Budget Estimates for Appropriations Committees, Fiscal Year 2007. Performance Detail

Justification of Budget Estimates FY 2007

Performance Detail

Summary of Measures

Measures and Results Summary Table

FY	Total Measures in Plan	Outcome Measures	Output Measures	Efficiency Measures	Results Reported	Results Met	Results Not Met
2002	60	NA	NA	NA	60	60	0
2003	47	8	35	4	39	39	0
2004	50	11	35	4	31	31	1¹
2005	47	24	20	3	47	45	2¹
2006	47	24	20	3	N/A	N/A	N/A
2007	47	24	20	3	N/A	N/A	N/A

Note: In FY 2007, AHRQ plans to continue to review program activity through the use of the PART tool and make appropriate adjustments to our performance measures.

^1. 2 measures not met due to program refunding.

Detail of Performance Analysis (Tables)

Quality/Safety of Patient Care

Long-term Goal: By 2010, prevent, mitigate, and decrease the number of errors, risks, hazards, and quality gaps associated with health care and their harmful impact on patients.

Measure	FY	Target	Result
Identify the Threats By 2010, patient safety event reporting will be standard practice in 90% of hospitals nationwide. Outcome	2007	Initiate network of patient safety database (NPSD) to identify patient safety threat	December 2007
	2007	Continue use of NHQR, NHDR, PSIs to monitor and report on changes in patient safety/quality	December 2007
	2006	Use NHQR, NHDR, PSIs to monitor changes in patient safety/quality	December 2006
	2005	Continue supporting data standards and taxonomy development for improved event reporting, date integration, and data usability	Ongoing: Supported NQF taxonomy consensus building. Taxonomy approved 2005
	2005	Redesigning PSIRS database system to produce NPSD that includes data specifications, standardized taxonomy	December 2006
	2004	Develop a data warehouse and vocabulary server to process patient safety event data	Completed
	2003	Develop reporting mechanism and data structure through the National Patient Safety network	Completed
Identify & Evaluate Effective Practices By 2010, double the number of patient safety practices that have sufficient evidence available and are ready for implementation (use EPC report for baseline data) Outcome	2007	50 participants in the PSIC train-the-trainer program will initiate local patient safety training activities	December 2007
	2007	Hold annual patient safety/healthcare information technology conference	December 2007
	2006	Implement and evaluate best practice use of NHQR-DR Asthma Quality Improvement Resource Guide and Workbook for State Leaders in 2 to 5 States	December 2006
	2005	5 health care organizations/units of state/local governments will evaluate the impact of their patient safety best practices interventions	Completed: 17 grant awards made for implementing patient safety improvement practices
	2005	Implement and evaluate best practice use of NHQR-DR Diabetes Quality Improvement Resource Guide and Workbook for State Leaders in 2-5 States	Completed: Diabetes workbook has been developed and 2 States (Delaware and Vermont). These States are engaged in using it and setting an action agenda
	2004	6 health facilities or regional initiatives to implement interventions and service models on patient safety improvement will be in place	Completed
	2003	Awards to be made to at least 6 facilities or initiatives	Completed 6 awards made
Educate, Disseminate, and Implement to Enhance Patient Safety/Quality By 2010, successfully deploy hospital practices so that medical errors are reduced nationwide. Outcome	2007	50 participants in the PSIC train-the-trainer program will initiate local patient safety training activities	December 2007
	2007	Hold annual patient safety/healthcare information technology conference	December 2007
	2006	15 additional States/major health care systems will have on-site patient safety experts trained through the PSIC program	December 2006
	2005	15 additional States/major health care systems will have on-site patient safety experts trained through the PSIC program	Completed: 19 States and 35 hospitals/health care systems participated in the PSIC
	2004	10 States/major health care systems will have trained through the PSIC program	Completed: 15 States 13 hospitals-health care systems
	2004	5 health care organizations or units of State/local government will implement evidence-based proven safe practices	Completed: 7 organizations received grants to implement evidence-based safe practices
		Develop 4 NHQR-DR Knowledge Packs on Quality for priority populations and care settings	Completed: Knowledge Packs were replaced by reports on gender, children, and inpatient care
		Conduct annual patient safety conference transferring research findings, products, and tools to users	Completed: Annual PS conference held Sep. 26-28, 2004
	2003	Established a PSIC training program.	Completed
	2003	Award to 5 health care organizations or units of State/local government grants to implement evidence-based proven safety practices	Completed
	2002	Planning study	Completed: Conducted PSIC planning study
Maintain vigilance By 2010, deploy and use measures of safety and quality for improvement in various care settings Report on national trends in health care quality Output	2007	Initiate Network of Patient Safety Databases (NPSD)	December 2007
		Deliver fifth NHQR-DR	December 2007
		Use NPSD, NHQR, NHDR, PSIs to monitor changes in patient/safety quality	December 2007
	2006	Deliver fourth NHQR-DR and continue use of NHQR, NHDR, PSIs to monitor changes in patient safety/quality	December 2006
	2005	Develop measures of patient safety culture (ambulatory and longer term care)	December 2006 Contract award in FY 2005
	2004	Develop measures of patient safety culture (hospital-based)	Completed
Implement an interim reporting requirement for grantees that builds on a system already in place, identifying the unexpended funds that are available for project activities in the upcoming budget period (Proposed Efficiency measure.)	2007	Increase baseline by 50%	December 2007
	2006	Establish baseline	December 2006

