1. Health IT Success Stories AHRQ Conference September 29, 2010 Rebecca Roper

2. Success Stories Easy-to-understand summaries of research project and its momentum to go forward Easy-to-understand summaries of research project and its momentum to go forward – Enable Layman’s understanding of who and how health IT implementation was beneficial – Illustrations – Demonstrated, significant improvement in outcome(s) – Resiliency, Adaptability, Sustainability, Transferability of intervention, etc. – Quotes from different perspectives Plus, succinct, substantive ~2-page detail discussion Plus, succinct, substantive ~2-page detail discussion

3. Two Reports: Using Health IT: Eight Quality Improvement Stories – – Contract No. HHSA 290200900019I, T.O. 3 – – Prepared by: Mathematica Policy Research – – http://healthit.ahrq.gov/SuccessStoriesTHQIT (October 2010) http://healthit.ahrq.gov/SuccessStoriesTHQIT Success Stories from the AHRQ-Funded Health IT Portfolio (CY 2009) – – Contract No. HHSA 290200900018I, T.O. 3 – – Prepared by: John Snow, Inc (JSI) – – http://healthit.ahrq.gov/SuccessStoriesCY2009 (November 2010) http://healthit.ahrq.gov/SuccessStoriesCY2009

4. Transforming Healthcare Quality through Health IT (THQIT): 118 Individual Projects 118 Individual Projects

5. Transforming Healthcare Quality through Health IT (THQIT): September 2004 – January 2010 40 Cooperative Agreements, THQIT Implementation I (HS-04-011) – $ 53.6 Million from AHRQ, plus in-kind support – 24 No-cost extensions 24 R-01 THQIT Value Grants (HS-04-012) – $ 33.0 Million from AHRQ – 22 No-cost extensions 38 P-20 THQIT Planning Grants (HS-04-010) 38 P-20 THQIT Planning Grants (HS-04-010) – $ 7.1 Million from AHRQ – 15 No-cost extensions 16 Cooperative Agreements, THQIT Implementation II (HS-05-013) – $ 22.5 Million from AHRQ, plus in-kind support – 14 No-cost extensions

6. Quality Improvement

7. THQIT Implementation EMS Responders Use Health IT to Improve Cardiac Care Nursing home Health IT Reduces Pressure Ulcers and Increases Staff’s Job Satisfaction Project Echo: Extension for community Healthcare Outcomes Through Telemedicine Network of Rural Hospitals in Iowa Redesign Patient Care Workflow to Use EHR

8. The Problem: Many heart attack patients do not receive needed treatment in the recommended timeframe Many heart attack patients do not receive needed treatment in the recommended timeframe The Health IT Contribution: Clinical Decision Support Software Clinical Decision Support Software – Helped paramedics quickly determine proper treatment Web-Based Quality Reporting System Web-Based Quality Reporting System – Combined data from the prehospital and hospital experience – Data was used to tailor quality improvement programs Project Director: Dr. Harry Selker Project Location: Massachusetts AHRQ Grant: UC1 HS015124 AHRQ Grant: UC1 HS015124 http://healthit.ahrq.gov/FRPT_Selker_UC1HS015124 EMS Responders Use Health IT to Improve Cardiac Care

9. Results: 150% increase in the number of patients receiving treatment in less than 90 minutes 150% increase in the number of patients receiving treatment in less than 90 minutes Improved quality of care provided by paramedics Improved quality of care provided by paramedicsSustainability/Transferability: Technology was used in new communities and to address other conditions Technology was used in new communities and to address other conditions The system was integrated with other health IT The system was integrated with other health IT

