PROGRAM BRIEF AHRQ’s Ambulatory Safety and Quality Program: Health IT Portfolio

The mission of AHRQ is to improve the quality, Introduction Key Acronyms safety, efficiency, and effectiveness of health care by: The purpose of the Agency for CDS - clinical decision support • Using evidence to improve health care. Healthcare Research and Quality’s CHC - community health center • Improving health care outcomes through (AHRQ) Ambulatory Safety and CHN - community health network Quality (ASQ) program is to improve research. EHR - electronic health record the safety and quality of ambulatory • Transforming research into practice. health care in the United States. For the EMR - electronic medical record purpose of this program, AHRQ defines Health IT - health information ambulatory care as health services technology provided by health care professionals in HIE - health information exchange outpatient settings. These settings include practitioner offices, clinics, PHR - personal health record outpatient departments of hospitals, large or small group practices, especially for patients with chronic community health centers (CHCs), illnesses. The opportunity to turn the emergency departments, diagnostic potential of health information imaging centers, dialysis centers, home technology (health IT) toward care, mental health centers, improving safety and quality in the occupational health centers, and school ambulatory care setting, especially health facilities. within care transitions, forms the The scope of ambulatory care has cornerstone of the ASQ program. The increased over the past decade, as the program accentuates the role of health volume and complexity of interventions IT through the following funding have expanded. Safe, high-quality opportunity announcements (FOAs): ambulatory care requires complex • Enabling Quality Measurement information management and Through Health IT (also includes a coordination across multiple settings, patient safety focus)

Agency for Healthcare Research and Quality Advancing Excellence in Health Care • www.ahrq.gov • Improving Quality Through American Gastroenterological Clinician Use of Health IT Association, and the Ambulatory Care • Enabling Patient-Centered Care Quality Alliance (AQA). A variety of Through Health IT ambulatory settings and organizations are addressed, from large integrated • Improving Management of delivery systems to small provider Individuals With Complex Health practices and from urban settings to Care Needs Through Health IT small rural communities. Overall, 65 health IT grants have been Closing the Feedback Loop To awarded, totaling approximately $35 Improve Diagnostic Quality million. Estimated Total Funding: $998,509 Enabling Quality Measurement Develops ways to close the loop of Through Health IT outpatient diagnosis in an effort to improve the quality of diagnostic and The purpose of this FOA is to develop therapeutic decisionmaking in safety and quality measures in ambulatory settings. ambulatory care settings, automate Focus Area(s): Quantitative scale to quality measurement, demonstrate the determine quality of diagnosis in the ability of electronic data systems (such clinical setting as electronic health records [EHRs] or Type of Health IT: Clinical decision claims data merged with EHR data) to support (CDS) expand potential safety and quality Principal Investigator: Eta Berner measures, and demonstrate improved Grant No. 1R18HS017060 ability to export data for reporting Applicant Institution: University of performance on measures and Alabama at Birmingham, Birmingham, improvement. AL Applicants were encouraged to consider Estimated Dates: 9/14/2007–8/31/2010 projects that focus on a variety of aspects Colorado Associated Community of quality measurement. Some aspects of Health Information Exchange interest include process, data elements, (CACHIE) value and accuracy, creation of Estimated Total Funding: $986,302 meaningful information, and timeliness Designs, develops, implements, and of data integration. evaluates an interoperable quality Enabling Quality Measurement information system for a collaborative Grants network of CHCs that permits real-time and synchronous quality reporting to In total, 17 health IT grants were inform patient care, quality awarded under this FOA. Of these, four interventions, and health policy and grants were funded through a patient advocacy efforts. safety set-aside. The projects described Focus Area(s): Specific measures to be focus on common chronic illnesses and determined prevention. There is prominent Type of Health IT: Health information involvement of national organizations exchange (HIE), quality of care decision and initiatives such as the American support Medical Association, the National Committee for Quality Assurance, the

2 Principal Investigator: Arthur Davidson Grant No. 1R18HS017067 Electronic Support for Public Health Grant No. 1R18HS017205 Applicant Institution: Weill Medical - Vaccine Adverse Event Reporting Applicant Institution: Denver Health College of Cornell University, New System and Hospital Authority, Denver, CO York, NY Estimated Total Funding: $999,995 Estimated Dates: 9/30/2007–6/30/2010 Estimated Dates: 9/30/2007–6/29/2010 Seeks to improve the quality of Automating Assessment of Asthma Surveillance for Adverse Drug Events vaccination programs by improving the Care Quality in Ambulatory Pediatrics quality of physician adverse vaccine Estimated Total Funding: $871,711 Estimated Total Funding: $992,699 event detection and reporting to the Develops, validates, applies, and Uses a computerized system to detect national Vaccine Adverse Event evaluates a scalable method for routine and report adverse drug events (ADEs) Reporting System. and comprehensive measurement of that occur in the outpatient setting, in Focus Area(s): Vaccine adverse effects outpatient asthma care quality. the emergency department, and during Type of Health IT: Registry Focus Area(s): 19 asthma care quality the transitions of hospital admission and (vaccination), clinical/medication measures from the RAND Quality discharge. reminders (provider-focused) Assessment Tools Focus Area(s): ADEs for pediatric Principal Investigator: Ross Lazarus Type of Health IT: Quality of care patients in ambulatory settings, Grant No. 1R18HS017045 decision support, data electronic emergency departments, and transitions Applicant Institution: Harvard Pilgrim transform and load of care Health Care, Inc., Boston, MA Principal Investigator: Brian Hazlehurst Type of Health IT: Operational decision Estimated Dates: 9/30/2007–9/29/2010 Grant No. 1R18HS017022 support – quality of care Medication Monitoring for Applicant Institution: Kaiser Principal Investigator: Peter Kilbridge Vulnerable Populations via IT Foundation Research Institute, Grant No. 1R18HS017010 Estimated Total Funding: $994,325 Portland, OR Applicant Institution: Washington Demonstrates the ability of health Estimated Dates: 9/30/2007–9/29/2010 University, St. Louis, MO information interoperable exchange and Developing and Using Valid Clinical Estimated Dates: 9/01/2007–8/31/2010 EHRs to provide useful quality and Quality Metrics for Health IT With Cardio-HIT Phase II safety measures for the vulnerable HIE Estimated Total Funding: $996,166 populations served by a CHC. Estimated Total Funding: $974,545 Studies exception reporting to: (1) Focus Area(s): Medication safety Proposes to derive a set of quality document the prevalence and patterns monitoring for angiotensin converting metrics that can capture the effects of of exception reporting for performance enzyme inhibitors/angiotensin receptor health IT with HIE and be retrieved measures for coronary artery disease and blockers (ACEI/ARB), Digoxin, electronically through the contributions heart failure, (2) assess the feasibility and diuretics, and statins of the Health Information Technology accuracy of exception reporting, and (3) Type of Health IT: System integration, Evaluation Collaborative, the New York analyze and address stakeholder quality of care decision support State Department of Health, and four concerns regarding exception reporting. Principal Investigator: Christopher regional health information Focus Area(s): Coronary artery disease Lehmann organizations that are implementing and heart failure measures Grant No. 1R18HS017018 health IT with HIE and focusing on the Type of Health IT: Operational decision Applicant Institution: Johns Hopkins ambulatory setting. support – quality of care University, Baltimore, MD Focus Area(s): Ambulatory quality Principal Investigator: Karen Kmetik Estimated Dates: 9/21/2007–5/31/2010 metrics responsive to the effects of Grant No. R18HS017160 health IT and HIE Applicant Institution: American Type of Health IT: HIE Medical Association, Chicago, IL Principal Investigator: Rainu Kaushal Estimated Dates: 9/30/2007–12/31/2009