Data Source: PSRCC database, NHQR /DR database.

Data Validation: Spread sheets are created and maintained for accepted applications to the program.

Cross Reference: Strategic goals 1/5; Healthy People 2010 goal 17.

The long-term goal is to improve quality and safety by preventing, mitigating, and decreasing the number of quality gaps, errors, risks, and hazards associated with healthcare by 2010. With the passage of the Patient Safety and Quality Improvement Act of 2005, the capacity to identify and monitor threats to patient safety and to identify interventions that prevent or mitigate medical errors and patient harm is greatly increased.

The Act and its resulting data supplement ongoing efforts reflected in the NHQR/DR reports, in which quality and safety are monitored annually on a national basis. The new database resulting from the Act informs and helps target the research agenda used to create new knowledge about medical errors, identify the need for specific interventions, support their development and testing, and disseminate the knowledge and those interventions deemed effective in improving patient safety.

Health Information Technology

Long-term Goal: Most Americans will have access to and utilize a Personal Electronic Health Record by 2014.

Measure	FY	Target	Result
By 2008, increase the number of: —Hospitals using Computerized Physician Order Entry (CPOE) by 10%. —Providers using the system from none to over 50%. Output	2007	Provider utilization of CPOE increased to 25%	December 2007
	2006	Provider utilization of CPOE increased to 15%	December 2006
	2005	10% of hospitals using CPOE	Completed: 25% increase in the utilization of CPOE systems¹
	2005	10% of providers using CPOE	Completed: 14% of all medical group practices utilize a CPOE²
By 2008, in hospitals funded for CPOE, maintain a lowered medication error rate Outcome	2007	Decrease preventable ADE's by 10%	December 2007
	2006	Increase rate of detection by 75%	December 2006
	2005	Increase the rate of detection by 50%	December 2006 Funded implementation study
By 2014, most Americans will have access to and utilize a Personal Electronic Health Record Outcome	2007	AHRQ will partner with one major HHS Operating Division to expand the capabilities of the Electronic Health Record	December 2007
	2006	AHRQ will partner with one major HHS Operating Division to expand the capabilities of the Electronic Health Record	December 2006
	2006	The core capabilities and function of the Personal Health Record will be delineated	December 2006
	2005	Complete at least two phased EHR improvements that could facilitate transferability to other public/private providers	Completed: Phased improvement of Indian Health Service EHR. Discussions with Indian Health Service and NASA Health HIT
	2005	Summit; FY 2006 Grant program regarding the utilization of PHR by patients and providers	Completed: Summit held in partnership with the Markle Foundation and the Robert Wood Johnson Foundation
By 2006, Engineered Clinical Knowledge will be routinely available to users of EHRs Output	2007	Standards development organizations will be in the early development of tools enabling engineered clinical knowledge transfer	December 2007
	2006	Standards development and adoption with regard to Engineered Clinical Knowledge will be underway	December 2006
	2005	Convene at least one national summit exploring public-private partnerships with regard to Clinical Knowledge Engineering; Proceedings will be widely disseminated to affected stakeholders	Completed: Expert meeting convened with National Coordinator for Health HIT and American Medical Informatics Association

Data Source: Hospital CPOE usage as documented by the annual HIMSS survey; Detection of ADE's noted in recent published articles (JAMA, Archives of Internal Medicine); MGMA survey of HIT uptake in physician offices; Leapfrog annual survey.

Data Validation: Data obtained regarding ADE detection published in peer reviewed journals. HIMSS data verified by other smaller efforts.

Cross Reference: Strategic goals 1/5; Healthy People 2010 goals 11/23.

^1.Data obtained from 2005 KLAS Enterprises survey.

^2.Gans, David, Kralewski, John, et al. Medical Groups' Adoption of Electronic Health Records and Information Systems. Health Affairs 24:5 September/October 2005.

Achieving AHRQ's long-term HIT goal—assuring most Americans access to and utilization of personal electronic health records by 2014—will require evidence-based information and the cooperation of both public and private stakeholders. Core elements including HIT planning and implementation challenges, potential improvements in care, financial impact, privacy and security issues and essential EHR/PHR capabilities are currently being explored and better defined by the AHRQ HIT portfolio.

Health information technologies such as CPOE and EHRs have been shown to improve the delivery and quality of care. AHRQ's projects continue to demonstrate and monitor the benefits of HIT adoption. AHRQ research builds the evidence base for the technologies that are most effective, and the impact HIT has on quality and patient outcomes. For example, AHRQ's current projects show that computerized decision support improves physician adherence to high quality clinical practice guidelines, and are collecting data to demonstrate how this improves population health in the long term.

Many current cost-benefit models of HIT rely on expert opinion and simulation models. AHRQ's projects are generating real-world data to test quality and financial assumptions. A solid evidence base for HIT informs practitioners about which technologies to choose, how best to implement them, how well they work, and how the technologies should develop. Additional projects are investigating other critical issues such as privacy and security of health data, workflow implementation challenges, and the impact of electronic prescribing.

AHRQ has funded more that 100 research, demonstration, and implementation projects that address the specific challenges facing the myriad stakeholders either actively utilizing or contemplating HIT activities. Many of these projects will be nearing completion by 2007, with interim results and lessons learned being harvested and disseminated broadly by AHRQ's National Resource Center for HIT.

Specifics include:

Computerized Physician Order Entry Utilization and Impact. Proper CPOE implementation and utilization has been shown to reduce errors and improve the quality of care in a variety of health care settings. AHRQ's work to date has developed the evidence base critical to the increased utilization of CPOE by providers. Until recently, a majority of CPOE related information came from a small number of institutions. This highly selective process left gaps in the knowledge base. Current AHRQ CPOE projects are changing that by expanding the makeup of participating institutions; for example, East Huron hospitals with a predominately African American population. AHRQ grantees are exploring all phases of CPOE integration, including planning, implementation, and post-implementation evaluation. Projects can be found in a variety of settings including small community, rural, and urban environments. Building on these robust experiential base future efforts will explore the specific impact CPOE has on patient care and safety with an initial effort aimed at the detection and mitigation of preventable adverse drug events.
Personal Electronic Health Record. The EHR and the PHR are significant and important tool to improve the quality, safety, and efficiency of care. Both offer providers and patients a powerful mechanism to understand and manage increasingly complex and disparate medical information. The administration has made access to personal electronic health records a key component to improving care. However, before this goal can become reality, a number of challenges and barriers must be overcome. AHRQ projects and programs are presently informing both public and private stakeholders regarding successful strategies to overcome these obstacles.
The Agency's Transforming Healthcare Quality through IT (THQIT) grant program, located in 38 States, encompasses a wide variety of EHR and PHR projects and demonstration programs. Transforming Healthcare Quality Through IT seeks to better understand the intersection between HIT, improvements in quality, safety, and efficiency. Knowledge and a greater understanding of EHR implementation and impact are constantly being harvested from the grants.

Without effective means of exchanging information between personal electronic health records, even the best systems will remain digital silos of information. AHRQ is funding on-the-ground implementation of regional and State level health information exchanges, both through grants and contracts. As an example, the AHRQ-funded Utah Health Information Network is expanding their claims infrastructure to exchange clinical and public health information, covering 97 percent of the healthcare providers in Utah. These high-value projects will continue to inform the Federal Government as it moves toward interoperable personal electronic health records.

In 2005, AHRQ co-sponsored a national summit to discuss and explore the PHR core capabilities, as well as the challenges and benefits facing increased uptake and utilization. The summit demonstrably moved the field forward, creating momentum among a wide variety of stakeholders. In FY 06 and FY 07 the Agency will move these efforts forward by increasing our understanding of the core elements of PHR needed to improve the quality, safety, and efficiency of care.

In addition the Agency has been a critical partner to the Indian Health Service in the enhancement and deployment of the Indian Health Service Resource and Patient Management System (RPMS) electronic health record. The ability of the Indian Health Service clinical reporting system to report and improve at the point of care was recently recognized by the Public Health Davies Award.

AHRQ has also been in partnership with the nation's Community Health Centers (CHC) and rural hospitals/clinics through technical assistance and program support. The AHRQ National Resource Center for HIT recently opened up a knowledge portal to the CHCs and rural partners. A CHC-specific portal is being developed in collaboration between AHRQ and HRSA.
Clinical Decision Support and Engineered Clinical Knowledge. Health information technology applications are highly dependent on accurate, relevant, and usable clinical decision support (CDS) technologies to impact and improve care. Many personal and electronic health records include a CDS component. However, in both ambulatory and hospital settings, provider experience with CDS has been uneven. AHRQ has a long history of improving the clinical knowledge base that forms the infrastructure for CDS. In recent years, government, academic and industry leaders have become increasingly interested in the concept of improving CDS systems and standardized development of engineered clinical knowledge. AHRQ grantees are currently exploring the challenges with CDS integration and its impact on clinical outcomes. As an example, AHRQ is working with the Florida Initiative for Children's Healthcare Quality and NIH to develop an improved process for the development of clinical guidelines that will directly enhance CDS.
E-prescribing is an immediate opportunity to impact the safety, efficiency, and quality of health care. AHRQ has sponsored ground-breaking research through its CLIPS grants and other programs, and with CMS is currently conducting standards testing as required by the Medicare Modernization Act of 2003. The Agency is prepared to leverage its research and implementation infrastructure and experience to advance this opportunity.

Additional efforts are needed to fully appreciate the issues including a better understanding of the barriers at both the provider and industry level, further definition of the CDS engineered clinical knowledge requirements and fostering a collaborative developmental environment.

AHRQ is in the early stages of accomplishing this challenge. In 2005 an expert meeting was convened (in cooperation with ONC and the American Medical Informatics Association) to better understand and define core CDS requirements. In FY 2006 and 2007, the Agency will continue this work through further development of engineered clinical knowledge and improved integration into EHR and CDS workflow.

Return to Contents
Proceed to Next Section