Executive Summary

We are at the beginning of a digital revolution in healthcare, and it’s an exciting time with the potential for innovative whole-person care, data- and evidence-based solutions, and improvements in the healthcare system. The evolution of technology and digitization of data can now make care available to people everywhere, and digital healthcare carries great promise to help patients better manage their conditions, coordinate their care, and partner with their clinicians for better health. However, these advances are only possible if the people, processes, and technologies that receive data from data sources are able to make sense of the data and use them to make informed decisions.

The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the quality and safety of America's healthcare system. To support this charge and support the digital healthcare revolution, AHRQ’s Digital Healthcare Research Program provides foundational research to ensure that digital healthcare systems are designed and implemented in ways that improve quality and safety, while not resulting in excessive burden on physicians and other members of the care team. The Digital Healthcare Research Program funds research to create actionable findings around “what and how health information technology works best” for its key stakeholders: patients, clinicians, and health systems working to improve healthcare quality and safety.

In 2019, the program supported 120 research grants and seven contracts that represent a total investment of $150 million. This includes $43 million in grants and contracts to improve patient engagement and shared decision making, $71 million to support clinicians’ decision making, and $36 million to improve the delivery of healthcare at the systems level.

This Year in Review report outlines the innovative health services research funded by the Digital Healthcare Research Program and highlights the impact the research has on improving patient-centered care, supporting clinicians and other healthcare professionals in providing health services, and sharing health information across technologies and healthcare environments to leverage data and technology to strengthen health systems. The report details the Digital Healthcare Research Program’s 2019 research activities and outcomes through research summaries, spotlights, and dissemination activities. Within the research summary section of this report, research completed in 2019 is synthesized by the three following research themes:

 
 

Following this synthesis, we have highlighted exemplary research in impact stories, which further amplify and demonstrate the effect of AHRQ-funded research. We invite you to read these impact stories that highlight research studies in the researchers’ own words. Key information from these impact story exemplars is captured below.

Table 1: Impact Stories of AHRQ-Funded Research Exemplars Completed in 2019
Organization Principal Investigator Impact Story Title Key Findings and Impact
University of Wisconsin – Madison Kevin Ponto

It’s Not Just for Video Games: Using Virtual Reality to Enhance Patient Care

Research Investment: $2,424,627

Virtual reality technology can be used to recreate issues patients may experience in their homes and identify the complex and concurrent interactions impacting personal health information management.
Beth Israel Deaconess Medical Center Charles Safran

High Tech as High Touch: Using InfoSAGE to Connect Caregivers and Older Adults

Research Investment: $2,407,309

Using an online platform to facilitate information exchange and care coordination between those over 75 years of age and their support network is feasible and has the potential to increase quality of life for older adults.
Trustees of Dartmouth College Corey A. Siegel

Helping Patient Better Understand Effective Treatment Options for Crohn’s Disease

Research Investment: $2,277,681

Use of the Crohn’s Disease Prediction Tool, a validated individualized risk prediction tool plus a web-based decision aid, resulted in improved shared decision making and patients choosing a more effective Crohn’s Disease therapy.
University of Colorado Bonnie Gance-Cleveland

Smart Mobile Health App Improves Screening for Risks and Protective Factors for Pregnant Women

Research Investment: $298,304

A screening tool for risk and protective factors during pregnancy can be integrated in clinic flow and improve customized discussions with pregnant women to improve outcomes for women and their babies.
Northwestern University David Liss

Using Smartphone Location Data for Care Coordination

Research Investment: $300,000

A smartphone app that uses location data to notify primary care providers when a patient arrives in the hospital is a simple and scalable approach to improve care coordination after a hospital visit.
Trustees of Columbia University Melissa Stockwell

Texting Reminders to Low-Income, Minority Patients Improves Vaccination Rates

Research Investment: $998,401

Human Papillomavirus vaccine series completion rates in a low-income, Latino adolescent population were high for patients receiving text message reminders.
MedStar National Center for Human Factors in Healthcare Aaron Zachary Hettinger

Using Aviation Technology to Prevent Healthcare Errors: The Health IT Black Box

Research Investment: $297,840

Similar to the airline industry’s use of a “black box” that captures actions leading up to an incident, the health IT black box allows for root cause analysis of EHR errors that can inform improvements in EHR design and usability.
Alaska Native Tribal Health Consortium Elizabeth D. Ferucci

Using Telemedicine to Improve Rheumatoid Arthritis Care for Patients in Alaska

Research Investment: $261,167

There was no difference in rheumatoid arthritis disease activity over 1 year and no difference in quality of care for patients who receive care through telemedicine versus patients receiving only in-person care.
University of Utah Mollie Cummins

Health Information Exchange Streamlines Communication Between Poison Control Centers and Emergency Departments

Research Investment: $1,249,994

The team created the first health information exchange capability between a poison control center and emergency department to reduce errors, improve decision making, and improve continuity of care for poisonings, including drug overdoses.

