Digital healthcare is the use of health information technology to collect and share health information to improve the efficiency, quality, and accessibility of care. Digital healthcare approaches have grown exponentially in recent years such that they are now a ubiquitous and essential part of care.24
Digital healthcare encompasses a variety of technologies and approaches, including:
- Electronic health records (EHR) or electronic medical records (EMR) along with patient portals are used to securely track, share, and review health information across a practice or health system and provide clinical decision support.
- Telehealth or telemedicine includes the use of phone calls, video conferences, or other online tools to host virtual consultations between patients and clinicians.
- Mobile health (mHealth) and electronic health (eHealth) refers to the use of smart phones or wearable devices to collect patient-generated health data for the purpose of remote health monitoring and data collection, or to provide care reminders and health education.
- Artificial Intelligence (AI) uses algorithms and machine learning to support patient care, such as to aid diagnosis and to support shared decision making.
The use of digital healthcare in primary care has the promise of increasing access to care, especially for patients living in rural or other limited-access areas; enhancing care coordination across healthcare settings; supporting clinical decision making; reducing clinician burden; and enhancing patient engagement through electronic self-management tools. However, digital healthcare has also been linked to increased clinician burnout, introduces problems with lack of interoperability across systems, can increase barriers for patients without adequate access to technology, and can lead to moving a clinician’s focus from the patient in front of them to a computer screen.24 Research is needed to understand how to best realize the potential of digital healthcare while minimizing the risks.
AHRQ’s authorizing legislation requires the agency to promote healthcare quality improvement through research on “existing and innovative technologies.”14 AHRQ’s Division of Digital Healthcare Research produces and disseminates evidence on how digital healthcare can improve the quality, safety, and effectiveness of healthcare while also improving patient experiences.25 This section of the report includes a summary of AHRQ’s digital healthcare grants, initiatives, and resources with a focus on primary care.
Grants
Across AHRQ primary care research grants with active funding in FYs 2023 and 2024, 10 focus mainly on digital healthcare. This includes five R01 grants (Research Projects), two R18 grants (Research Demonstration and Dissemination Projects), two R21 grants (Exploratory/Developmental Grants), and one R03 grant (Small Research Project).
An additional 27 grants include some focus on digital healthcare and are described in other topic area sections, including 10 in Patient Safety, five in Practice and Quality Improvement, four in Person-Centered Care, three in Primary Care Workforce, two in Behavioral Health and Substance Use Disorders, one in Healthcare Systems and Infrastructure, one in Health Disparities, and one in Public Health and Community Integration.
We summarize the 10 grants focused on digital healthcare below, organized by subtopic. Subtopics are:
mHealth and eHealth
Four grants examine various approaches to providing care and monitoring through mobile devices and other electronic approaches.
Care Transitions App for Patients with Multiple Chronic Conditions (R01)
PIs: Lipika Samal; Patricia C. Dykes
Organization: Brigham and Women’s Hospital
Grant Start Date: September 30, 2022
Develops and tests the effectiveness of an app to support care transitions between the hospital, home, and primary care clinic to reduce adverse events post-discharge from the hospital. The app contains a digital post-discharge transitional care plan, modules for multiple chronic conditions, relevant lab values, education specific to the patient’s prescribed medications, and a functionality that allows patients to ask questions to support their recovery goals.
Impact and Sustainability of a Digitally-Based Diabetes Prevention Program (R01)
PI: Yoshimi Fukuoka
Organization: University of California, San Francisco
Grant Start Date: August 1, 2021
Assesses the effectiveness and sustainability of a digitally-based diabetes prevention program for reducing body weight and HbA1c in adults with prediabetes and obesity through a randomized controlled trial. The findings from this study have clear implications for primary care, where diabetes prevention is a common part of care.
A Novel Patient-Facing Mobile Platform to Collect and Implement Patient-Reported Outcomes and Voice Biomarkers in Underserved Adult Patients with Asthma (R21)
PIs: Jonathan M. Feldman; Sunit Jariwala
Organization: Albert Einstein College of Medicine
Grant Start Date: April 1, 2023
Enhances the ASTHMAXcel PRO mobile app for patients with asthma by adding a respiratory symptoms risk score based on vocal biomarker technology (ASTHMAXcel Voice), which facilitates shared decision making and social determinants of health screening and referrals and enables self-management and remote care coordination. ASTHMAXcel Voice is adjusted based on stakeholder feedback and implemented in an outpatient setting (including primary care and specialty care), where measurements such as asthma control, emergency department visits, and patient/clinician satisfaction are collected.
Learn more about this study in a recent Digital Healthcare Research webinar: Digital Healthcare Innovations to Engage and Empower Patients in Their Care.
