Remarks by Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality (AHRQ)
Inaugural Meeting of the National Health IT Collaborative for the Underserved, National Press Club, Washington, DC, June 12, 2008
Good afternoon, everyone. I can't tell you how happy I am to see this day arrive.
The type of comprehensive approach we are discussing today is critical to expanding the reach of our national health IT framework, and I am glad to be here in support of the National Health IT Collaborative for the Underserved.
We are making great strides in transforming the health care system. We have new tools, a greater focus on the evidence base, an increasing shift in priorities toward patient-focused activities, and a host of additional initiatives that are designed to turn the U.S. health care system into a real system. Yet, always looming in the background is the issue of addressing the needs of priority populations. We must ensure that these populations experience the benefits of health IT.
Making health information technology available on a national scale is daunting on its own. Making it available to the underserved and in many instances the uncounted—it's hard to even comprehend the kind of effort that is going to be required to do this.
This project is in line with AHRQ's mission to improve the quality, safety, effectiveness, and efficiency of health care for all Americans. And when we say all Americans, we mean all Americans.
To that end, we work closely with the Office of the National Coordinator of Health IT and other Federal agencies to assure that our investments are closely aligned and concentrate specifically on the use of health IT to improve safety and quality in diverse health care settings, with a strong focus on those organizations providing care to underserved and rural populations.
To suggest that health care quality in the United States is nowhere near as good as it could or should be is an understatement. According to research from RAND, partially funded by AHRQ, Americans have just a 50-percent chance of receiving the care they need when they go to a doctor's office.
Other research indicates that as many as 1.5 million medication errors occur in hospitals each year. Serious problems with quality exist in all areas in health care. According to data from AHRQ's annual, congressionally mandated National Health Care Quality Report, health care quality improved just 2.3 percent in 2007—a bit lower than the rate of improvement during the previous 2 years.
Its companion report, the National Health Care Disparities Report, found that access to high-quality care varied widely between racial, ethnic, and economic groups. The Disparities Report focuses on a number of health care processes and outcomes that are useful for tracking quality of care. Of the 22 core measures that support comparisons across racial and ethnic groups, African Americans received poorer quality care than whites for 73 percent of the core measures. Hispanics received poorer quality of care than non-Hispanic whites for 77 percent of the measures. Poor people received lower quality of care than high-income people for 71 percent of the measures.
The Disparities Report also documents the quality of care for residents of rural America. We know that, compared with their urban counterparts, rural residents are more likely to be elderly, poor, in fair or poor health, and to have chronic conditions. In addition, they are less likely to receive recommended preventive services and report, on average, fewer visits to health care providers.
The good news is that we are working to resolve these quality problems and we are making progress. According to the quality and disparities reports, the greatest quality gains occurred in U.S. hospitals, where quality improved 7.8 percent. Ambulatory care–health services provided at doctors' offices, clinics, or other settings without an overnight stay–improved by 3.2 percent. Nursing home and home health care improved by 1 percent.
The bad news is that this pace is slow, and it is even slower for minorities, the poor, and other traditionally underserved populations.
So how do we accelerate change? How do we engage all health care stakeholders to ensure that citizens receive the highest quality, safest health care possible?
We must recognize, as HHS Secretary Mike Leavitt has said, that we don't have a health care system in the United States. We have a large, rapidly growing health care sector with many different parts working largely independent of each other. Then, we need to find ways to connect the various parts of this sector to function more like a system, and an important connector is health IT. It is important to note that health IT is not a magic bullet. It alone won't transform the health care system, but it is impossible to envision that the transformation we need can occur without the capabilities it brings.
Think for a moment about what is happening in health care settings around the country. Millions of decisions are being made about people's lives without the right information in hand:
- Is chemotherapy alone the best treatment for a patient with breast cancer, or should she be treated with radiation and chemotherapy?
- How do people with diabetes, high blood pressure, and obesity manage all the different demands of their conditions?
