AHRQ-funded researchers presented their work at a variety of health IT, medical, and other key conferences, such as the Annual Symposium for the American Medical Informatics Association (AMIA), AcademyHealth’s Annual Research Meeting, the Human Factors and Ergonomics in Health Care Annual Symposium, International Conference on Healthcare Informatics, and the Health Information Management Systems Society’s Global Conference and Exhibition.
At the 2018 AMIA Annual Symposium alone, AHRQ Health IT-funded research was highlighted in:
- 11 oral presentations
- 4 panel presentations
- 4 posters
- 2 systems demonstrations
- 2 instructional workshops
2018 AMIA Year in Review
A special livestreaming event held during the 2018 AMIA Annual Symposium featured the year’s most noteworthy publications. This popular Biomedical and Health Informatics Year in Review session is informed by AMIA’s Working Groups, who identify papers from over 90 domains, representing the most influential biomedical and health informatics work published. It is intended to help biomedical and health informatics professionals stay current with the most “relevant, interesting, or innovative” papers of the year. Presented by James Cimino, MD, FACMI, FAMIA, of the Informatics Institute at the University of Alabama at Birmingham, many of the 67 papers reviewed at the 2018 Symposium were authored by AHRQ-funded health IT researchers. Papers from 45 of the domains were presented, including the following AHRQ-funded health IT research.
Patient Engagement Research
Dr. Anuj Dalal’s formative research on identifying critical components for developing patient portals for use in the acute care setting and during transitions of care was highlighted. As hospitalizations have become increasingly shorter, more recovery takes place in the home, resulting in greater information burden and decision-making responsibilities on patients and their caregivers. To support patients and their caregivers with care transitions and post-discharge responsibilities, innovative information and communication tools will be critical to the delivery of safe, high-quality, accessible care. The authors held a patient care portal workshop with 71 attendees from over 30 institutions to discuss a sociotechnical and evaluation research agenda for the use of informatics to support patients and care coordination after discharge. The following areas were identified to be addressed: interoperability standards; privacy and security issues, including remote access and proxies; user-centered design to support complex data and communication; implementation factors such as adoption, cost, and technical support; data and content knowledge management in the EHR; CDS to avoid errors; and measurement standards to support formative assessments. Using these components, the authors suggest that increasing the use of patient portals in the acute care setting and during transitions of care will improve patient engagement and empowerment, and positively affect quality and safety.
Clinical Information Systems and Data Capture Research
It is common for clinicians to write patient notes well after a patient visit, even hours later, including into the evenings and on weekends. Dr. Thomas Payne’s research looked at the use of mobile phone transcription and its impact on when notes were completed and the quality of those notes. This system allows clinicians to dictate notes while they are with patients or walking around. The notes are sent to a secure server, where they are transcribed using NLP and made available for later review, editing, and a signature. Availability is within 5 minutes, which is a significant improvement over traditional dictation methods. During the 2018 AMIA Year in Review session, Dr. Payne was featured in a video clip dictating notes for a patient encounter that he later retrieved from his inbox. The researchers evaluated the amount of time providers spent after midnight on their clinical notes and found that using mobile phone transcription reduced the amount of time compared with traditional dictation. Additionally, the dictated notes generated with the tool had more new information and far less old text carried forward.
Dr. Richard Holden and his colleagues are researching the use of health IT to inform and support self-management of congestive heart failure. The AMIA Year in Review session highlighted his systematic review on the use of smartphone apps to change health status and behavior of patients. The reviewed studies had samples of up to 171 individuals, representing those with bipolar disorder, schizophrenia, and depression; older adults; and the general population. Numerous benefits to patients were found, including ability to detect changes in health status and behavior, and an increase in accountability of users. Challenges identified were related to the technology implemented, methods used, and privacy concerns.
Consumer Informatics Research
Called by Dr. Cimino “one of the best papers in the AMIA proceedings last year,” this paper, co-authored by Dr. Gretchen Jackson, examined factors that influenced information seeking by pregnant patients and their caregivers. The authors found that those with a strong belief in the power of luck, as well as those who believe others are in control, sought information less frequently than their counterparts. When there are “powerful others” and luck, individuals do not see the point in looking for additional information on their care.
A second paper highlighted in this domain was authored by Dr. David Vawdrey, who is researching use of patient portals by inpatients. Recognizing a gap in research, he and others evaluated the impact of sharing clinical notes with hospitalized patients. Ten inpatients were given access to an acute care portal and interviewed for their perspectives around that access to their clinical information. Benefits reported included improved access to information, better understanding of their conditions, and greater appreciation for their providers. Four patients reported changing a health behavior, and two reported the possible prevention of medical errors due to the portal. Usage logs indicated that patients accessed the notes feature of the portal more frequently and for a longer duration than other portal features. Contrary to expectations, an increase in patient anxiety was not found, with the researchers theorizing that access to information reduces the uncertainty and the disempowerment commonly felt by hospitalized patients. The authors concluded that their results should encourage providers to be open-minded about patient access to inpatient notes.
Evaluation: It's About Methods Domain
Dr. Rebecca Schnall’s AHRQ Health IT-funded research evaluated the use of a mobile Video Information Provider (mVIP), a mobile app targeted to those with HIV. In this paper she and her colleagues describe a usability evaluation based on the Health IT Usability Evaluation Model (Health-ITUEM), with mVIP used as a case study. The authors described the application of user-centered design reverse card sorting, in which end users sorted features by perceived importance. In the usability lab, a think-aloud protocol with eye tracking heuristic evaluation was completed. Usability of mVIP in real-life situations was evaluated by surveys and interviews. Dr. Cimino described the project as a “nice start-to-finish evaluation.”