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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 186 kB

Date submitted: September 02, 2009

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
Evaluation of the effectiveness and quality of patient care using an electronic health record system (EHR).
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
Questions that this research will address include:

1. How does use of an EHR by a physician’s practice provide improved care to patients?
2. What are the barriers to adoption of EHRs from a workflow perspective?
3. What is the necessary education and use of an EHR to achieve improved delivery of care?

This research will provide a comparative analysis of the quality of health care delivery according to “meaningful use” criteria. Physicians using an EHR and practices still using paper health records will be evaluated based on objectives within the “meaningful use” criteria as proposed by ONC/HHS that will subsequently be legislated and approved by CMS.
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
The research will focus on primary care physician practices and clinics. This segment of healthcare provides services to patients of various ages, genders, and potential clinical diagnoses.
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
The research will focus on practices within metropolitan areas.
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Specific health-related benefits will include care for patients with chronic clinical conditions (e.g. Diabetes, CHF, etc.) – a focus of the research. In Europe, EHRs have been shown to improve care for patients through identification of risk factors with proactive referrals from primary physicians to specialty practice physicians (e.g. for Diabetes this would mean referral to an endocrinologist to prevent health complications from the disease.)
Describe any health-related risks, side effects, or harms that you are concerned about.
There are no expected risks, side effects, or harms that would result from the research. The HITECH Act / HIPAA Privacy and Security guidelines would not be breached as a result of the study, and appropriate consent would be received from potential participants.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Arthritis and nontraumatic joint disorders
  • Cancer
  • Cardiovascular disease, including stroke and hypertension
  • Developmental delays, attention-deficit hyperactivity disorder, and autism
  • Diabetes mellitus
  • Pregnancy, including preterm birth
  • Pulmonary disease/asthma
AHRQ Priority Populations
  • Low income groups
  • Minority groups
  • Women
  • Children
  • Elderly
  • Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care
Federal Health Care Program
  • Medicaid
  • Medicare


Describe why this topic is important.
Migrating from paper to Electronic Health Records is a key component of the nation’s resolve to improve health care, as evidenced by ARRA and the stimulus package. One key component of the stimulus package is the migration from paper to electronic records with government financial incentives for providers and facilities.

Understanding how use of an EHR can identify risk factors and alert providers to take steps to reduce and/or eliminate potential onset of chronic health conditions.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
After spending over 17 years in technology as an Executive Director of IT for a Fortune 1000 company, I decided to change careers to become a Registered Nurse in the State of Florida. In doing so, I have consulted and worked with hospitals and physician/ARNP practices where their health records were on paper and I have first hand knowledge of the inherent difficulties in using paper records to track and manage patient conditions.

That said, I recently was appointed Co-Chair of the Ambulatory Workgroup of the Commission for Certification of Health IT (CCHIT), and have extensive experience in understanding the implications of care goals, priorities, objectives and measurements for the coming years leading up to 2015.

I am also the Co-Author of the HITECH / HIPAA Survival Guide for Practitioners ( that provides guidance to physician practices when implementing an HER and describes the implications for the new HITECH / HIPAA Privacy & Security regulations.

Finally, I have been asked to speak at a conference in Virginia this fall at the HITECH and HIPAA Compliance Management for Providers: Solutions to Expose Risk, Minimize Liability and Maintain Compliance with New HITECH Act Provisions and Expanded HIPAA Requirements under the ARRA 2009. This conference is undertaken by The World Congress and will be co-located with The 5th Annual World Healthcare Innovation and Technology Congress (WHIT v.5.0). Speakers at this engagement include David Brailer, MD, PhD, former Coordinator for Health Information Technology, Bill Clinton, 42nd President of the United States, and Paul Tank, Consultant to ONC, among others.

So to directly answer your question, I have a unique triad of expertise at the intersection of health care, technology, and the law. It’s not just a hobby, it’s a passionate interest. As a Registered Nurse, however, my first and foremost passion is to deliver the highest quality of care to my patients. I believe that with appropriate use of a quality electronic health record, patient outcomes can be improved.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
If yes, please explain:
I don’t think there is any doubt there is a high level of uncertainty for adoption and use of Electronic Health Records by providers. In fact, reliable statistics show an extremely low level of EHR adoption in the US. Furthermore, to meet the criteria in the meaningful use matrix, providers and facilities must be able to securely exchange health data with appropriate entities when, in fact, data exchange standards have not yet been finalized.

In addition, the 2013 criteria in the meaningful use matrix specifically requires an EHR to be able to update a Personal Health Record (PHR), a feat that may or may not be achieved within that timeframe.

Finally, it is my personal belief that physicians, nurses, and other health care professionals are not at a comfortable point of “computer literacy,” where they will embrace the use of computers in their daily workflow. I believe education is a key, and critical component, of meaningful use of an EHR - beyond the criteria and regulations implicit in the legislation.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
Questions that this research will address include:

• How does use of an EHR by a physician’s practice provide improved care to patients?

This question will be answered in a manner that provides guidance to physicians desiring to implement an EHR; what education is required, how does their selected system help them do their work, how to select a system based on practice workflow and “specialty.”

• What are the barriers to adoption of EHRs from a workflow perspective?

This question will provide insight into the following areas: How has an EHR helped or hindered the work of the physician and their staff? How did they manage to overcome barriers to adoption? What were their barriers to adoption and use of an EHR?

• What is the necessary education and use of an EHR to achieve improved delivery of care?

This question will provide suggestions on how to educate the practice on use of the electronic health record, including security and privacy issues for electronic data. It will also provide insight into how an EHR can be used for clinical decision support and knowledge management.
Describe the timeframe in which an answer to your question is needed.
The research should last no longer than 6 months after an appropriate number of participants are willing to participate and to devote their time to the project.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
Since the research will involve primary care practices and clinics in metropolitan areas, rural physicians and clinics will not be included as part of the study.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Nurse/Nurse Practitioner/Physician Assistant
  • Researcher
  • Other
Are you making a suggestion as an individual or on behalf of an organization?