Online Performance Appendix: Performance Detail, Health Information Technology
Budget Estimates for Appropriations Committees, Fiscal Year 2010
As the Nation's lead research agency on health care quality, safety, efficiency, and effectiveness, AHRQ plays a critical role in the drive to adopt health information technology (health IT). Established in 2004, the purpose of the Health IT Portfolio at AHRQ is to develop and disseminate evidence and evidence-based tools to inform policy and practice on how Health IT can improve the quality of American health care. This portfolio serves numerous stakeholders, including health care organizations planning, implementing, and evaluating health IT, health services researchers, policymakers and other decisionmakers. The portfolio achieves these goals through funding research grants and contracts, synthesizing findings, and developing and disseminating findings and tools.
The Health IT Portfolio disseminates its products and delivers technical assistance through its National Resource Center for Health IT (NRC), Web conferences, and through direct participation in select meetings and journals. Usage of the NRC Web site has continued to grow with over 170,000 unique users downloading nearly 160,000 tools, documents, and other resources from the Web site in FY 2008.
Some recent achievements and research findings related to the Health IT Portfolio include:
- Advancement of electronic prescribing, through delivery of a report to Congress and subsequent proposed adoption of standards for Medicare Part D beneficiaries. As shown in the performance table below, AHRQ partnered with CMS to award five pilot projects, which tested several promising standards, and delivered the evidence on those standards through a rigorous evaluation. Although CMS funded the project, AHRQ provided full-time staff and administrative support including: constructing the request for applications (RFAs), competing the RFAs, reviewing the applications, making the awards, and assigning project officers to manage and oversee the projects.
- Demonstration of best practices for health information exchange through projects like the Midsouth eHealth Alliance in Tennessee. Currently entering its fourth year of existence, this data exchange serves all major emergency rooms in Memphis with over 50 million laboratory results and other encounter information available on nearly 1 million individuals.
- Developing evidence and refining principles of privacy and security for health IT systems to respond to consumers' needs and desires. AHRQ has co-funded the Health Information Security and Privacy Collaborative, a 35-State and territory effort, which has defined the privacy and security landscape and has made concrete progress towards addressing inconsistencies and concerns. AHRQ is also conducting focus groups to determine consumers' information needs to improve their health care.
- Leadership in measurement of quality using health IT, including funding of a pivotal report from the National Quality Forum on the readiness of health IT to measure widely adopted consensus measures of quality.
The Health IT program at AHRQ set several ambitious performance measures in 2004, and has seen steady progress on all of the measures and some notable achievements. To meet the President's goals of widespread adoption of electronic health records (EHRs), we partnered with CMS to test and recommend e-prescribing standards for national adoption, which was a requirement of the Medicare Modernization Act of 2003. This major achievement began in May 2005, and over 2years several pilot projects were solicited, awarded, and conducted, and a detailedevaluation was performed. The result has been a mandated Report to Congress in April 2007, and a Notice of Proposed Rulemaking from CMS to require use ofthe ready standardsfor Medicarebeneficiaries.As this technology develops further, we look forward to showing the Nation the best ways to use e-prescribing to improve the safety and quality of health care.
EHR adoption has slowly increased—17 percent of providers have adopted EHRs (data provided from the 2008 National Ambulatory Medical Care Survey (NAMCS)—http://www.cdc.gov/nchs/products/pubs/pubd/hestats/physicians08/physicians08.pdf [Plugin Software Help]). Our grants and contracts have produced significant insight into the best practices in implementation and use of EHRs, and continue to advance this field of knowledge. External barriers to EHR adoption continue to pose a challenge, including the capital required from providers to purchase the system and uncertainty in the market for these products.
Similarly, hospitals have continued to steadily adopt computerized physician order entry, and in 2007 that technology is being utilized by 27 percent of providers across the Nation. The program awarded $5 million for two new contracts that will focus on the development, adoption, implementation, and evaluation of best practices using clinical decision support (CDS). This initiative will support the development, implementation, and evaluation of demonstration projects that advance the understanding of how best to incorporate CDS into health care delivery. We continue to develop evidence and tools that inform the best use of these technologies, and will continue to disseminate them through the National Resource Center for Health IT (NRC) and our public and private partnerships.
Supporting improved decisionmaking by health care organizations represents a critical next step beyond adoption of health IT, and represents significant potential for good information systems to help deliver high quality health care. Some of the basic building blocks are in place, as seen through the health IT certification criteria of the Certification Commission for Healthcare Information Technology. Our programs will develop and demonstrate the most effective use of evidence-based informationto inform the Nation's health care providers and policymakers.
