ongoing efforts to develop evidence-based information to improve health care quality. Conclusion Health care has lagged far behind many other industries in harnessing the capabilities of IT to improve services, knowledge, communication, outcomes, quality, and efficiency. Given the complexity of modern medicine, it is inevitable that IT will play an ever increasing role in improving health care quality.

Research is needed to: Evaluate the role of IT in improving clinical decision making, information management, communication, costs, and access to care; Assess barriers to successful implementation of proven IT, as well as strategies to overcome these barriers so that all patients and providers have access to technologies that can improve safety and quality of care; Generate solutions to eliminate the digital divide; Document the costs and resources associated with adopting and maintaining proven IT applications; and Evaluate transferability of IT solutions to other health care settings.

The Agency's research and demonstration projects will provide the evidence needed to guide future IT implementation to improve the effectiveness and efficiency of health care delivery in the United States.

Agency for Healthcare Research and Quality. Press Release, February 23. Agency for Healthcare Research and Quality Available at http: Agency for Healthcare Research and Quality U. Preventive Services Task Force. Yearbook of Medical Informatics. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press; 2001.