Brief Update from AHRQ
on Key Health IT Activities
David Meyers, MD
Director,
Director Center for Primary Care
Agency for Healthcare Research and Quality
June 27, 2009
Academy Health / Chicago, IL
Agency for Healthcare
Research and Q
Quality
y
AHRQ’s Mission
To improve the
quality, safety,
efficiency and effectiveness
of health care
for all Americans
AHRQ
Q
 Improves health care quality for all
Americans
 Transforms research into practice
 Improves health care outcomes through
research
 Uses evidence to improve health care
HHS Research Focus
NIH
CDC
AHRQ
Basic biomedical
bench research
and “efficacy”
clinical trials
The public health
system
y
and the
role of
community--based
community
interventions
“Effectiveness” of
health care
services and the
health care
delivery system
Agency for Healthcare
Research and Q
Quality
y
Quality is our
middle
iddl name
Agency for Healthcare
Research and Q
Quality
y
We don’t provide
health care, we
make
k th
the care you
receive better
Agency for Healthcare
Research and Q
Quality
y
More than
Comparative
Effectiveness
AHRQ
Q FY 2009 Funding
g
 $372 million federal appropriation
– $50 million for comparative effectiveness
research, $20 million more than FY 2008
– $49 million for patient safety activities
– $45 million for health IT
– $55 million
illi ffor MEPS
– $37 million more than FY 2008
 $20 million increase for comparative effectiveness
 $13 million for investigator initiated research
 $17 million for reducing health care acquired infections
Agency for Healthcare
Research and Q
Quality
y
Harnessing
Health IT to
Improve Quality
AHRQ Health IT
g
Research Funding
 Long
Long--term agency priority
 AHRQ has invested more
than $
$260 million in
contracts and grants
 More than 150
communities, hospitals,
providers, and health care
systems in 48 states
AHRQ Health IT
Investment: $260
Million
AHRQ
Q Roles and Resources
Health IT Research
Funding
• Support advances
th t iimprove hhealth
that
lth
care quality and
safety
• Emphasize use of
health IT to improve
ambulatory patient
care including care
care,
transitions
Develop Evidence Base
for Best Practices
Three key domains:
• Patient
P
Patientti t-centered
t d care
• Improved healthcare
decision making
• Medication
management
Promote Collaboration
and Dissemination
• Support efforts of ONC,
HRSA andd Centers
C t for
f
Medicare and Medicaid
Services
• Build on public and
private partnerships
• Use web tools to share
knowledge and
expertise
AHRQ National Resource Center
for Health IT
 Established in 2004
 Serves as a central national
source of information and
assistance for advancing
quality and health IT
 Maintains the AHRQ health IT
web site
 Provides direct technical
assistance to AHRQ grantees
 Creates a repository of
lessons learned from AHRQ’s
health IT initiative.
AHRQ National Resource Center for
Health IT Web Site
Features:
– AHRQ’s
–
–
–
–
http://healthit.ahrq.gov/
portfolio of
health IT
projects
Funding
opportunities
News releases
Emerging
lessons and
best practices
Meetings and
events
AHRQ
Q Health IT Initiative
AHRQ’s Health IT portfolio includes:
– Health IT Grants and ASQ Initiative
– State and Regional
Demonstrations for HIE
– Privacy and Security Solutions for
Interoperable Health Information
Exchange
– E-prescribing Pilots
– Clinical Decision Support
Demonstrations
– Technical Assistance for Medicaid
and CHIP agencies
Ambulatory Safety and
Quality (ASQ) Program (2004(2004-08)


Purpose:
p
Improve
p
safety
y and q
quality
y of ambulatory
y health care in
the U.S. More than 60 grants in 4 areas:
– Enabling Quality Measurement through Health IT (EQM)
– Improving Quality Through Clinician Use of Health IT
(IQHIT)
– Enabling Patient
Patient--Centered Care Through Health IT (PCC)
– Improving Management of Individuals with Complex
Healthcare Needs and those in High Risk Care Transitions
Sample types of Health IT used in projects:
– Personal Health Records
– Clinical/Medication Reminders
– Clinical Decision Support
– Telehealth
– Human/Machine Interface
AHRQ Health IT FOAs:
2008--2011
2008
 In September 2008
2008, AHRQ published
three Health IT Funding Opportunity
Announcements (FOAs) and a Special
Emphasis Notice to build upon the ASQ
initiative.
– Authorized for three years
– Designed
g
to offer incremental support
pp for
progressively more complex health IT
research projects
Health IT FOAs
 Small Research Grant to Improve
p
Healthcare
Q lit through
Quality
th
h Health
H lth IT (R03) FOA
(http://grants.nih.gov/grants/guide/pa
http://grants.nih.gov/grants/guide/pa--files/PARfiles/PAR-0808268.html )
 Exploratory and Developmental Grant to Improve
Health Care Quality through Health IT (R21) FOA
(http://grants.nih.gov/grants/guide/pa
http://grants.nih.gov/grants/guide/pa--files/PAR
files/PAR--08
08-269.html))
269.html
 Utilizing Health IT to Improve Health Care Quality
Grant (R18) FOA
(http://grants.nih.gov/grants/guide/pa
http://grants.nih.gov/grants/guide/pa--files/PARfiles/PAR-0808270.html))
270.html
Research Areas
 Grant must focus on Health IT
implementation and use to improve
y addressing
g at least
healthcare by
one of these areas:
Medication management
– Patient-centered care, coordination of
care, and use of electronic exchange of
i f
information
ti
– Health care decision making through
use of integrated data and knowledge
management
–
Parameters of AHRQAHRQ-sponsored Health IT FOAS
http://healthit.ahrq.gov/healthitfoas
p
qg
Small Research Grant to
Improve Health Care
Quality through Health IT
(R03) PAR-08-268
Exploratory and
Developmental Grant to
Improve Health Care
Quality through Health IT
(R21) PAR-08-269
PAR 08 269
Utilizing Health IT to Improve
Health Care Quality (R18)
PAR-08-270
9/25/2008 – 11/17/2011
9/25/2008 – 11/17/2011
9/25/2008 – 11/17/2011
Jan 16, 2009
Jan 16, 2009
Dec 26, 2008
Feb 16,
16 June 16,
16 Oct 16
Feb 16,
16 June 16,
16 Oct 16
Jan 25
25, May 25
25, Sept 25
2 years
2 years
3 years
$100,000
$300,000
$1.2 mil
$100,000/yr
$200,000/yr
$500,000/yr
Part D page limitation
15
20
25
N off R
No.