10. The Problem: Pressure ulcers are a prevalent and preventable condition for nursing home residents Pressure ulcers are a prevalent and preventable condition for nursing home residents The Health IT Contribution: Electronic documentation Electronic documentation – Part of larger On-Time quality improvement program – Documented residents’ behavior, weight, and skin integrity – Produced reports to help identify residents at high-risk of pressure ulcer development Project Director: Dr. Susan Horn Project Location: Multi-state AHRQ Grant: UC1 HS 015350 AHRQ Grant: UC1 HS 015350 http://healthit.ahrq.gov/FRPT_Horn_UC1HS015350 http://healthit.ahrq.gov Nursing Home Health IT

11. Results: Decreased percent of residents with high-risk pressure ulcers Decreased percent of residents with high-risk pressure ulcers Improved job satisfaction Improved job satisfactionSustainability/Transferability: 67 additional facilities have implemented or are starting to implement the technology 67 additional facilities have implemented or are starting to implement the technology On-Time Manual being created On-Time Manual being created On-Time emphasizes communication, you know the residents are better cared for; families are happy. ~ Quote from a staff member [At the beginning of the project] we had to practically beg [health IT] vendors to incorporate the set of On-Time reports into their system. Since then there has been a growing recognition that the value of health IT comes from impacting clinical decision making, not just automating the paper documentation process, and On-Time reports can add value to a vendor’s system. ~Quote from Principal Investigator

12. Nursing Home Health IT More information: More information: – http://ahrq.gov/research/ontime.htm http://ahrq.gov/research/ontime.htm – http://innovations.ahrq.gov/content.aspx?id=2153 http://innovations.ahrq.gov/content.aspx?id=2153

13. The Problem: Rural residents often have problems accessing specialty care for complex conditions Rural residents often have problems accessing specialty care for complex conditions The Health IT Contribution: Project ECHO: Extension for Community Healthcare Outcomes through Telemedicine Project ECHO: Extension for Community Healthcare Outcomes through Telemedicine – Enabled patients to be treated long-distance – Provided a platform for rural providers to hone their clinical skills Project Director: Dr. Arora Sanjeev Project Location: New Mexico AHRQ Grant: UC1 HS 015135 http://healthit.ahrq.gov/FRPT_Arora_UC1HS015135 Telemedicine Connects Rural Residents to Specialty Care

14. Results: Improved access to care for 4,000 patients with hepatitis C Improved access to care for 4,000 patients with hepatitis CSustainability/Transferability: Expanded program to other conditions Expanded program to other conditions Project selected as winner in search for Disruptive Innovations in Healthcare-New Models Project selected as winner in search for Disruptive Innovations in Healthcare-New Models We’re developing our knowledge networks so that every doctor can provide best practice care without being an expert in all chronic diseases. ~Quote from Principal Investigator.

15. Telemedicine Connects Rural Residents to Specialty Care Original Focus: Hepatitis C21 Expanded to these Conditions and Facilities Asthma/Pulmonary16 Child, Adolescent, and Family Psychiatry32 Child, Adolescent Psychology14 Chronic Pain/Headache9 Diabetes/Cardiovascular Risk Reduction19 High-Risk Pregnancy21 HIV/AIDS17 Integrated Addiction/Psychiatry14 Medical Ethics7 Occupational Medicine5 Pediatric Obesity43 Psychotherapy4 Rheumatology11

16. Telemedicine Connects Rural Residents to Specialty Care Original Focus: Hepatitis C21 Expanded to these Conditions and Facilities Asthma/Pulmonary16 Child, Adolescent, and Family Psychiatry32 Child, Adolescent Psychology14 Chronic Pain/Headache9 Diabetes/Cardiovascular Risk Reduction19 High-Risk Pregnancy21 HIV/AIDS17 Integrated Addiction/Psychiatry14 Medical Ethics7 Occupational Medicine5 Pediatric Obesity43 Psychotherapy4 Rheumatology11 Facility Count=233