3 Improving Quality in Cancer Massachusetts Quality E-Measure Using Electronic Records To Detect Screening: The Excellence Report for Validation Study and Learn From Ambulatory Colonoscopy Estimated Total Funding: $995,575 Diagnostic Errors Estimated Total Funding: $616,207 Evaluates the readiness of structured Estimated Total Funding: $873,108 Seeks to evaluate and improve the EHR data to support ambulatory Uses data from EHRs to detect quality of screening and diagnostic clinical quality measurement by using diagnostic errors in primary care, colonoscopies in ambulatory care the AQA ambulatory care measurement understand their causes, and lay settings. set to compare quality measurement groundwork for formulating future Focus Area(s): Colonoscopy pre- based on a structured EHR data prevention strategies. procedure, procedure, and post- measurement method to two standard Focus Area(s): Measuring potential procedure measures measurement methods. diagnostic errors in primary care Type of Health IT: Operational decision Focus Areas: AQA starter set for Type of Health IT: Operational decision support – quality of care primary care (26 measures) support (quality of care) Principal Investigator: Judith R. Logan Type of Health IT: System integration, Principal Investigator: Eric Thomas Grant No. 1R18HS017017 quality of care decision support Grant No. 1R18HS017244 Applicant Institution: Oregon Health & Principal Investigator: Eric Schneider Applicant Institution: University of Science University, Portland, OR Grant No. 1R18HS017048 Texas Health Science Center at Estimated Dates: 9/30/2007–8/31/2010 Applicant Institution: Harvard Houston, Houston, TX Standardization and Automatic University (School of Public Health), Estimated Dates: 9/30/2007–9/29/2010 Extraction of Quality Measures in an Boston, MA Monitoring Intensification of Ambulatory EMR Estimated Dates: 9/12/2007–8/31/2010 Treatment for Hyperglycemia and Estimated Total Funding: $889,681 Feedback of Treatment Intensification Hyperlipidemia Establishes the standardization efforts Data To Reduce Cardiovascular Estimated Total Funding: $533,431 necessary for data capture of quality Disease Risk Develops and validates a new diabetes measures in an ambulatory electronic Estimated Total Funding: $997,069 quality-of-care process measure and the medical record (EMR) system and Proposes to develop and evaluate a technology for monitoring that measure demonstrates the efficiency and accuracy treatment intensification protocol using using analysis of the text of physician of using a data extraction and reporting an EHR to identify patients in need of notes in the EMR. expert to perform quality measurement treatment intensification for systolic Focus Area(s): Development of new in the ambulatory care setting. blood pressure. diabetes quality-of-care process measures Focus Area(s): Physician quality Focus Area(s): Cardiovascular disease Type of Health IT: Quality of care reporting initiative process and outcome measures decision support, data electronic Type of Health IT: Standards Type of Health IT: CDS (provider- transform and load (semantic), data electronic transform focused) Principal Investigator: Alexander and load Principal Investigator: Joe Selby Turchin Principal Investigator: Denni McColm Grant No. 1R18HS017031 Grant No. R18HS017030 Grant No. 1R18HS017094 Applicant Institution: Kaiser Applicant Institution: Brigham and Applicant Institution: Citizens Foundation Research Institute, Women’s Hospital, Boston, MA Memorial Hospital District, Bolivar, Oakland, CA Estimated Dates: 9/30/2007–9/29/2010 MO Estimated Dates: 9/01/2007–8/31/2010 Using IT To Improve the Quality of Estimated Dates: 9/07/2007–8/31/2009 CVD Prevention & Management Estimated Total Funding: $605,862 Uses EMRs in a large health care system to: (1) identify practice variations in delivery of key cardiovascular disease

4 preventive and disease management populations, and small office practices. • Improved use of effective alert services, (2) relate practice variation to This project will design and test a strategies for decision support outcomes among patients in the clinical “quality dashboard” suitable for small practices, and (3) provide feedback to office practices that will integrate quality Improving Quality Through Clinician managers on how guidelines adherence measurement and CDS at the point of Use of Health IT Grants relates to morbid and mortal events, and care. Twenty-four projects were funded under to costs of care. Focus Area(s): Ambulatory care this FOA. The projects have a diverse Focus Area(s): Prevention index and screening measures range of interventions, using different disease management index Type of Health IT: HIE, quality of care health IT applications. Many Type of Health IT: Quality of care decision support applications target the primary care decision support Principal Investigator: Winifred Wu office as the setting of care while some Principal Investigator: Thomas Vogt Grant No. 1R18HS017059 address the home environment. Many Grant No. 1R18HS017016 Applicant Institution: New York City of the projects addressed use effective Applicant Institution: Kaiser Health/Mental Hygiene, New York, NY alert strategies for decision support Foundation Research Institute, Estimated Dates: 9/30/2007–9/29/2010 while others examine the impact of Honolulu, HI health IT on outcomes in ambulatory Estimated Dates: 9/05/2007–2/28/2010 Improving Quality Through settings. Clinician Use of Health IT Crossing the Quality Assessment Using Precision Performance Chasm: Aligning Measured and True Measurement To Conduct Focused The purpose of this FOA is to Quality of Care Quality Improvement investigate novel methods or evaluate Estimated Total Funding: $812,237 Estimated Total Funding: $1,199,415 existing strategies for clinician use of Identifies and quantifies the impact on health IT in ambulatory settings to Creates systems that improve quality quality assessment of real-world improve outcomes through more data and seamlessly link this data to circumstances where the current cross- effective CDS, medication practice-level quality improvement sectional measures of quality do not management, or care delivery. programs and point-of-care reflect the true quality of care being Applicants were encouraged to interventions. rendered. The result of the analysis will demonstrate the ability of EHRs and Focus Area(s): Impact of health IT on help to create a new set of quality medication management systems to outcomes in ambulatory settings measures that is more consistent with effectively move evidence-based Type of Health IT: Quality of care actual clinical care. information to the point of care, decision support, vocabulary/coding Focus Area(s): Diabetes care including the development/utilization of standards measurement techniques accounting for machine-actionable, evidence-based Principal Investigator: David W. Baker differences in patient populations clinical information to providers and Grant No. 1R18HS017163 Type of Health IT: Quality of care participates in health information Applicant Institution: Northwestern decision support exchanges. Applicants were encouraged University, Chicago, IL Principal Investigator: Mark Weiner to consider projects that focus on: Estimated Dates: 9/30/2007–9/29/2010 Grant No. 1R18HS017099 • The impact of health IT on Enabling Electronic Prescribing and Applicant Institution: University of outcomes in ambulatory settings and Enhanced Management of Controlled Pennsylvania, Philadelphia, PA across high-risk transitions of care Medications Estimated Dates: 9/30/2007–9/29/2010 • The relationship between health IT Estimated Total Funding: $1,199,794 Bringing Measurement to the Point and workflow redesign Uses electronic prescribing of Care • Systemic barriers to health IT (e-prescribing) for federally controlled Estimated Total Funding: $694,961 adoption medications in the ambulatory care Enables measurement of the quality of setting, to improve medication • Care for patients with multiple care, with a focus on public health management by ambulatory care chronic conditions priority issues, disadvantaged clinicians at the point of care.

5 Focus Area(s): Impact of health IT on Type of Health IT: Clinical/operational Applicant Institution: Healthpartners outcomes in ambulatory settings; decision support (provider-focused) Research Foundation, Minneapolis, systemic barriers to health IT adoption Principal Investigator: Christopher B. MN Type of Health IT: E-prescribing Forrest Estimated Dates: 9/30/2007–9/29/2010 Principal Investigator: Grant M. Carrow Grant No. 1R18HS017042 Pharmaceutical Safety Tracking Grant No. 1R18 HS017157 Applicant Institution: Children’s (PhaST): Managing Medications for Applicant Institution: Massachusetts Hospital of Philadelphia, Philadelphia, Patient Safety State Department of Public Health, PA Estimated Total Funding: $1,156,142 Boston, MA Estimated Dates: 9/30/2007–9/29/2010 Compares use of PhaST, an automated Estimated Dates: 9/30/2007–9/29/2010 The BLUES Project: Improving system for monitoring of medication Impact of Office-Based E-Prescribing Diabetes Outcomes in Mississippi adherence, side effects, and patient on Prescribing Processes and With Health IT symptoms, to usual care in a large, Outcomes Estimated Total Funding: $1,163,573 urban, multispecialty mental health Estimated Total Funding: $1,199,007 Demonstrates the effects of diabetes system serving a primarily Medicaid Evaluates the full spectrum of management practices at several population. e-prescribing by partnering with the ambulatory clinics throughout Focus Area(s): Impact of health IT on makers of an office-based, e-prescribing Mississippi when utilizing well- outcomes in ambulatory settings system that is already in widespread use designed, comprehensive health Type of Health IT: Clinical/medication and with multiple insurance companies information technology. reminders (provider-focused), and public programs who will provide Focus Area(s): Impact of health IT on human/machine interface claims data. outcomes in ambulatory settings Principal Investigator: William P. Focus Area(s): Impact of health IT on Type of Health IT: EMR Gardner outcomes in ambulatory settings; Principal Investigator: Karen Fox Grant No. 1R18HS017258 improved use of effective alert strategies Grant No. 1R18HS017233 Applicant Institution: Children’s for decision support Applicant Institution: Delta Health Research Institute, Columbus, OH Type of Health IT: E-prescribing Alliance, Inc., Jackson, MS Estimated Dates: 9/30/2007 –9/29/2010 Principal Investigator: Michael A. Estimated Dates: 9/30/2007–9/29/2010 RxSafe: Shared Medication Fischer eHealth Records To Improve Dental Management and Decision Support Grant No. 1R18HS017151 Care for Patients With Chronic for Rural Clinicians Applicant Institution: Brigham and Illnesses Estimated Total Funding: $1,200,000 Women’s Hospital, Boston, MA Estimated Total Funding: $996,737 Uses previously developed technology to Estimated Dates: 9/30/2007–9/29/2010 Conducts a randomized clinical trial to support shared medication management Improving Otitis Media Care With evaluate the effectiveness of an for persons with chronic conditions. EHR-Based Clinical Decision integrated EHR system that includes an Focus Area(s): Impact of health IT on Support and Feedback EMR, eDental Record, and a personal outcomes in ambulatory settings; care Estimated Total Funding: $877,011 health record (PHR) to improve the for patients with multiple chronic Uses Children’s Hospital of quality and safety of dental care for conditions; improved use of effective Philadelphia’s EHR to integrate care patients with chronic illnesses. alert strategies for decision support across time and to supply physicians Focus Area(s): Improved use of effective Type of Health IT: Clinical/operational with the knowledge they need about alert strategies for decision support decision support (provider-focused) how to treat a patient at the point of Type of Health IT: Systems integration, Principal Investigator: Paul N. Gorman care to address the overuse of antibiotics clinical/medication reminders (provider- Grant No. 1R18HS017102 for otitis media. focused) Applicant Institution: Oregon Health & Focus Area(s): Impact of health IT on Principal Investigator: James R. Fricton Science University, Portland, OR outcomes in ambulatory settings; Grant No. 1R18HS017270 Estimated Dates: 9/30/2007–9/29/2010 improved use of effective alert strategies for decision support

