Health Information Technology

Attached you find a link to several interesting articles from the recent edition of Health Affairs about the medical information technology applications.

Data gathered in electronic health records on the experience of millions of patients have the potential to dramatically accelerate clinical research and provide the nation with timely, urgently needed knowledge about the value of new medical technologies, researchers report in a special edition of Health Affairs on "rapid learning" published January 26. Strategies for advancing rapid learning in health care was the topic of a Health Affairs-sponsored conference in Washington, D.C., today that included an appearance by AHRQ Director Carolyn Clancy, as well as several authors from the January 26 issue.
A webcast of the briefing is available at:

www.rwjf.org/newsroom/activitydetail.jsp?id=10195&type=3

The attached prologue accurately reflects on the content and purpose of the articles.
Yours
Bernd


http://content.healthaffairs.org/cgi/content/full/hlthaff.26.2.w107/DC2


26 January 2007


Rapid Learning:
Getting Technology Into Practice

PROLOGUE: Amid persistent concerns about performance and quality, the health sector remains ambivalent about electronic health records (EHRs). Champions of accelerated adoption of health information technology (IT) have been unable to generate a groundswell of demand, despite excellent arguments for health IT's potential to save money, improve quality, and transform care. It may be, though, that the strongest argument for speeding IT adoption is still largely below the radar.

The dramatic pace of biomedical innovation has dazzled America but created nagging tensions as well. Our insatiable demand for new drugs and technologies is driving unsustainable growth in health spending. An explosion of new knowledge has strained clinicians' learning capacity and fostered subspecialization and fragmentation of care. Clinical research and regulatory capabilities are swamped with urgent questions about the safety and effectiveness of new treatments.

But on scattered islands within the dominant system, promising approaches to managing innovation are beginning to surface, and their foundation is the EHR. In organizations such as the Veterans Health Administration (VHA), Kaiser Permanente, and the Geisinger Health System, the richness of data capture in fully deployed patient record systems is enabling clinicians and researchers to answer practical questions about safety, effectiveness, and cost more efficiently than the traditional process of randomized clinical trials (RCTs) possibly could.

The implications of these approaches for the future of "rapid learning" are spelled out in an overview paper by Lynn Etheredge. "An inadequate knowledge base limits initiatives to improve health system performance," Etheredge writes. "With large, computer-searchable databases, studies that would now take years will be doable, at low expense, in a matter of weeks, days, or hours." Case studies accompanied by commentaries explore how EHR database research is being used at the VHA (for diabetes research and care), Kaiser (for cancer research and care), and Geisinger (to close the "inferential gap" between RCTs and real-world clinical decisions). David Eddy offers his vision for a health system that will use predictive models from large, merged databases of EHRs to advance the biomedical sciences as well as clinical care. Sean Tunis and colleagues suggest strategies to use large new government clinical care databases to support Medicare coverage decisions, comparative effectiveness studies, and postmarket drug safety surveillance.

The rapid-learning efforts described here were originally presented at a March 2006 conference in Washington, D.C., organized by Etheredge and Health Affairs and sponsored by the Robert Wood Johnson Foundation. The publication of the papers is also supported by Kaiser Permanente and the federal Agency for Healthcare Research and Quality.