17. The Problem: If EHR functions are not used effectively, preventable quality and safety issues may persist If EHR functions are not used effectively, preventable quality and safety issues may persist The Health IT Contribution: Enhance use of EHR functions, examples: Enhance use of EHR functions, examples: – 54 clinical decision support rules were added to the system – Pharmacists from the rural referral center use the EHR to remotely check medication dosing and drug alerts at critical access hospitals – Nursing documentation functionality added – Electronic ordering of tests and medications added Project Director: Dr. Donald CrandallProject Location: Iowa AHRQ Grant: UC1 HS 015196 htt p://healthit.ahrq.gov/FRPT_Crandall_UC1HS015196 htt p://healthit.ahrq.gov/FRPT_Crandall_UC1HS015196htt p://healthit.ahrq.gov/FRPT_Crandall_UC1HS015196 Enhancing Use of EHR Functions to Improve Quality of Care

18. Results: Improved the timeliness of indwelling catheter removal Improved the timeliness of indwelling catheter removalSustainability/Transferability: Implemented additional clinical decision support rules Implemented additional clinical decision support rules Enhanced EHR function use in other system hospitals Enhanced EHR function use in other system hospitals Enhancing Use of EHR Functions to Improve Quality of Care

19. Planning and Implementation THQIT Grants Public-Private Partnership Creates Web- Based System to Improve Rural Children’s Access to Health Care Through a Medical Home Replication of Health Information Exchange Framework Across Oklahoma

20. Public-Private Partnership: Web-based System Improves Childrens’ Access The Problem: Rural, lower income children lack access to appropriate healthcare Rural, lower income children lack access to appropriate healthcare The Health IT Contribution: iReach web-based system iReach web-based system – Tracks patients enrolled in a program that helps children obtain insurance and links children to providers (Access El Dorado) Project Director: Dr. Gregory BergnerProject Location: California AHRQ Grants: P20 HS 014908 (planning) UC1 HS 016129 (implementation) http://healthit.ahrq.gov/FRPT_Bergner_P20HS014908 http://healthit.ahrq.gov/FRPT_Bergner_UC1HS016129

21. Public-Private Partnership: Web-based System Improves Childrens’ Access Results: iReach reduced errors by Access El Dorado staff iReach reduced errors by Access El Dorado staff 23% reduction in time to manage a single case 23% reduction in time to manage a single caseSustainability/Transferability: Health care providers are funding ongoing operating costs for program Health care providers are funding ongoing operating costs for program I feel that iREACH has been extremely efficient. I just know from before, it’s a much less tedious process, more streamlined….The paper process was bogging us down. ~ Quote from a user A great success [of the AHRQ-funded planning process] was creating a community of trust and commitment among the partners, so that they perceived those being served as “our” patients rather than “yours” or “mine.” ~ Quote from ACCEL program director

22. The Problem: Patients often see multiple providers and their care becomes fragmented Patients often see multiple providers and their care becomes fragmented The Health IT Contribution: Health Information Exchange (HIE) Health Information Exchange (HIE) – Local groups of providers use an established framework to develop an HIE – Local HIEs are connected to create a “network of networks” Project Director: Mark JonesProject Location: Oklahoma AHRQ Grant: P20 HS 015365 (planning) UC1 HS 016131 (implementation) http://healthit.ahrq.gov/FRPT_Jones_P20HS015364 http://healthit.ahrq.gov/FRPT_Jones_UC1HS016131 HIE Spreads Across Oklahoma

23. Results: HIE has 49 member organizations and data on 3 million patients HIE has 49 member organizations and data on 3 million patientsSustainability/Transferability: In 2011, HIE is expected to cover 70% of Oklahoma In 2011, HIE is expected to cover 70% of Oklahoma Central Florida providers use “network of networks” model Central Florida providers use “network of networks” model This started as 1 network with 4 health facilities and 400,000 records, and it grew to 5 networks across Oklahoma with 49 health facilities and 37 million records in 2.5 years. ~ Quote from Principal Investigator

24. HIE Spreads Across Oklahoma

25. Value Grants Electronic Prescribing: Lowering Patients’ Prescription Drug Costs Integrated Telemedicine System Demonstrates Reduction in Children’s Emergency Department Visits

26. The Problem: Prescription drug costs can put much-needed medication beyond the reach of low-income patients and those with chronic conditions Prescription drug costs can put much-needed medication beyond the reach of low-income patients and those with chronic conditions The Health IT Contribution: Electronic-Prescribing Electronic-Prescribing – Color-coded drug list indicating the relative cost of drugs Project Director: Dr. Joel Weissman Project Location: Massachusetts AHRQ contract: R01 S015175 http://healthit.ahrq.gov/FRPT_Weissman_R01HS015175 Electronic-Prescribing Lowers Drug Costs

27. Results: $3.26 saved per electronic prescription $3.26 saved per electronic prescriptionSustainability/Transferability: Health plans offered the system free of charge to more providers Health plans offered the system free of charge to more providers [The study findings indicate that] doctors want to do the right thing, but they don’t always have the right information available. ~ Quote from Principal Investigator

28. The Problem: Children often exhibit symptoms of illness and school staff are unable to decide which students need to be sent home Children often exhibit symptoms of illness and school staff are unable to decide which students need to be sent home Wages lost when parents care for children who could be at school can be detrimental for low income families Wages lost when parents care for children who could be at school can be detrimental for low income families Low income parents, needing to quickly return to work, often seek attention from costly EDs Low income parents, needing to quickly return to work, often seek attention from costly EDs The Health IT Contribution: Telemedicine Telemedicine – Schools and child care centers have access to telemedicine equipment – PCPs provide remote consultations Project Director: Dr. Kenneth McConnochieProject Location: New York AHRQ Contract: R01 HS 015165 http://healthit.ahrq.gov/FRPT_McConnochie_R01HS015165 http://healthit.ahrq.gov/FRPT_McConnochie_R01HS015165 Telemedicine Reduces Children’s ED Visits

29. Results: 83% of providers were equally confident in their telemedicine diagnoses and in-office diagnoses 83% of providers were equally confident in their telemedicine diagnoses and in-office diagnoses Children with access to telemedicine sites had 24% fewer ED visits Children with access to telemedicine sites had 24% fewer ED visitsSustainability/Transferability: Payers started reimbursing telemedicine visits Payers started reimbursing telemedicine visits Telemedicine program is expanding to other settings Telemedicine program is expanding to other settings It’s both convenience—health care when and where you need it—and continuity—by people you trust. Who couldn’t use more of that from health care? ~ Quote from Principal Investigator

30. Telemedicine Reduces Children’s ED Visits Results: 83% of providers were equally confident in their telemedicine diagnoses and in-office diagnoses 83% of providers were equally confident in their telemedicine diagnoses and in-office diagnoses Children with access to telemedicine sites had 24% fewer ED visits Children with access to telemedicine sites had 24% fewer ED visitsSustainability/Transferability: Payers started reimbursing telemedicine visits Payers started reimbursing telemedicine visits Telemedicine program is expanding to other settings Telemedicine program is expanding to other settings It’s both convenience—health care when and where you need it—and continuity—by people you trust. Who couldn’t use more of that from health care? ~ Quote from Principal Investigator

31. Telemedicine Reduces Children’s ED Visits Visits for Illness: Total: 22.9 % increase Emergency Department: 23.6 % decrease Costs of illness visits: 3.0 % decrease

32. Telemedicine Reduces Children’s ED Visits Number and Cost of Medical Care Visits, by Type of visit, For Children Enrolled in Health-E-Access vs. Comparison Children

33. THQIT Synthesis Grantee Surveys (early 2011) Grantee Surveys (early 2011) Group of Follow-up Grantee interviews Group of Follow-up Grantee interviews – Depth, Clarification Tool/Guideline: Tool/Guideline: – Use of EHR and HIE in rural hospitals

