Electronic Health Records

Adoption & Implementation News

AHRQ to study health IT, EHR impact on ambulatory care workflows

By Kyle Murphy, PhD

- The Agency for Healthcare Research and Quality (AHRQ) aims to fill the knowledge gap concerning the impact of health information technology on workflow in ambulatory care settings, according to notice issued by the agency in the Federal Register. The agency is requesting approval for its proposed study, “Using Health Information Technology in Practice Redesign: Impact of Health Information Technology on Workflow,” from the Office of Management and Budget (OMB).  “The goal of the project is to understand the impact of implementing health IT enabled care coordination on workflow within small community-based primary care clinics in various stages of practice redesign,” states the notice.

In particular, the study targets the “enablers and barriers to care coordination” caused by health IT that affect providers’ care of patients with diabetes in small primary care clinics. The agency is responding to a noticeable dearth of information not just in practice but also in research:

These gaps and limitations of existing research study designs and findings related to health IT and workflow limit the relevance and quality of the available evidence for health care organizations wishing to effectively implement health IT systems to support current work without negatively affecting existing workflow processes. The existing evidence is of equally limited utility to those organizations seeking to use health IT systems to support redesign of their ambulatory care settings.

Over the course of 14 months, AHRQ will observe effects of implementing health IT, in this case an electronic health record (EHR) system, on workflows in six clinics affiliated with Vanderbilt University Medical Center (VUMC). Each clinic currently has an EHR system in place but is currently engaged in introducing “the health IT component of a care coordination redesign program called My Health Team (MHT).”

Integrated with the EHR, these components provide five significant enhancements for providers to use:

• registries for diabetes, hypertension, and congestive heart failure
• ability share view of care plan among clinical staff
• tracking of acute care episodes via alerts and reminders
• at-home physiological monitoring and two-way electronic clinical message through a patient portal

Increased patient engagement via telephone and the patient portal

The timeline proposed by AHRQ represents represent an important opportunity to gauge progress at the various sites. Moreover, it should provide practical insight into the impact MHT has on staff:

Combining this formal approach with iterative observations and analysis across six clinics for 14 months will generate a detailed understanding of changes in health IT workflow interaction for each clinic over time, and across clinics in various implementation phases (pre-MHT, early-MHT, or mature-MHT). Each clinic will be observed at two time points: the first (time = 0 months) to capture baseline interactions, and the second (time = 12 months) to capture interactions later in adoption. Although each clinic will be observed over a period of 12 months, the total study period will span 14 months to allow for staggered observation windows for the clinics.

This is the same VUMC that highlighted the benefits of patient portals at AHIMA 2012 in Chicago, Illinois. A leader in patient engagement via patient portals (with more than 200,000 patients signing on to use My Health at Vanderbilt), it likely comes as no surprise that the healthcare organization should serve as the testing ground for assessing the impact of health IT on care coordination and provider workflow.

The complete notice is available through the Federal Register.

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