Resubmissions
b i i
1
2
2
Page limit for Intro in
resubmission
1
2
3
Authorized Duration
Earliest submission date to
Grants.gov *
Recurring Due Dates (new
applications)
Maximum Project Period
Total Costs (TC) over grant
lifetime
Max TC in a given year
•Electronic submission of Adobe application package is required; will be released in December 2008 see( NOT-OD-08-117)
Supporting the Next Generation
of Investigators
g
 Special Emphasis Notice NOTNOT-HS
HS--08
08--014
(http://grants.nih.gov/grants/guide/notice
http://grants.nih.gov/grants/guide/notice--files/NOT
files/NOT--HS
HS--08
08-014.html))
014.html
– Career
Career--Awards:
 Mentored Clinical Scientist (K08)
http://grants.nih.gov/grants/guide/pa--files/PAR
http://grants.nih.gov/grants/guide/pa
files/PAR--07
07--443.html
 Mentored Research Scientist (K01)
http://grants.nih.gov/grants/guide/pa--files/PAR
http://grants.nih.gov/grants/guide/pa
files/PAR--08
08--022.html
 Independent Scientist (K02)
http://grants.nih.gov/grants/guide/pa--files/PAR
http://grants.nih.gov/grants/guide/pa
files/PAR--07
07--444.html
–
Grants for HSR Dissertation (R36)
http://grants.nih.gov/grants/guide/pa--files/PAR
http://grants.nih.gov/grants/guide/pa
files/PAR--06
06--118.html
Children’s
Children s Health Insurance Program
Reauthorization Act of 2009 (CHIPRA)
AHRQ’s Role
Child Health Quality
p
Activities
Improvement
 Title IV directs HHS to
– Identify, develop and publish quality measures for
–
–
–
–
–
children
Establish a children’s health quality program
Provide technical assistance to states
P d
Produce
a new model
d l electronic
l t i h
health
lth record
d
format for children
Implement
p
demonstration p
projects
j
on q
quality
y
improvement and health IT for children
Conduct a study to report to Congress on pediatric
health measures
CHIPRA Demonstration
j
Projects
 $20 million per year for 5 years for up to 10
states and child health providers
 Four areas:
– Experiment with, and evaluate the use of, new
measures for quality of Medicaid/CHIP children’s
health care
– Promote the use of health IT for delivery of care to
Medicaid/CHIP children
– Evaluate p
provider-based models that improve
providerp
the
delivery of Medicaid/CHIP children’s health care
services
– Demonstrate impact of model EHR format for
children
CMS/AHRQ
Q Collaboration
 Development,
Development dissemination and
reporting of measures
 Development,
Development award and evaluation of
demonstration projects
 Development of pediatric EHR format
QUESTIONS?
Comparative Effectiveness
y Act
and the Recovery
 The American Recovery and
Reinvestment Act of 2009 includes
$1 1 billion for comparative
$1.1
effectiveness research:
– AHRQ: $300 million
– NIH: $400 million (appropriated to
AHRQ and transferred to NIH)
– Office of the Secretary: $400 million
((allocated at the Secretary’s
y discretion))
Recovery
y Act Timeline: AHRQ
Q
February 17:
The American
Recovery and
Reinvestment
Act of 2009 is
signed into law
2009 January
May 1: Due
d t for
date
f Agency
A
wide and
program-program
specific
R
Recovery
A
Actt
plans
April
March 19: The
Federal
Coordinating
C
Council
il ffor
Comparative
Effectiveness
Research is
established
t bli h d
Julyy 30:
AHRQ to
submit
FY ’09
Operations
Plan
July
June 30: Due
date for IOM
submission of a
list of national
priority
conditions**
conditions
D
December
b
31, 2010: All
Recovery
Act funding
t be
to
b
obligated
October
2010
November 1:
AHRQ
FY ‘10
operations
ti
plan due
* Stakeholder input required
American Recovery and Reinvestment Act
of 2009 – HITECH Act Provisions
Regional
g
Extension Centers
 Purpose:
p
to p
provide TA and disseminate best
practices from the HITRC to support and accelerate
efforts to adopt, implement and effectively utilize
health information technology
 Objective: to enhance and promote the adoption of
health IT
 Key notions:
–
–
–
–
–
Assistance with wide spectrum of implementation issues
Broad participation from industry, universities and State
g
government
Active dissemination
Participation in health information exchange
Integration
g
of health IT into initial and ongoing
g g training
g of
health professionals and others
Health IT Research Center
((HITRC))
 Provide technical assistance and develop
p or
recognize best practices
–
–
For establishment and evaluation of regional and local
health information networks
For development and dissemination of solutions to barriers
to the exchange of electronic health information
 Provide forum for exchange of knowledge and
experience
i
 Accelerate and transfer lessons learned
 Assemble,
sse b e, a
analyze,
a y e, a
and
d widely
de y d
disseminate
sse
ate evidence
e de ce
and experience
 Learn about effective strategies to adopt and utilize
health IT in medically underserved communities