In 2019, AHRQ funded 28 new research projects to address important priority areas, including improving clinical decision making, integration of patient-reported outcomes into clinical care, and use of telehealth and telemedicine to improve access to care, an increasingly important focus amidst public health emergencies. Recently funded research projects are also highlighted within the emerging research summary, including the goals of the research and anticipated outcomes or future potential application of the work. The following table captures information about the innovative, new digital healthcare research work highlighted as emerging research stories within this report.

Table 2: Emerging Research Stories of AHRQ-Funded Research Exemplars Awarded in 2019
Organization Principal Investigator Emerging Research Story Title Significance and Potential Impact
University of Utah Kensaku Kawamoto

Decision Precision+: Increasing Lung Cancer Screening for At Risk Patients

Research Investment: $1,184,380

Widely disseminating a clinical decision support tool that supports individualized shared decision making for lung cancer screening is expected to increase appropriate screening and save lives.
Emory University Ann E. Vandenberg

Creating Age-Friendly Health Systems: Implementing Decision Support in the ED to Improve Geriatric Prescribing Practices

Research Investment: $398,907

Scaling and disseminating a clinical decision support system that provides physicians with targeted medication information may enhance safe prescribing practices for geriatric patients in the emergency department.
Wake Forest University Health Sciences Brian Wells

Using Direct-to-Patient Technology and Clinical Decision Support to Increase Type-2 Diabetes Screening

Research Investment: $296,695

A low-cost, novel direct-to-patient clinical decision support tool which identifies patients at high risk of type 2 diabetes and offers them a screening test could increase the number of patients screened and save physicians’ time.
University of Washington Heidi M. Crane and William B. Lober

Tailoring Visits Using Person Specific Patient Reported Outcomes to Improve Care for People with HIV

Research Investment: $1,193,479

By identifying and addressing priority PROs relevant to individual patients, this research has the potential to maximize clinic time spent with patients with HIV and chronic conditions to tailor and improve their care.
New York University School of Medicine Heather Gold and Enrico Bertini

Optimization of Patient-Reported Outcome Data Visualization to Improve Shared Decision Making

Research Investment: $293,981

Optimizing PRO data visualization with clinicians’ and patients’ input will improve clinicians’ ability to effectively synthesize and communicate complex data to provide patient-centered clinical management.
University of California, San Francisco Ida Sim

How You Feel is Important: Making PROs Meaningful

Research Investment: $1,183,244

A tool to collect and share PROs in a primary care setting for a diverse patient population with multiple chronic conditions can potentially improve the patient-clinician relationship and improve patients’ quality of life.

The report also spotlights two areas where the AHRQ Digital Healthcare Research Program has been a leader: creating and disseminating evidence-based clinical decision support (CDS) to improve patient care, and advancing the knowledge base of how to collect and use patient-reported outcomes (PROs) using digital methods. For each spotlight, we highlight the impact of our recently completed CDS and PRO work as well as our newly funded, exciting research in these areas. Click on the links to read about the spotlights:

Lastly, since dissemination of research findings is critical to knowledge transfer and the spread of impactful digital healthcare evidence-based strategies, this report contains a section devoted to the program’s 2019 dissemination efforts. The impacts of AHRQ digital healthcare web conferences as well as grantee presentations and publications are noted in this section. Web conferences reached several hundred live participants, and the webcasts are available on the website for current and future viewing. Presentations at large national and international conferences allowed researchers to discuss the impact of their work to thousands of attendees, and over 100 published research articles extend the dissemination of results even further.

We hope that you enjoy reading about many of the AHRQ Digital Healthcare Research Program accomplishments in 2019 and the significant impact of all of the health services funded research. We invite you to share any comments or questions you might have by contacting us at: DigitalHealthcareResearch@ahrq.hhs.gov.