34. AHRQ’s Interest No expiration date No expiration date Send articles to AHRQ JournalPublishing@ahrq.hhs.gov Send articles to AHRQ JournalPublishing@ahrq.hhs.gov JournalPublishing@ahrq.hhs.gov Include grant citation in your presentations and publications Include grant citation in your presentations and publications

35. Questions?

36. Success Stories from the AHRQ- Funded Health IT Portfolio (CY 2009) Contract No. HHSA 290200900018I, T.O. 3 – – Prepared by: John Snow, Inc (JSI) – – http://healthit.ahrq.gov/SuccessStories CY2009 (November 2010) http://healthit.ahrq.gov/SuccessStories CY2009

37. Research Grants Larry Garber: SAFEHEalth, A Health Information Exchange Improving Health Care Delivery in Central Massachusetts Pascale Carayon: Using Human Factor Research to Increase the Success of a Health Information Technology Implementation Denni McColm: Measuring Quality in Physicians’ Practices in Southwestern Missouri Using and Electronic Health Record

38. SAFEHealth: A Health Information Exchange Improving Health Care Delivery in Central Massachusetts Regional HIE that securely transfers patient health information in “real time” between providers Dr. Lawrence Garber, AHRQ grant (UC1 HS015220)

39. SAFEHealth: A Health Information Exchange Improving Health Care Delivery in Central Massachusetts Goal: Improve patient safety, quality of care, and health care efficiency, while protecting patient privacy Data exchange includes medication lists, allergies, vital signs, lab results

40. SAFEHealth: Steady Increase in Number of Documents Exchanged No more huge piles of paper. I can set up a follow-up with a Fallon Clinic specialist based on the ER note…. Essentially, we have cut out the middle man – talk about GREEN and LEAN! ~ Quote from primary care physician at Fallon Clinic

41. SAFEHealth Key Decisions/Success Factors Available through different EHRs Single Opt in, automated at patient registration, revoke at any time/any or all organizations Developed internally, costs shared by partners

42. SAFEHealth: Continuing as a Successful HIE Still continues as an active HIE Key is to instill trust and value to stakeholders Must integrate into workflows of patients, registration staff and providers Patients will see greater value as more organizations participate Providers are most satisfied when data is easy to find, so data should be sorted by sections into EHR

43. Using Human Factor Research to Increase the Success of a Health IT Implementation CPOE can reduce medication errors Success is tied to how well CPOE is designed and integrated into workflow Examined impact of implementation in ICUs on quality of care and safety, staff tasks and perceptions, and financial value Conducted human factors research to evaluate and identify issues with interface and workflow Dr. Pascale Carayon, AHRQ grant R01 HS 015274 CPOE

44. Impact Decrease in some errors while increase in others Increase timeliness of antibiotic medication administration Short term negative staff perception, disappeared after 12 months. Staff tasks changed No impact on financial value, no difference in ICU costs or physician productivity CPOE

45. Human Factors Research: Leading to More Effective Technology Identified potential problems with the system Identified potential problems with the system Addressed issues by changes in workflow or design interface Addressed issues by changes in workflow or design interface Identified potential negative impact on patients & providers before the system went live in the ICUs. Identified potential negative impact on patients & providers before the system went live in the ICUs. ‘I thought this was a very useful process with different perspectives generating good discussion of potential issues” ~ Geisinger Employee CPOE

46. EHRs have potential to provide reliable, valued clinical data for quality measurement Challenge lies in having unstructured documentation, often in many places within EHR – – complicates search algorithms & makes for confusing results Aim: To use pre-existing EHR technology to facilitate quality measurement Measuring Quality in Physicians’ Practices in Southwestern Missouri Using an EHR Denni McColm, AHRQ grant (HS017094)

47. Ambulatory EHR System Used in Quality Measurement for PQRI Reporting Participants included 15 practices within Citizens Memorial Healthcare (CMH) Toolkit was developed to help w/ implementing quality measures into CMH’s EHR EHR data elements were standardized Automated data extraction was developed Efficiency/accuracy of automated vs. manual data extraction was evaluated