6 Improving Posthospital Medication Electronic Prescribing and Electronic Management of Older Adults Transmission of Discharge Through Health IT Medication Lists Estimated Total Funding: $1,199,952 Estimated Total Funding: $1,187,674 Develops and evaluates the value of a Consists of three studies that will health IT-based medication measure the impact of health IT on reconciliation system superimposed on patient safety in the ambulatory setting. the ambulatory EMR to improve the Focus Area(s): Impact of health IT on quality and safety of medication outcomes in ambulatory settings management, focusing particularly on Type of Health IT: E-prescribing, the transition from the inpatient to the quality of care decision support ambulatory setting for older adults with Principal Investigator: Rainu Kaushal multiple comorbid conditions who are Grant No. 1R18HS017029 prescribed high-risk medications. Applicant Institution: Weill Medical Focus Area(s): Impact of health IT on College of Cornell University, New outcomes in ambulatory settings; care York, NY for patients with multiple chronic Estimated Dates: 9/30/2007–9/29/2010 conditions; improved use of effective Evaluation of a Computerized alert strategies for decision support Clinical Decision Support System and Type of Health IT: Quality of care EHR-Linked Registry To Improve decision support Management of Hypertension in Principal Investigator: Jerry H. Gurwitz Community-Based Health Centers Grant No. 1R18HS017203 Estimated Total Funding: $1,132,569 Applicant Institution: University of Analyzes the efficacy of office-based Massachusetts Medical School electronic decision support and provider Worcester, Worcester, MA feedback in improving hypertension Estimated Dates: 9/30/2007–9/29/2010 control in CHCs. STEPStools: Developing Web Services Focus Area(s): Impact of health IT on for Safe Pediatric Dosing outcomes in ambulatory settings Estimated Total Funding: $1,157,753 Type of Health IT: Registries Constructs, pilot tests, and evaluates (hypertension), CDS generally available tools that provide Principal Investigator: Helene Kopal medication-specific knowledge about Grant No: 1R18HS017167 rounding and extemporaneous Applicant Institution: Primary Care formulations necessary for small Development Corporation, New York, children. NY Focus Area(s): Impact of health IT on Estimated Dates: 9/30/2007–9/29/2010 outcomes in ambulatory settings Optimizing Medication History Value Type of Health IT: Health IT in Clinical Encounters With Elderly architecture, CDS (provider-focused), Patients electronic prescribing Estimated Total Funding: $1,199,989 Principal Investigator: Kevin B. Johnson Conducts a randomized clinical trial to Grant No. 1R18HS017216 test geriatric specific algorithms and Applicant Institution: Vanderbilt compliance triggers for improved University, Nashville, TN medication management at the point of Estimated Dates: 9/30/2007–9/29/2010 care.

7 Focus Area(s): Improved use of effective Focus Area(s): Impact of health IT on Principal Investigator: Steven M. alert strategies for decision support outcomes in ambulatory settings Ornstein Type of Health IT: E-prescribing, CDS Type of Health IT: EMR, telehealth Grant No. 1R18HS017037 (provider-focused) (patient-focused), quality of care Applicant Institution: Medical Principal Investigator: Kate L. Lapane decision support University of South Carolina, Grant No. 1R18HS017150 Principal Investigator: David R. Mehr Charleston, SC Applicant Institution: Brown University, Grant No. 1R18HS017035 Estimated Dates: 9/30/2007–9/29/2010 Providence, RI Applicant Institution: University of A Partnership for Clinician EHR Use Estimated Dates: 9/30/2007–9/29/2010 Missouri-Columbia, Columbia, MO and Quality of Care Improving Quality Through Decision Estimated Dates: 9/30/2007–9/29/2010 Estimated Total Funding: $1,184,765 Support for Evidence-Based VA Integrated Medication Manager Studies the effectiveness of a partnership Pharmacotherapy Estimated Total Funding: $594,582 that shares resources and utilizes a data- Estimated Total Funding: $1,198,429 Studies a new technology called the driven approach to promote full Seeks to improve care quality and safety Integrated Medication Manager that clinician use of an EHR in three nurse in an ambulatory care setting through facilitates improved decisionmaking by managed health centers and three CDS for evidence-based pharmaco- helping clinicians to consider more CHCs to improve the quality of care in therapy delivered as point-of-care relevant data and to better plan patient areas of preventive care, chronic disease reports to clinic-based practitioners and care. management, and medication as population health-based alerts to care Focus Area(s): Improved use of effective management for vulnerable populations. managers. alert strategies for decision support Focus Area(s): Improved use of effective Focus Area(s): Improved use of effective Type of Health IT: CDS alert strategies for decision support alert strategies for decision support Principal Investigator: Jonathan R. Type of Health IT: Quality of care Type of Health IT: HIE, CDS Nebeker decision support (provider-focused) Grant No. 1R18HS017186 Principal Investigator: Joanne M. Pohl Principal Investigator: David F. Lobach Applicant Institution: Western Institute Grant No. 1R18HS017191 Grant No. R18HS017072 for Biomedical Research, Salt Lake City, Applicant Institution: Michigan Public Applicant Institution: Duke University, UT Health Institute, Ann Arbor, MI Durham, NC Estimated Dates: 9/30/2007–9/29/2010 Estimated Dates: 9/30/2007–9/29/2010 Estimated Dates: 9/30/2007–9/29/2010 Medication Safety in Primary Care Harnessing Health IT To Prevent Using Health IT To Improve Practice - Translating Research Into Medication-Induced Birth Defects Ambulatory Chronic Disease Care Practice Estimated Total Funding: $1,199,370 Estimated Total Funding: $1,192,603 Estimated Total Funding: $1,183,549 Develops and evaluates ways computers Conducts a phased implementation of Develops a set of medication safety may be able to help doctors counsel selected ambulatory care health IT measures relevant for primary care, women about preventing birth defects systems and functions to: (1) improve incorporates these measures in practice caused by use of certain medications. providers’ access to information, performance reports sent quarterly to Focus Area(s): Improved use of effective allowing individual providers to participating practices, and assesses the alert strategies for decision support compare and improve their clinical impact of the intervention on the Type of Health IT: CDS (provider- performance against standardized incidence of medication errors. focused), human/machine interface performance targets and peers’ Focus Area(s): Relationship between Principal Investigator: Eleanor B. performance and (2) enhance patient- health IT and workflow redesign; Schwarz provider connectivity and Improved use of effective alert strategies Grant No. 1R18HS017093 communication to improve clinical for decision support Applicant Institution: University of decisionmaking, patient participation in Type of Health IT: Quality of care Pittsburgh at Pittsburgh, Pittsburgh, PA the care process, and, ultimately, patient decision support Estimated Dates: 9/30/2007–9/29/2010 outcomes.