The Health It Portfolio underwent a program assessment in 2008. The program received a Results Not Demonstrated rating. The assessment cited that:(1) the program lacked performance measures to gauge how well it was developing and disseminating research on how well health IT can improve the quality of health care; (2) the program's Web site struggled to reach its intended audience and lacked practical information; and (3) the program lacked an efficiency measure. As a result of the program assessment, the Health IT program has embarked on a plan to improve the performance and management of the program and has met or exceeded all improvement deadlines. In FY 2008, the program developed and gained Office of Management and Budget (OMB) approval of an efficiency measure. In addition, for activities begun in FY 2008 and completed thus far in FY 2009, the program gained feedback on how to improve its Web site by conducting focus groups of program stakeholders and summarizing the results, developed multiple "how-to guides" for the NRC Web site, and developed and gained OMB approval for a long-term performance measure.
The FY 2010 President's Budget Request for Health Information Technology is $44,820,000, the same level as the FY 2009 Omnibus Level. This request includes $29,388,000 in new and continuation support for grants and contracts to support the Ambulatory Safety and Quality Program (ASQ) and other health IT grant activities. In FY 2010, AHRQ will reinvest $3,842,946 in grants related to ASQ. This integrated set of grant activities is focused on demonstrating value and best approaches to broader diffusion, implementation, and effective use of health IT to improve the quality and safety of care delivered in the ambulatory setting and across transitions.
In FY 2009, AHRQ announced three new standing funding opportunities to address research to support the program's three strategic focus areas: the use of health IT to support patient -centered care and transitions in care, CDS and improved decisionmaking, and the effective use of electronic prescribing and medication management. The program will reinvest $7,500,000 in these grants and fund $14,545,036 in new grants in FY 2010. A summary of that funding is below:
- Ambulatory Patient Safety Program (ASQ): $29,388,000
- New FY 2010 Grants: $14,545,036.
- Continuation of ASQ and Program Grants funded in FY2008: $3,842,964.
- Continuation of Program Announcement Grants funded in FY 2009: $7,500,000.
- Health IT CERTs Grant: $1,000,000.
- Clinical Decision Support Demonstrations: $ 2,500,000.
In addition, the FY 2010 budget will allow AHRQ to award projects which develop and disseminate evidence and evidence-based tools on the use of health IT to improve quality and support the meaningful use of health IT. AHRQ will continue to partner with our Federal and private sector stakeholders to promote our shared goals. Coupled with effective dissemination efforts, evidence and tools derived from AHRQ Health IT program research can inform implementation and policy activities to overcome barriers and drive adoption and meaningful use of Health IT. A key challenge to reaching FY 2010 performance goals are the many factors outside of AHRQ control which influence use of Health IT, including payment policy, regulatory requirements, and clinical practice standards. Specific activities include:
- National Resource Center for Health IT: $6,000,000.
- Portfolio Assessment and Evaluation Activities: $1,000,000. The 2010 portfolio assessment and evaluation activities are currently in the planning stages. The program expects to include all relevant health IT Federal stakeholders per the forthcoming operations plan of the HHS Office of National Coordination for Health Information Technology (ONC).
- Dissemination, Translation, and Other Rapid Cycle Research Activities: $8,432,000.
At the FY 2010 President's Budget Request, a total of $14.5 million in grants related to the ASQ program end. The FY 2010 President's Budget will reinvest these funds back into Health IT grants to advance its mission and to support their long-term outcome goals. The FY 2010 President's Budget Request will also allow AHRQ to continue projects and partnerships which develop and disseminate evidence on the use of health IT to improve quality.
|1.3.52: The percentage of visits to doctors' offices at which patients with coronary artery disease are prescribed antiplatelet therapy among doctors' offices that use electronic health records with clinical decision support|
|2010||TBD||Jan 30, 2012|
|2009||TBD||Jan 30, 2011|
|2008||TBD||Jan 30, 2010|
|2007||Set Baseline||Aug 31, 2009|
|1.3.48: Average cost per grantee of development and publication of annual performance reports and final reporting products on the AHRQ National Resource Center for Health IT (NRC) Web site (http://healthit.ahrq.gov).|
|2010||TBD||Jun 30, 2010|
|2009||Set Baseline||Jun 30, 2009|
|Measure||Data Source||Data Validation|
|1.3.52||National Ambulatory Medical Care Survey (NAMCS)||NAMCS—using a nationally representative sample of primary care, non-pediatric practices and their patients with coronary artery disease|
|1.3.48||AHRQ Internal Figures||AHRQ Internal Figures—the process includes capturing the per-grantee cost of: developing and posting annual performance summaries for each grant; developing and posting a series of products (short and long summaries) of research findings upon grant completion; and posting final reports in the National Technical Information Service database of government research. The program will monitor the process of developing and publishing these reports online by attaching resource costs to each step of the process by creating a Gantt chart to map the current process, including who currently performs each step of the process and the time that each step takes. Multiplying this by personnel costs and then summing the total costs for each step of the process will produce an annual estimate of the cost to produce these documents per grantee.|