48. Accurate quality measurement for PQRI reporting through an ambulatory EHR system Compared manual to automatic for 3 diabetes measures Coding completeness 20% for manual coding compared to 100% for automated data extraction Automated data extraction also more accurate in reporting results

49. Outcomes and Lessons Without accurate documentation; quality of care may not be accurately reflected – – 62 quality measures built into documentation and workflow Automated data extraction relied heavily on the use of custom documentation queries – – Toolkit was expanded and refined to include custom queries Various strategies can improve physicians’ documentation within the EHR system. – – Web-based report on aggregate organizational performance (developed through this project) – – Additional training on quality measures and effective use of the EHR (as was done in this project)

50. Research Contracts Dr. Lynne Nemeth: Electronic Standing Order in Primary Care Physician Offices Boosts the Delivery of Adult Vaccinations and Other Health Maintenance Services Dr. Doug Bell: Electronic Referrals Show Promise for Improving Quality Care in Outpatient Settings

51. E-Standing Orders Dr. Lynn Nemeth – – 10 am – – Salon E

52. Electronic Standing Orders in Primary Care Services (screening tests, adult immunizations, diabetes care) often overlooked. Implemented and and examined effectiveness of electronic standing orders (SO) SOs triggered by a patient visit and authorize appropriate medical staff to carry out services Dr. Nemeth AHRQ Contract (HHSA290200710015)

53. EHR Integration of SO Customized EMR page to integrate SOs and display health maintenance (HM) items HM table indicates a patient’s need for a preventive service. Overdue items are highlighted in red for easy viewing, serving as electronic reminders.

54. Improvement of Practice Performance Participating Participating practices reported: practices reported: 8-17% increase in adult immunizations 8-17% increase in adult immunizations 6-10% increase in preventive care screenings 6-10% increase in preventive care screenings Up to 18% increase in diabetes care measures Up to 18% increase in diabetes care measures The project made us more aware that our patients were missing regular health maintenance....we did not realize that we missed this. We are now keeping up with their health maintenance issues, and patients realize that they are cared about. ~Participating Physician

55. Electronic Referrals Show Promise for Improving Quality of Care in Outpatient Settings Lack of communication between referring providers & specialists causes fragmented patient care eReferral is a web-based service that streamlines and facilitates communication between clinics and thereby has the potential to increase efficiencies and improve clinical outcomes Assessment of how electronic referral systems can best be used to support improvements in health care processes and outcomes Dr. Bell, AHRQ Contract (HHSA290200600017)

56. eReferral Process PCP submits electronic referral Consult reviewed electronically by specialist Appropriate specialty referral AND Pre-referral work-up complete PCP can manage with guidance OR Pre-referral work-up incomplete Schedule next available Overbook NonurgentUrgentNot scheduled OR More information requested PCP re-submits referral ScheduledNever scheduled

57. Improving Quality of Care in Outpatient Settings “It just keeps everything organized…It really helps me track everything a lot more easily than what we used to have…It’s an electronic trail that is very logically set up.” – Specialty Reviewer “I think the patient’s visit is more productive because the specialists have already done some of the initial diagnostic work. - Referring Physician

58. Future Considerations Generalizability to other settings will depend on EMR infrastructure and financial incentives Successful implementation requires careful consideration of end user workflow User education is critical to support realistic expectations and long-term adoptability Learning curve impacts use of new technology and its outcomes

59. Contracts Anne Peterson: Building Bridges Workshop: Healthcare Consumer Needs and the Design of Health Information Technology Jeffrey Kerwin: Healthcare Consumers’ Perspectives on the Design and Use of Health Information Technology Cheryl McDonnell: Strategies for Integrating Usability in Electronic Health Records