8 Can Risk Score Alerts Improve Office A Systems Engineering Approach: Electronic Prescribing and Decision Care for Chest Pain? Improving Medication Safety With Support To Improve Rural Primary Estimated Total Funding: $687,539 Clinician Use of Health IT Care Quality Implements and evaluates electronic risk Estimated Total Funding: $1,200,000 Estimated Total Funding: $1,181,866 alerts to risk stratify outpatients with Modifies and implements an IT-based Examines whether, in rural ambulatory chest pain and present this information Crew Resource Management tool called care settings, the use of an e-prescribing to primary care clinicians within the ACORN to examine the impact of the system with CDS related to medication context of an EHR. intervention on reducing selected management increases patient Focus Area(s): Improved use of effective adverse drug events among geriatric prescription adherence, improves health alert strategies for decision support patients in a primary care setting; outcomes in hypertensive patients, and Type of Health IT: Clinical/operational examines the impact of the intervention improves the medication management decision support (provider-focused) on improving monitoring for geriatric process. Principal Investigator: Thomas D. patients on Persistent Medications; and Focus Area(s): Systemic barriers to Sequist evaluates office staff use and application health IT adoption; improved use of Grant No. 1R18HS017075 of the tool for improving geriatric effective alert strategies for decision Applicant Institution: Brigham and medication safety by examining support Women’s Hospital, Boston, MA utilization of the IT tool and changes in Type of Health IT: CHNs (rural Estimated Dates: 9/30/2007–9/29/2010 safety attitude constructs. communities), e-prescribing, Improving Laboratory Monitoring in Focus Area(s): Impact of health IT on clinical/medication reminders (provider- Community Practices: A Randomized outcomes in ambulatory settings focused) Trial Type of Health IT: Quality of care Principal Investigator: James Thomas Estimated Total Funding: $990,640 decision support Veline Principal Investigator: Gurdev Singh Grant No. 1R18HS017149-01 The Massachusetts e-Health Grant No. 1R18HS017020-01 Applicant Institution: Avera Health, Collaborative (MAeHC) will conduct a Applicant Institution: State University Sioux Falls, SD trial of computerized point-of-care alerts of New York at Buffalo, Buffalo, NY Estimated Dates: 9/30/2007–9/29/2010 in the EHR to prevent errors related to Estimated Dates: 9/30/2007–9/29/2010 laboratory monitoring at the initiation Enabling Patient-Centered Care and continuation of drug therapy and a Using Information Technology To Through Health IT results management system to prevent Provide Measurement-Based Care for Chronic Illness errors related to the delay in followup of The purpose of this FOA is to Estimated Total Funding: $1,196,703 abnormal laboratory testing. investigate novel methods or evaluate Focus Area(s): Improved use of effective Tests the implementation of existing strategies for using health IT to alert strategies for decision support measurement-based care in an create or enhance patient-centered Type of Health IT: Community health ambulatory care setting with an models of care in the ambulatory network (CHN), results reporting, integrated CDS system and an EHR. setting. Applicants were expected to clinical/medication reminders (provider- Focus Area(s): Improved use of effective demonstrate how patient-centered care focused) alert strategies for decision support can improve health outcomes, patient Principal Investigator: Steven R. Simon Type of Health IT: CDS (provider- safety, and patients’ reported experience Grant No. 1R18HS017201 focused) with care. Applicants were encouraged Applicant Institution: Harvard Pilgrim Principal Investigator: Madhukar H. to consider projects that focus on: Health Care, Inc., Boston, MA Trivedi • Shared decisionmaking Estimated Dates: 9/30/2007–9/29/2010 Grant No. 1R18HS017189 • Patient-clinician communication Applicant Institution: University of Texas Southwest Medical Center at Dallas, Dallas, TX Estimated Dates: 9/30/2007–9/29/2010

