A new set of reports from AcademyHealth, undertaken with the support of the California HealthCare Foundation and with seed money from the U.S. Agency for Healthcare Research and Quality, explore the implications of electronic health records (EHRs) for purposes beyond simply the storage of patient information from clinical encounters. The widespread adoption of EHRs is not only a key component in the nation’s commitments to both comparative effectiveness research and the transformation of health care delivery, but also central to the evolution of health services research as a field.
Over the last three years, AcademyHealth has partnered with six early adopters of health information technology (IT) to understand how these organizations use clinical data for research, evaluation, and quality improvement — key components of the iterative process of innovation often referred to as the learning health care system. The six health systems that participated in the Health IT for Actionable Knowledge project are the Veterans Health Administration, Geisinger, Kaiser Permanente, the Palo Alto Medical Foundation, Denver Health, and the New York City Primary Care Information Project (PCIP).
The experiences of these health systems provide clear evidence of the advantages of EHR data for researchers. Compared to traditional sources of research data, health IT data can provide richer measures of actual patient outcomes. In addition, such data tends to be more proximate to the location of care, and is often available in near real-time. AcademyHealth found that health care delivery organizations can use EHRs to support not only health services research, but also traditional quality improvement (QI) activities, training and research involving simulations, analysis that helps root out waste, collaborative research with other organizations, public health research, and new types of clinical and basic scientific investigation. The experience of the PCIP also shows how data from traditional physician encounters can further public and population health goals.
Among the most interesting trends AcademyHealth observed is how electronic data is providing new opportunities for health services researchers to collaborate with health systems or to pursue careers as employees of those organizations. Furthermore, the traditional distinctions between research, especially HSR, and QI, have begun to blur, creating new opportunities for multidisciplinary innovation in care delivery and the development of new research methodologies.
AcademyHealth also found, however, that despite it great potential, the use of EHR data for research presents new challenges. The reports highlight how researchers must be particularly sensitive to the actual capabilities of the hardware and software they use, potential threats to data quality, legal requirements designed to protect human research subjects and patient privacy, and the cultural gulf that can exist between the worlds of research and health care delivery.
The Health IT for Actionable Knowledge project represents only the first major initiative by AcademyHealth to understand how the proliferation of electronic data will affect our field. Other AcademyHealth projects undertaken since we began this project include our AHRQ-funded Electronic Data Methods (EDM) Forum and the Relevant Evidence to Advance Care and Health (REACH) Challenge. Indeed, the project provided for us, as we hope it will for many of you, a foundation for understanding and addressing the myriad implications of health IT for research and quality improvement.
The five reports are: