The report finds that many of the 16 AHRQ-funded projects had positive effects on processes of care, intermediate patient outcomes, or both. It also highlighted a number of areas -- including some that figure in stage 2 of Meaningful Use -- where commercial vendors have not yet made much of an impact.
Paul Tang, MD, the lead researcher for one of the AHRQ projects and also vice chair of the Health IT Policy Committee, which advises the federal government on its EHR incentive program, told InformationWeek Healthcare that a lack of standardization has held back progress in the development of patient-centered health IT applications that involve home monitoring devices.
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"The availability of widely adopted standards is very scant," he said. "So you're pretty much connecting from one [electronic] record system to one supplier of devices or even one model." He believes, however, that the patient engagement criteria in Meaningful Use stage 2 will prompt more commercial R&D in this area.
The AHRQ grant program, known as the Enabling Patient-Centered Care Through Health IT (PCC) initiative, was launched in 2007. It focused on the use of health IT to create or enhance patient-centered models of care in ambulatory settings.
The PCC's four areas of focus included patient self-management, which was addressed in all 16 projects; providing access to information (10 of the projects), patient-clinician communication (seven), and shared decision-making (two). The AHRQ also funded projects in three preference areas: medication management (eight), vulnerable populations (seven), and practice-based research networks (five).
Several of the research projects involved personal health records (PHRs). For example, one team developed a Web-based PHR that allows patients to enter, view and print current and past medicines, and monitor allergies, conditions and health events over time.
Although most of the researchers created their own applications, they were all based on existing technologies, such as interactive voice response systems or electronic health records, and some were quite basic. For example, one team developed an automated telephone system to support shared decision-making. The system used medication claims data to provide tailored queries and prompts based on each patient’s medication history, with patients responding via touch-tone commands.
In contrast, the team led by Tang, who is VP and chief innovation and technology officer at the Palo Alto Medical Foundation, used state-of-the-art technology in its project. It developed an online diabetes management system that featured wireless uploading of home glucometer read¬ings to the EHR, with graphical feedback correlated to parameters such as laboratory results, medications and clinical findings. This sophisticated system included a summary status report, tailored care plans, education and advice via text and video. Patients communicated online regularly with nurse case managers and a dietician.