9 • Access to medical information Grant No. 1R18HS017248 Focus Area(s): Patient self-management • Patient self-management of chronic Applicant Institution: Boston Medical of chronic illness conditions Center, Boston, MA Type of Health IT: clinical/medication Estimated Dates: 9/30/2007–9/29/2010 reminders (patient-focused), The long-term goal of this effort is to human/machine interface improve the delivery of patient-centered Using a Telemedicine System To Principal Investigator: Edith Burns care in ambulatory settings. Promote Patient Care Among Underserved Individuals Grant No. R18HS017276 Patient-Centered Care Grants Estimated Total Funding: $1,198,371 Applicant Institution: Medical College of Wisconsin, Milwaukee, WI Seeks to advance care for hypertension Sixteen grants were awarded under this Estimated Dates: 9/01/2007–8/31/2010 FOA. The projects have a diverse range for African Americans in North Personal Health Records and Elder of interventions, using different health Philadelphia by enhancing an existing Medication Use Quality IT applications. Most applications target telemedicine system that supports the Estimated Total Funding: $1,199,999 the primary care office as the setting of chronic care model by increasing access, care while others address the home incorporating hypertension treatment Investigates the effect of a current PHR environment. Two projects address guidelines, quality measures, automating system among older adults on patient- subspecialty care and one specifically reminders and feedback for both reported medication therapy focuses on transitions between the patients and health care providers, and management behaviors, beliefs about inpatient and ambulatory setting. While enabling the PHR to exchange data medications, medication-use quality all areas of patient-centered care are between other HL7-compliant EMR indicators, and on medication addressed across the grants, most of the systems. adherence. projects focus on patient self- Focus Area(s): Patient self-management Focus Area(s): Patient self-management; management. of chronic illness; access to medical access to medical information (patients) Conversational IT for Better, Safer information (patients and clinicians); Type of Health IT: Human/machine Pediatric Primary Care shared decisionmaking; patient-clinician interface, PHR, clinical/medication Estimated Total Funding: $1,159,609 communication reminders (patient-focused) Principal Investigator: Elizabeth Develops and evaluates an integrated Type of Health IT: Telehealth (patient- Chrischilles patient-centered health information focused), data electronic transform and Grant No. 1R18HS017034 system, the Personal Health Partner load, clinical/medication reminders Applicant Institution: University of (PHP) that will use fully automated, (patient and provider-focused) Iowa, Iowa City, IA interactive, conversations to gather Principal Investigator: Alfred Bove Estimated Dates: 9/30/2007–9/29/2010 personal health data and counsel parents Grant No. 1R18HS017202 before scheduled visits, exchange that Applicant Institution: Temple Ambulatory Care Compact To data with the child’s primary care University, Philadelphia, PA Organize Risk and Decisionmaking clinician via the EHR, and offer Estimated Dates: 9/30/2007–9/29/2010 (ACCORD) personalized followup assessment and Enhancing Self-Management of Estimated Total Funding: $923,783 counseling after visits. T2DM With an Automated Reminder Designs, develops, implements, and Focus Area(s): Patient self-management; and Feedback System evaluates a model of care delivery that access to medical information Estimated Total Funding: $1,166,243 enables patients and primary care (clinicians) Tests an Automated Self-Management providers to agree upon shared, Type of Health IT: Telehealth (patient- Monitor (ASMM) with low-income followup care plans that incorporate focused), PHR, human/machine housing sites and through primary care patient and provider preferences. interface clinics to determine whether ASMM Focus Area(s): Patient self-management; Principal Investigator: William G. can improve self-monitoring of blood shared decisionmaking Adams glucose and glycemic control in patients Type of Health IT: System architecture, with type II diabetes mellitus. PHR

10 Principal Investigator: Henry Chueh Center, Boston, MA Applicant Institution: Brown University, Grant No. 1R18HS017190 Estimated Dates: 9/01/2007–8/31/2010 Providence, RI Applicant Institution: Massachusetts An Interactive Preventive Health Estimated Dates: 9/30/2007–9/29/2010 General Hospital (MGH), Boston, MA Record To Promote Patient-Centered Impact of a Wellness Portal on the Estimated Dates: 9/30/2007–9/29/2010 Care Delivery of Patient-Centered Implementing a Low-Literacy, Estimated Total Funding: $1,198,677 Prospective Care Multimedia IT System To Enhance Investigates whether an interactive Estimated Total Funding: $902,411 Patient-Centered Cancer Care preventive health record (IPHR), called Develops, tests, and refines an Internet- Estimated Total Funding: $1,198,839 My Preventive Care, increases the based patient wellness portal linked to Tests whether a low-literacy-friendly, delivery of recommended preventive the previously developed Preventive multimedia information and assessment services and whether the IPHR increases Services Reminder System (PSRS), to system used in daily clinical practice shared decisionmaking and improves will facilitate preventive care in primary enhances patient-centered care and clinician-patient communication. care practices. improves patient outcomes for Focus Area(s): Shared decisionmaking; Focus Area(s): Patient self-management; vulnerable populations. patient-clinician communication shared decisionmaking Focus Area(s): Patient self-management Type of Health IT: PHR, Type of Health IT: Telehealth (patient- of chronic illness; patient-clinician clinical/medication reminders (patient- focused) communication and provider-focused) Principal Investigator: James Mold Type of Health IT: Human/machine Principal Investigator: Alexander Krist Grant No. 1R18HS017188 interface, clinical/medication reminders Grant No. 1R18HS017046 Applicant Institution: University of (patient focused) Applicant Institution: Virginia Oklahoma Health Sciences Center, Principal Investigator: Elizabeth Hahn Commonwealth University, Richmond, Oklahoma City, OK Grant No. 1R18HS017300 VA Estimated Dates: 9/01/2007–8/31/2010 Applicant Institution: Evanston Estimated Dates: 9/01/2007–8/31/2010 Patient-Centered Informatics System Northwestern Healthcare, Tailored DVD To Improve To Enhance Health Care in Rural Chicago, IL Medication Management for Low Communities Estimated Dates: 9/30/2007–9/29/2010 Literate Elderly Patients Estimated Total Funding: $1,199,999 Virtual Patient Advocate To Reduce Estimated Total Funding: $1,199,014 Evaluates whether integrating the Ambulatory Adverse Drug Events Uses an electronic medication history to functions of an EMR, PHR, and Estimated Total Funding: $1,180,772 develop tailored patient education communication system leads to more Focuses on the transition between DVDs and print materials for low- patient-centered care in rural hospitalization and the first ambulatory literate audiences to empower geriatric communities in the Intermountain visit; also tests a Virtual Patient patients and their caregivers to West. Advocate to prepare patients for participate in treatment decisions and Focus Area(s): Patient self-management; discharge and determines their degree of negotiate acceptable medication access to medical information (patients understanding of self-care, medications, regimens that are more amenable to and clinicians); patient-clinician and followup. followthrough. communication Focus Area(s): Patient self-management; Focus Area(s): Patient self-management; Type of Health IT: CHN (rural), access to medical information (patients shared decisionmaking; patient-clinician clinical/medication reminders (provider- and clinicians) communication and patient-focused) Type of Health IT: Clinical/medication Type of Health IT: clinical/medication Principal Investigator: Matthew Samore reminders (patient-focused), human/ reminders (patient-focused), Grant No. 1R18HS017308 machine interface human/machine interface Applicant Institution: University of Principal Investigator: Brian Jack Principal Investigator: Kate Lapane Utah, Salt Lake City, UT Grant No. 1R18HS017196 Grant No. 1R18HS017281 Estimated Dates: 9/30/2007–9/29/2010 Applicant Institution: Boston Medical

