In early 2020, the burdens of the global COVID-19 pandemic forced society to shut down and disrupted our healthcare system within the span of a few weeks. Fortunately, the application of digital healthcare technologies and digital practices in healthcare—such as artificial intelligence, telemedicine or telehealth, and mobile health—supported healthcare delivery during the pandemic. The evolution of technology and digitization of data now make healthcare delivery available to people everywhere. At the same time, digital healthcare carries great promise to help patients better manage their conditions, coordinate their care, and work with their clinicians for better health. However, these advances are only possible if the people, processes, and technologies (systems) that receive data from disparate 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 the evolution of digital healthcare, 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 digital healthcare technologies work best” for its key stakeholders: patients, clinicians, and health systems working to improve healthcare quality and safety.
In 2020, the program supported 103 research grants and eight contracts that represent a total investment of $144.5 million. This includes $37.4 million in grants and contracts to strengthen patient engagement and shared decision making, $65.3 million to support clinicians’ decision making, and $41.8 million to improve the delivery of health services at the health systems level.
This Improving Healthcare Through AHRQ’s Digital Healthcare Research Program report outlines the innovative health services research funded by the Digital Healthcare Research Program. The report details the program’s recent research activities and outcomes through research summaries, impact and emerging stories, spotlights, and dissemination activities. Within the research summary section of this report, recently completed research has been categorized by these three research themes:
Following this synthesis, research stories further reflect the impact of AHRQ-funded studies in the researchers’ own words. Key information from these impact stories is captured below.
|Organization||Principal Investigator||Impact Story Title||Key Findings and Impact|
|Denver Health and Hospital Authority||Susan Louise Moore||
Research Investment: $298,267
|Commercial off-the-shelf technology, including mobile phones, can successfully engage disadvantaged patients to collect patient-generated health data and patient-reported outcomes that can be integrated into electronic health records to improve chronic disease care planning during clinical visits.|
|University of Utah||Andrea Wallace||
Research Investment: $299,620
|The use of an emergency department referral infrastructure that includes an electronic assessment of patients’ social needs (e.g., transportation, food, and housing assistance) can facilitate referrals for those in need and help with monitoring patients post-discharge.|
|Indiana University-Purdue University at Indianapolis||Christopher Albert Harle||
Research Investment: $1,954,230
|By characterizing common patterns in information availability, information use, and care planning by primary care providers during patient visits for chronic pain, researchers created new electronic health record-based decision support tools to guide clinicians’ perceptions and judgments of pain to increase use of guideline-based patient assessment and treatment.|
|MedStar Health Research Institute||Aaron Zachary Hettinger||
Research Investment: $2,491,816
|The use of cognitive engineering systems methodology helps to better understand the interactions of the cognitive and workflow processes of frontline emergency medicine providers. Its use also can inform the design of health IT solutions to improve effectiveness of clinical work in high-intensity healthcare environments.|
|Washington University||Michael Avidan||
Research Investment: $299,999
|Using algorithms for real-time monitoring during surgery can predict and prevent adverse outcomes, leading to better outcomes for patients.|
|University of Arizona||Gondy Leroy||
Research Investment: $292,404
|Applying algorithms on free text in electronic health records can identify criteria for autism spectrum disorder, which improves earlier detection and treatment as well as research with large-scale data.|
|MedStar Health Research Institute||Deliya Wesley and Raj M. Ratwani||
Research Investment: $1,483,876
|Using mobile applications developed with standards allows for smoother integration of PRO data into EHRs and will increase the use of PROs for clinical care, patient self-management, and health services research.|
|University of Wisconsin-Madison||Michelle Anne Chui||
Research Investment: $285,897
|Successful implementation of CancelRx, an e-prescribing functionality to electronically communicate medication discontinuation orders between electronic health records and pharmacies, can improve medication safety and reduce adverse drug events.|
In 2020, AHRQ funded 23 new research projects to address priority areas, including improving clinical decision making, integration of patient-reported outcomes (PROs) into clinical care, and use of telehealth and telemedicine to improve access to care, an increasingly important focus during public health emergencies. Exciting new research is highlighted in the report, 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 highlighted as emerging research stories within this report.
|Organization||Principal Investigator||Emerging Research Story Title||Significance and Potential Impact|
|Oregon Health and Science University||Karen Eden, Heidi Nelson||
Research Investment: $1,985,507
|Integrating patient-generated breast cancer risk information with patients’ electronic health records will enhance decision support for clinicians and patients and improve screening and preventive services for patients at risk.|
|University of Wisconsin-Madison||David H. Gustafson, Marie-Louise Mares||
Research Investment: $1,987,467
|Enhancing an evidence-based electronic health intervention, Elder Tree, with voice-controlled technology can broaden its use, leading to improved overall health and reduced hospital readmission for older adults with multiple chronic conditions.|
|University of Texas-Austin||Kevin John Bozic, Joel Tsevat||
Research Investment: $299,878
|Successful validation of a patient-reported outcomes-guided shared decision making tool for patients with osteoarthritis of the knee may lead to widespread scaling and use by musculoskeletal providers and their patients.|
|Johns Hopkins University||Jeremiah Hinson, Scott Levin||
Research Investment: $1,963,619
|Successful development and implementation of an artificial intelligence-driven clinical decision support system for detection and treatment of acute kidney injury in the emergency department may improve the quality of kidney care and generate best practice methods to advance the application of artificial intelligence as well as develop a scalable clinical decision support product.|
|HealthPartners Institute||Elyse Kharbanda, Catherine Benziger||
Research Investment: $1,995,774
|Patient-specific and evidence-based treatment recommendations for identification and management of elevated blood pressure and hypertension in youth, delivered via clinical decision support, may promote adherence to clinical practice guidelines and may improve long-term cardiovascular health in an at-risk population.|
|University of Washington||Giana Davidson||
Research Investment: $2,000,000
|Standardizing the hospital-to-skilled nursing facility transition by using a structured handoff between clinical teams along with a pharmacist to monitor patient medications during the transition may improve care coordination and communication, and reduce medication-related issues for patients.|
|Indiana-Purdue, University at Indianapolis||Titus Schleyer||
Research Investment: $1,143,378
|Integrating health information exchange data directly into electronic health records has the potential to improve delivery of care and patient outcomes, as well as increase clinician satisfaction by providing efficient access to health information exchange data.|
In communities across the Nation, telehealth and technologies to support collection of patient-generated health data emerged as a lifeline for care during the COVID-19 pandemic. These rapidly advancing technologies connected patients to healthcare services in ways that were unimaginable pre-pandemic. This past year has expanded and cemented telehealth’s role in healthcare delivery in the United States, but challenges still remain. This report spotlights the AHRQ Digital Healthcare Research Program’s ongoing research investment on telehealth’s potential to support patient care that’s effective, safe, affordable, and equitable. Our current research is focusing on how to evolve post-pandemic patient care to ensure the highest quality of care, support changes in payment regulations, reduce the health disparities that are currently present with the delivery of telehealth services, and promote equal access for all.
Lastly, since dissemination of research findings is critical to knowledge transfer and the spread of impactful evidence-based strategies, this report contains a section devoted to the program’s dissemination efforts that include national web conferences, research presentations, and publications. 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 disseminate their research results even further.
We hope that you enjoy reading about many of the AHRQ Digital Healthcare Research Program accomplishments and the significant impact of all of the health services-funded research. Please send any comments or questions to DigitalHealthcareResearch@ahrq.hhs.gov.