Tuesday, January 1, 2013

AHRQ Reports on HIT

AHRQ’s “Transforming Healthcare Quality Through IT” (THQIT) program, with 118 grantees in 38 states has planned, implemented, and studied health IT implementations from 2004 to 2009 across a wide range of care settings, communities, and health IT systems. The majority of grantees report that health IT upgrades and investments in the health IT infrastructure are warranted.

The report “Sustainability, Partnerships, and Teamwork in Health IT Implementation” published December 2012, presents THQIT grantees and their experiences working on the grants along with follow-up interviews with selected grantees. The report was prepared by Mathematica Policy Research and Geisinger Health System under Contract HHSA 290200900019.

One year planning grants of up to $200,000 were awarded and two sets of 3 year implementation cooperative agreements of up to $1.5 million from AHRQ were made available with a requirement for equal matching funds.

The first 40 grants were available to a broad group of applicants. The second 16 grants were awarded to grantees that completed THQIT planning grants. In addition, three year grants for up to $1.5 million were awarded to 24 grantees.

Eighty six percent of funded projects included at least one hospital as a partner, more than half included private physician practices, and over a quarter included safety net providers. The most common technologies of interest were HIEs, EHRs, CPOE, and telehealth. Eighty six percent of the grantees pursued more than one type of technology.

In general grantees reported that most health IT implemented and upgraded during the study is still used. However, in order for health IT projects to be successful, clinician buy-in and support must be established early in the planning and be sustained during implementation and maintenance phases.

Effective planning includes completing a workflow analysis, developing an implementation plan, and developing a process redesign assessment prior to implementation. Strategic partnerships were indicators for success and helped grantees to overcome challenges in health IT implementation.

The grantees reported that what influenced sustainability the most was:

  • The ability to demonstrate benefits from health IT to their organizations
  • Having adequate clinician support available to sustain or increase their use of health IT. Four grantees reported that lack of clinician or physician enthusiasm was a reason they never implemented or they discontinued the use of health IT
  • Related to cost-related issues and was one of the main reasons why some of the THQIT funded health IT stopped being used at least two years after the end of their project
 There were several successful stories. For example the Erie Family Health Center’s EHR-focused project initially implemented a single centrally operated EHR in four FQHCs. Today, 32 safety net clinic sites spread across eleven states use this EHR system.

In another case, International Severity Information Systems implemented health IT in 15 nursing homes through the “On Time Quality Prevention Program for Long-Term Care” program. It was found that the use of health IT helped to reduce pressure ulcers. Twenty-one additional nursing homes implemented health IT the next year and now at least 46 others have implemented the system encouraged by Medicaid incentives to use health IT.

The report drew information from four sources which included final reports available form AHRQ, a web-based survey of all the grantees in 2011, and interviews with 16 grantees in 2011, plus quality improvement stories completed with nine grantees.

Go to http://healthit.ahrq.gov/THQIT to view the report.