60. Building Bridges Workshop: Consumer Needs and the Design of Health IT Consumer-based health care has been identified as a critical strategy to improve health outcomes Empowering healthcare consumers is critically dependent on the ability to collect, store, and manage “personal health information” (PHI) A 2-day workshop (July, 2009) was held to bring together a multi-disciplinary group of experts to address and promote the design of consumer health IT systems based on a solid understanding of consumers’ PHIM practices Anne Peterson, AHRQ Contract (#HHSA290200710072T )

61. 3 Themes Emerged Defining PHIM – Systems needs to be flexible and accessible to different types of users, across different settings. Design Issues – Systems need to take into account the particular needs of the consumer, rather than the needs of the physician, insurance company, or some other entity with a stake in the patient’s health care. Steps for the Advancement of Consumer Health IT - Additional research on consumers’ PHIM practices and increased sharing of info within the technology field is needed to lead to better, more efficient designs.

62. Future Opportunities Field of PHIM still in its infancy: no existing systems, models, or classifications Time is ideal to incorporate consumers’ needs into the PHIM framework – – “ Who & what are we designing for?” User-centered PHIM tools can: – – empower patients as partner in their own health care, – – improve patient-doctor communication, and – – Make tools and systems more widely available to all consumers One of the most underused resources in health care in America is the consumer. ~Carolyn Clancy, Director, AHRQ

63. Health Care Consumers’ Perspectives on the Design and Use of Health IT Surveys suggest the public could be better informed regarding health IT capabilities and how physicians use EHRs 20 focus groups offered patient perspectives on health IT – – Awareness, beliefs, perceptions, fears of health IT – – At what point patients want to be engaged in development of health IT Dr. Jeffrey Kerwin, PhD, Contract PSC TO TO#07R000131, IAA Number 06-443R-06

64. Consumer Perspectives “…my doctor comes in … she has, like, a big, thick [file] because I've been going to her for years … But, if she had a laptop or something, she'd be able to go back to that date and time and just pull that up and it would pop right up. It would be easier for her, as far as being organized and being systematic.” -Focus Group Participant Almost complete agreement that patients should have a say in how data is shared/used General Agreement that health IT would improve efficiency, reduce errors. Little agreement about the role of patients in the design/ use of health IT

65. Fears / Concerns “That's your personal information. You should have every right to say how it's used.” Consumers feel that patient health info belongs to the patients Concerns raised over privacy, security, interpersonal impact  Doubts in cost savings – fear of rising costs  Uncertainty re: how health IT can enhance health care decisions “Everything else has been hacked. Government files have been hacked; banks have been hacked. My credit cards have been stolen. What else is left?” “Everything else has been hacked. Government files have been hacked; banks have been hacked. My credit cards have been stolen. What else is left?”

66. Suggestions for Engaging Consumers in Health IT Design & Use Engage consumers early in process More surveys and focus groups on consumer opinions or perspectives Involvement of patient advocacy orgs Consumers involved in advisory committees More public education on health IT, its impact on patients, and security/privacy issues

67. Strategies to Integrate Usability in EHRs EHRs revolutionize medicine, however lack of usability data to inform design and practice A panel of multidisciplinary EHR experts & vendors was convened to participate in informal interviews This is AHRQ’s first initiative to guide EHR innovations in usability Dr. Cheryl McDonnell, AHRQ Contract (HHSA2900710073T)

68. Reports Document Expert Recommendations Three documents were developed to focus on key areas of interest to policymakers, researchers, and EHR developers: Framework Evaluation Interface Design Vendor Practices and Perspectives “There is strong evidence (outside health care) that usability testing in the design and development phase is more effective and less expensive than after market release.” - Expert Panel Member

69. Findings Framework Evaluation: definition of categories for usability and evaluation Interface Design: incorporation of recommendations for evidence-based lessons from other fields Vender Practices and Perspectives: description of usability engineering processes and engagement of end users throughout the product life cycle

70. Dissemination of Findings