Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What impacts may the use of EHR have in primary care; how can the benefits be maximized, the costs limited, and the harms minimized?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

By a systematic exploration of both traditional and EHR-using practices, the benefits, costs (time and workload) and potential hazards which could lead to harms may be brought to light. Comparisons would not be required, but might be useful to elucidate the issues.

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.)

Patients in Primary Care (FM, IM, PEDS) practices. There is a real need to focus on primary care, its processes and the potential for the improvement for both patients and for clinicians -- The current projects are excessively disease-specific. In primary care the elderly (65+) have an average of 3-4 conditions being co-managed at each visit -- and the implications of this must be studied if we are to improve practice.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Again, most patients have multiple conditions, and this is more prevalent in the elderly -- therefore if any specific group should be studied it is the elderly as their care is more complex with more risk of harms -- and potential for improvement.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

The benefits might include better identifications of conditions needing intervention (e.g. alcohol abuse), better patient outcomes and lower rates of medical errors as well as, potentially decreasing clinicians' workload and reducing attrition from the workforce.

Describe any health-related risks, side effects, or harms that you are concerned about.

Any intervation (e.g. implementing EHRs) has potential hazards as well as benefits. These need to be explored. If the study results in any modifications of EHRs or their use these modifications could results in new and unexpected harms or benefits.

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.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

None

AHRQ Priority Populations

None

Federal Health Care Program

None

Importance

Describe why this topic is important.

EHRs are coming into widespread use and are being promoted to improve safety and efficiency. Since this represents a major change in medical care, careful evaluation and guided improvement are essential. There may be impacts on patients, the care process and clinicians that have not yet been identified. What limited literature exists in this area has focused almost exclusively on in-patient settings and only minimally in primary care -- where most patients are seen and where substantial opportunities for improvement exist.

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.)

This is an ongoing area of research for a team composed of Industrial Engineers and primary care physicians that focuses on patient safety and practice quality. Issues of patient access or candor, workflow optimiization, inter-professional communication and quality of primary care professional worklife have been under-studied and this is an area we intend to pursue.

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.)

yes

If yes, please explain:

It could have implications for the speed of, or manner of EHR implementation, as well as implications for health care funding.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will help physicians (those of us in this group) to be more effective in our care and perhaps to avoid premature burnout. It will help us to guide our medical care corporation in the manner in which it implements and utilizes and EHR as well as the specific training needs of clinicians and staff.

Describe the timeframe in which an answer to your question is needed.

These are questions which should have been addressed years ago as EHRs were being designed and guidelines (internal or external) for use being developed. So,the "timeframe" is now. Not more than 5 years.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Patients with complex medical problems, who may also suffer from inequities and be more vulnerable would benefit from this research.

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)

It will help physicians (those of us in this group) to be more effective in our care and perhaps to avoid premature burnout. It will help us to guide our medical care corporation in the manner in which it implements and utilizes and EHR as well as the specific training needs of clinicians and staff.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

None