William A. Hyman
Professor Emeritus, Biomedical Engineering
Texas A&M University, w-hyman@tamu.edu
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The Agency for Healthcare Research and Quality (AHRQ) has issued a Funding Opportunity Announcement (FOA) regarding research on the use of health information technology related to patient outcomes.
Maybe it is the grumpy old man part of my persona, but I found it curious that the FOA defines the outcome of the research in advance. Namely the announcement says that it is for research that “demonstrates how health information technology (IT) can improve patient-centered health outcomes and quality of care in primary care and other ambulatory settings”. The review criteria include “Will extending the original health-IT enabled PRO implementation to the newly proposed site(s), setting(s) or population(s) have a significant, quantifiable impact on the number or type of patients and clinicians now using PRO measures to improve the quality of care.” This too seems to have already assumed that the quality of care is or has been improved in the smaller effort, and that extending it will also have this result. Wouldn’t a better objective be to fund research that seeks to determine if healthcare IT does those things? In fact, if you already know that it does, is this research? Rather than rely entirely on my prejudices I looked up “research” and found that it is “the systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions”. I think the FOA misses that mark. This prove-what-we-want-to-be-true approach may be consistent with a broader statement of AHRQ’s mission which Is said to be “to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable”. Here too, to me this pre-judges the evidence that might result.
In another arena, the AHRQ takes a similar it’s-our-program-and-it-is-therefore-good approach. Patient Safety Organizations (PSOs) were created by Congress in 2005. This reached fruition as a final rule in 2008. Note that a PSO is not simply an organization that focuses on patient safety just like Meaning Use is not simply to use an EHR meaningfully. A PSO is a specific government defined thing which AHRQ is in charge of. (Unless you were thinking of Provider-Sponsored Organization which is a different government defined thing.) Despite some portions of the PSO program never having been implemented, and there being little research to demonstrate value other than by anecdote, AHRQ knows that it is a good thing. Notably the Network of Patient Safety Databases (NPSD), which was supposed to integrate findings and data from the many independent PSOs and thereby provide a valuable and broader look at safety issues does not exist. The fact that NPSD does not exist has not deterred AHRQ from citing its value as if it did. One such statement says the NPSD “aggregates nonidentifiable information on patient safety…on a national basis to discern quality and safety problems and their solutions, more quickly and effectively. The more data that PSOs submit, the more we can learn about improving patient safety.” The present tense seems out of place here since national data is not being collected.
None-the-less the AHRQ has a number of laudatory brochures including one entitled “How PSOs Help Health Care Organizations Improve Patient Safety Culture”. This is consistent with their general approach that says PSO’s are good because we say they are. This has a parallel in EHRs wherein value is asserted but not proven, and downsides ignored. I note in this regard that MD Anderson announced it would lay off 1000 people to offset the costs of its new EHR.
Doing research to establish value is one thing. Being an advocate and declaring your own success is another.