11 Harnessing Health IT for Self- Patient-Centered Online Disease Management Support and Medication Management Using a Personal Health Activation in a Medicaid Health Plan Record System Estimated Total Funding: $1,130,769 Estimated Total Funding: $1,158,401 Tests the impact of the automated Evaluates a Customized, Continuous telephone self-management support on Care Management (CCCM) program diabetes management and combine it for diabetes care and examines the with a medication activation CCCM’s impact on HgA1C as well as communication strategy. self-management practices, better Focus Area(s): Patient self-management processes of care, lower cardiovascular of chronic illness risk, enhanced patient experience and Type of Health IT: Telehealth (patient- satisfaction, and improved patient focused), human/machine interface, psychosocial well-being. clinical/medication reminders (patient- Focus Area(s): Patient self-management focused) of chronic illness; access to medical Principal Investigator: Dean Schillinger information (patients and clinicians) Grant No. 1R18HS017261 Type of Health IT: PHR, clinical/ Applicant Institution: University of medication reminders (patient-focused) California; San Francisco, San Francisco, Principal Investigator: Paul Tang CA Grant No. 1R18HS017179 Estimated Dates: 9/01/2007–8/31/2010 Applicant Institution: Palo Alto Medical Enabling Sleep Apnea Patient- Foundation Research Institute, Palo Centered Care Via an Internet Alto, CA Intervention Estimated Dates: 9/01/2007–8/31/2011 Estimated Total Funding: $1,155,062 Using an Electronic Personal Health Examines the effect of a Web-based Record To Empower Patients With intervention designed for patients with Hypertension obstructive sleep apnea syndrome that Estimated Total Funding: $1,181,369 integrates a telemetry treatment device Examines the feasibility, acceptability, and an internet-based portal that tracks and impact of a health IT intervention management of continuous positive (the ePHR) that has been modified to airway pressure. incorporate the experiences, Focus Area(s): Patient self-management perspectives, and insights of patients and of chronic illness family members actually using the Type of Health IT: Telehealth (patient- system. focused), PHR Focus Area(s): Patient self-management Principal Investigator: Carl Stepnowsky of chronic illness; access to medical Grant No. 1R18HS017246 information (patients); patient-clinician Applicant Institution: Veterans Medical communication Research Foundation, San Diego, CA Type of Health IT: PHR Estimated Dates: 9/30/2007-9/29/2010 Principal Investigator: Peggy Wagner Grant No. 1R18HS017234-01 Applicant Institution: Medical College of Georgia, Augusta, GA Estimated Dates: 9/01/2007–8/31/2010

12 Using IT for Patient-Centered clinical alerts and reminders, with an Principal Investigator: Elizabeth Communication and Decisionmaking emphasis on prevention and chronic Ciemens About Medications illness management was encouraged. Grant No.: R18HS017864-01 Estimated Total Funding: $1,199,997 Applicant Institution: Billings Clinic Management of Individuals With Develops and tests a multimedia Foundation, Billings, MT Complex Health Care Needs Grants program to help patients understand the Estimated dates: 9/30/2008-9/29/2011 importance of both giving and receiving Twelve projects were funded under this Enhancing Complex Care Through accurate information about medications. FOA. The projects described use an Integrated Care Coordination Focus Area(s): Patient self-management; innovative methods including Information System shared decisionmaking; patient-clinician interactive voice systems and other Estimated Total Funding: $1,155,147 communication information systems as well as Creates, implements, and evaluates an Type of Health IT: CDS, medication randomized trials to determine how integrated care coordination management (patient-focused) health IT can improve patient self- information system in a diverse set of Principal Investigator: Michael Wolff management. clinics using certified EHRs and existing Grant No. 1R18HS017220 Chronic Mental Health: Improving standards. Applicant Institution: Northwestern Outcomes Through Ambulatory Care Focus Area(s): Impact of health IT on University, Chicago, IL Coordination chronic illness outcomes in a rural Estimated Dates: 9/30/2007–9/29/2010 Estimated Total Funding: $1,199,871 ambulatory clinic Improving Management of Develops and implements an HIE Type of Health IT: EHRs Individuals With Complex network focused on coordination of care Principal Investigator: David Dorr for individuals with chronic mental Grant No.: R18HS017832-01 Health Care Needs Through illness. Applicant Institution: Oregon Health & Health IT Focus Area(s): Behavioral health Science University, Portland, OR Type of Health IT: HIE Estimated dates: 9/30/2008-9/29/2011 The primary goal of this FOA is to Principal Investigator: Wende Baker identify, promote, and disseminate An Electronic Personal Health Record Grant No.: R18HS017838-01 models of patient-centered care. This for Mental Health Consumers Applicant Institution: Southeast includes the use of personal health data Estimated Total Funding: $1,199,379 Nebraska Behavioral Health and evidence-based information to Adapts an existing PHR to fit the needs Information Network, Inc., Lincoln, support both providers and patients in of persons with a serious mental NE managing health and illnesses and disorder and one or more chronic Estimated dates: 9/30/2008-9/29/2011 improve health outcomes in ambulatory medical conditions. care for patients with complex health Evaluation of Effectiveness of an HIT- Focus Area(s): Mental health care needs and across high-risk health based Care Transition Information Type of Health IT: Web-based PHR care transitions. Transfer System Principal Investigator: Benjamin Druss Estimated Total Funding: $1,155,371 Applicants were encouraged to Grant No.: R18HS017829-01 demonstrate the ability of EHRs and/or Develops and evaluates a care transition Applicant Institution: Emory University, PHRs to effectively move evidence- information transfer system that Atlanta, GA based information to the point of care, provides high-risk rural patients and Estimated dates: 9/30/2008-9/29/2011 including the development and their primary care providers with utilization of machine-actionable, discharge information, particularly evidence-based clinical information, and focused on medication management participation of both providers and Focus Area(s): Impact of health IT on patients/families in health information outcomes in a rural ambulatory clinic exchanges. In particular, examination of Type of Health IT: EHR, HIE the role of workflow and effective use of

13 Improving Medication Management Focus Area(s): Patients with multiple Improving Pediatric Cancer Practices and Care Transitions chronic diseases Survivorship Care Through Through Technology Type of Health IT: Interactive voice SurvivorLink Estimated Total Funding: $1,199,998 response Estimated Total Funding: $1,199,998 Conducts a randomized trial to assess Principal Investigator: Robert Friedman Develops, implements, and evaluates an the effectiveness and cost effectiveness of Grant No.: R18HS017855-01 electronic PHR to support improved two CDS interventions aimed at Applicant Institution: Boston Medical self-management and clinical outcomes improving medication management in Center, Boston, MA in pediatric cancer survivors. Estimated dates: 9/30/2008-9/29/2011 home health care. Focus Area(s): Patient self-management Focus Area(s): Home health patients at Randomized Controlled Trial Type of Health IT: Web-based PHR risk of medication problems due to the Embedded in an Electronic Health Principal Investigator: Ann Mertens drugs they are taking and/or the Record Ambulatory Care Grant No.: R18HS017831-01 complexity of their medication regimens Estimated Total Funding: $1,199,928 Applicant Institution: Emory University, Type of Health IT: CDS Assesses the effective of an electronic Atlanta, GA Principal Investigator: Penny Feldman PHR for improved self-management Estimated dates: 9/30/2008-9/29/2011 Grant No.: R18HS017837-01 and clinical outcomes in HIV/AIDS E-Coaching: IVR-Enhanced Care Applicant Institution: Visiting Nurse positive individuals. Transition Support for Complex Service of New York, New York, NY Focus Area(s): HIV/AIDS Patients Estimated dates: 9/30/2008-9/29/2011 Type of Health IT: Web-based PHR Estimated Total Funding: $1,199,999 Using HIT To Improve Transitions of Principal Investigator: James Kahn A randomized trial of the use of an Complex Elderly Patients from SNF Grant No.: R18HS017784-01 interactive voice response system to to Home Applicant Institution: University of facilitate post-hospital discharge Estimated Total Funding: $1,188,157 California San Francisco, San Francisco, transitions for patients with congestive Develops and evaluates an EMR-based CA heart failure or chronic obstructive medication reconciliation system for Estimated dates: 9/30/2008-9/29/2011 pulmonary disease into the community. medication monitoring and followup of Improving Care Transitions for Focus Area(s): Home health elderly patients discharged from a skilled Complex Patients Through Decision Type of Health IT: Interactive voice nursing facility (SNF) to ambulatory Support Ambulatory Care response settings. Estimated Total Funding: $1,198,254 Principal Investigator: Christine Ritchie Focus Area(s): Drug-induced injury in Develops and evaluates a decision Grant No.: R18HS017786-01 the ambulatory geriatric population support system that will augment the Applicant Institution: University of Type of Health IT: EMR availability of information at Alabama at Birmingham, Birmingham, Principal Investigator: Terry Field ambulatory practices following three AL Grant No.: R18HS017817-01 types of care transitions; hospital Estimated dates: 9/30/2008-9/29/2011 Applicant Institution: University of discharges, emergency department Using Electronic Data To Improve Massachusetts Medical School, encounters, and specialty clinic Care of Patients With Known or Worcester, MA evaluations. Suspected Cancer Estimated dates: 9/30/2008-9/29/2011 Focus Area(s): Ambulatory clinics Estimated Total Funding: $1,199,531 A Longitudinal Telephone and Type of Health IT: HIE, CDS Tests the use of health IT to identify Multiple Disease Management System Principal Investigator: David Lobach patients experiencing delays in diagnosis To Improve Ambulatory Care Grant No.: R18HS017795-01 and/or treatment of some types of Estimated Total Funding: $1,199,934 Applicant Institution: Duke University, cancer and to facilitate their movement Assesses the effectiveness of an Durham, NC through the health care system. interactive voice response system for Estimated dates: 9/30/2008-9/29/2011 providing hospital discharge followup of patients with complex health care needs.

14 Focus Area(s): Integrated care network Type of Health IT: EMRs Principal Investigator: Hardeep Singh Grant No.: R18HS017820-01 Applicant Institution: Baylor College of Medicine, Houston, TX Estimated dates: 9/30/2008-9/29/2011 For More Information

For additional information on AHRQ projects on health information technology, please visit www.healthit.ahrq.gov. or contact the health IT staff at [email protected].

15 www.ahrq.gov

AHRQ Pub. No. 10-P004 Replaces AHRQ Pub. No. 09-P001 July 2010