Patients and consumers struggle with even more basic decisions:
- Which provider to see.
- When to seek care.
- Which treatment option is best for their needs.
Many of these decisions are difficult, even in the most ideal circumstances, when there is sufficient time to assess good, reliable information. But as we all know, these decisions frequently must be made at times and places where information is not available, and time is of the essence. This is one of the areas in which health IT can have a considerable impact.
For many years, AHRQ has worked to advance the convergence of research and the application of how new knowledge can be applied to improve care. Since 2004, we have invested $260 million to support and stimulate investment in health IT. This translates to almost 200 projects in 48 States and territories.
AHRQ-funded projects cover a broad range of health IT issues, including electronic health records, the patient's own information that he or she collects known as a personal health record, health information exchange, electronic prescribing, privacy and security, clinical decision support, quality measurement, patient-centered care, provider workflow, and Medicaid technical assistance. And, at the direction of Congress, we have committed a significant portion to rural and underserved settings. For example, under our newly funded Ambulatory Safety and Quality Initiative, we have already committed $6.5 million for health IT grants targeting vulnerable populations, with additional grants pending.
Some of the grants we have funded so far include:
- Enhancing an existing telemedicine system in North Philadelphia to advance care for hypertension for African-Americans.
- A project in Providence, Rhode Island, that uses an electronic medication history to develop tailored DVDs and print materials to help low-literacy audiences and their caregivers participate in treatment decisions.
- An initiative under way in Iowa City, Iowa, involving a low-literacy personal health record and medication adherence of elders.
We also have the Transforming Healthcare Quality through Health IT Program. A primary focus of this program involves the challenges facing rural and small communities in integrating IT into their health care delivery systems. Included in this program are a diabetes registry for Latinos in California, and the Project ECHO extension for Community Healthcare Outcomes for Native Americans and Latinos in New Mexico.
AHRQ also has supported many health IT initiatives along the Gulf Coast. At Franklin Foundation Hospital in coastal Louisiana, where health care providers are still recovering from the devastation of Hurricane Katrina, safety net health care providers will integrate health information and communications systems to support chronic disease management, improve patient safety, and eliminate duplication of effort. As we face the beginning of another hurricane season, it is important to note that in 2005, providers in Gulf Coast States that had already made strides in health IT recovered more quickly after Katrina than those which had not.
The States play a critical role in all aspects of health care delivery. To that end, in FY 2007, we funded a $3 million contract with Research Triangle Institute to provide technical assistance to up to 20 States on the best use of health IT to improve the quality of health care for Medicaid and SCHIP beneficiaries.
To make sure that as many Americans as possible benefit from our research, we created the online National Resource Center for Health IT. At its core, the Resource Center provides a Web portal with critical infrastructure for convening practitioners, encouraging collaboration, and disseminating best practices.
There are many facets of health IT, which require different roles. AHRQ's primary role is to furnish health care providers with evidence about which health IT applications work most effectively in improving the care that patients receive.
Here are a few brief observations stemming from our work in health IT:
- First, health IT is essential to improving health care safety, quality and value, but on its own, it is not sufficient. In fact, without attention to workflow and processes, it can actually speed up mistakes.
- Second, public/private/community partnerships are essential to our success. None of us here can accomplish this alone—in sectors. It will require the best efforts of everyone involved, working together. And, we will need to establish credible ways of determining our successes and failures by using specific, measurable outcomes.
- Finally, perhaps the best measure of our success may be evidence of the extent to which the underserved are provided access to better quality care through the use of health information technology. Any attempt to enhance the U.S. health care system through the use of health information technology will be much less than acceptable, if we fail to reach the people who need us the most.
Current as of June 2008
National Health IT Collaborative for the Underserved: A Public-Private Partnership for a Healthier America. Remarks by Carolyn Clancy at the Inaugural Meeting of the National IT Collaborative for the Underserved, June 12, 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/sp061208.htm