Using Smart Devices to Implement an Evidence-Based eHealth System for Older Adults (R18)
PIs: David H. Gustafson; Marie-Louise Mares
Organization: University of Wisconsin – Madison
Grant Start Date: August 1, 2020
Implements a smart-system (a smart speaker plus visual display) version of an existing Elder Tree intervention – a program that supports the self-management of health for older adults with multiple chronic conditions who live independently and whose care is managed by primary care clinicians. This grant tests a smart-system version compared with the computer-based system on outcomes, including quality of life, hospital readmission, and medication adherence.
Learn more about this study in a recent Digital Healthcare Research webinar: Digital Healthcare Innovations to Engage and Empower Patients in Their Care.
Telehealth/Telemedicine
Three grants focus on use of telehealth or telemedicine. See the section in Telehealth/Telemedicine in Appendix B for more grants and information about this topic.
Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections (R01)
PIs: Tamar Barlam; Mari-Lynn Drainoni
Organization: Boston Medical Center
Grant Start Date: June 1, 2022
Examines whether telehealth visits can be used to improve the management of acute respiratory tract infections, including reducing inappropriate prescribing of antibiotics in ambulatory care settings including primary care.
The Role of Telehealth in Improving Access to and Costs of Unscheduled Care Among Lower-Income Individuals (R01)
PI: Lindsay Allen
Organization: Northwestern University at Chicago
Grant Start Date: September 30, 2023
Aims to measure the impact of different telehealth delivery models on cost, downstream care (e.g., primary care) and immediate access to care among low-income individuals to provide Medicaid agencies and policymakers with information needed to decide whether to permanently extend COVID-era telehealth policies.
Telemedicine Preparation for Older Adults with Type 2 Diabetes (R03)
PIs: Goutham Rao; Kelsey Ufholz
Organization: University Hospitals of Cleveland
Grant Start Date: September 1, 2023
Aims to develop a digital skills training intervention to prepare older, mostly African American adults with Type II diabetes to participate in and benefit from telemedicine appointments for primary care. Feedback is collected from patients who complete the training about their satisfaction with it and whether it helped them during their telemedicine appointment (if applicable).
Clinical Decision Support Tools
Two grants create or expand existing clinical decision support tools.
An AI-Directed CDS Tool to Reduce Iron Deficiency Anemia in Pregnancy: A Randomized Controlled Trial (AID-IDA Trial) (R21)
PI: Mark Allen Clapp
Organization: Massachusetts General Hospital
Grant Start Date: August 1, 2024
Builds a clinical decision support tool to identify iron deficiency and anemia in pregnancy and prevent postpartum hemorrhage. The tool comprises an iron deficiency screening and management predictive model for individuals at high risk for postpartum hemorrhage. Tool includes prompts for clinicians to screen and treat identified patients during routine obstetric care. Conducts a randomized controlled trial to determine the tool's efficacy.
Engaging Patients to Enable Interoperable Lung Cancer Decision Support at Scale (R18)
PI: Kensaku Kawamoto
Organization: University of Utah
Grant Start Date: August 1, 2022
Expands an existing clinical decision support program (Decision Precision+) designed to analyze electronic health record data to prompt doctors to discuss lung cancer screening with eligible patients with individually tailored information on the benefits and harms of screening. Adapts Decision Precision+ to integrate with a patient portal (MyLungHealth) that patients use directly to learn about lung cancer screening. Tests how healthcare systems implement MyLungHealth in primary care practices and examines the additional benefit of MyLungHealth for practices that already use Decision Precision+.
Learn more about this study in a recent Digital Healthcare Research webinar: Transforming Guidelines into Action: Clinical Decision Support at the Point of Care.
Other EHR Tools
This grant evaluated EHR tools that were not a clinical decision support tool.
Assessing the Effects of EHR Optimization Interventions in Primary Care (R01)
PIs: David W. Bates; Lisa Rotenstein
Organization: Brigham and Women’s Hospital
Grant Start Date: August 1, 2024
Evaluates the impact of three interventions for EHR optimization in primary care settings to better understand the pros and cons of each intervention in the context of the primary care clinician’s work experience. Using data from 210 practice sites, interviews with clinicians, and estimating the costs of implementing each intervention, the study hopes to gather insights about how to improve clinicians’ experiences working with EHRs and the quality of care provided.
Initiatives and Resources
AHRQ’s Digital Healthcare Research Program’s webpages include many reports, tools and resources, and information about funding opportunities that may be of interest to primary care researchers. This includes an article from the Journal of the American Informatics Association (“AHRQ’s Digital Healthcare Research Program: 20 Years of Advancing Innovation and Discovery”) and the report Improving Healthcare Through AHRQ’s Digital Healthcare Research Program: 2023 Year in Review.
No new primary care–related digital healthcare initiatives or resources were released by AHRQ in 2023 and 2024.
