Improving Quality Through Clinician Use of Health IT

The purpose of this funding opportunity announcement (FOA) is to investigate novel methods or evaluate existing strategies for clinician use of health information technology (health IT or HIT) in ambulatory settings to improve outcomes through more effective clinical decision support (CDS), medication management, or care delivery. Applicants were encouraged to demonstrate the ability of electronic health records (EHRs) and medication management systems to effectively move evidence-based information to the point of care, including the development/utilization of machine-actionable, evidence-based clinical information to providers and participates in health information exchanges. Applicants were encouraged to consider projects that focus on:

• The impact of health IT on outcomes in ambulatory settings and across high-risk transitions of care.
• The relationship between health IT and workflow redesign.
• Systemic barriers to health IT adoption.
• Care for patients with multiple chronic conditions.
• Improved use of effective alert strategies for decision support.

Improving Quality Through Clinician Use of Health IT Grants

Twenty-four projects were funded under this FOA. The projects have a diverse range of interventions, using different health IT applications. Many applications target the primary care office as the setting of care while some address the home environment. Many of the projects addressed use effective alert strategies for decision support while others examine the impact of health IT on outcomes in ambulatory settings.

Using Precision Performance Measurement To Conduct Focused Quality Improvement
Estimated Total Funding: $1,199,415
Description: Creates systems that improve quality data and seamlessly link this data to practice-level quality improvement programs and point-of-care interventions.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: Quality of care decision support, vocabulary/coding standards
Principal Investigator: David W. Baker
Grant No.: 1R18HS017163
Applicant Institution: Northwestern University, Chicago, IL
Estimated dates: 9/30/2007—9/29/2010

Enabling Electronic Prescribing and Enhanced Management of Controlled Medications
Estimated Total Funding: $1,199,794
Description: Uses electronic prescribing (e-prescribing) for federally controlled medications in the ambulatory care setting, to improve medication management by ambulatory care clinicians at the point of care.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings; systemic barriers to health IT adoption
Type of Health IT: E-prescribing
Principal Investigator: Grant M. Carrow
Grant No.: 1R18 HS017157
Applicant Institution: Massachusetts State Department of Public Health, Boston, MA
Estimated dates: 9/30/2007—9/29/2010

Impact of Office-Based E-Prescribing on Prescribing Processes and Outcomes
Estimated Total Funding: $1,199,007
Description: Evaluates the full spectrum of e-prescribing by partnering with the makers of an office-based, e-prescribing system that is already in widespread use and with multiple insurance companies and public programs who will provide claims data.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings; improved use of effective alert strategies for decision support
Type of Health IT: E-prescribing
Principal Investigator: Michael A. Fischer
Grant No.: 1R18HS017151
Applicant Institution: Brigham and Women's Hospital, Boston, MA
Estimated dates: 9/30/2007—9/29/2010

Improving Otitis Media Care With EHR-Based Clinical Decision Support and Feedback
Estimated Total Funding: $877,011
Description: Uses Children's Hospital of Philadelphia's EHR to integrate care across time and to supply physicians with the knowledge they need about how to treat a patient at the point of care to address the overuse of antibiotics for otitis media.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings; improved use of effective alert strategies for decision support
Type of Health IT: Clinical/operational decision support (provider-focused)
Principal Investigator: Christopher B. Forrest
Grant No.: 1R18HS017042
Applicant Institution: Children's Hospital of Philadelphia, Philadelphia, PA
Estimated dates: 9/30/2007—9/29/2010

The BLUES Project: Improving Diabetes Outcomes in Mississippi With Health IT
Estimated Total Funding: $1,163,573
Description: Demonstrates the effects of diabetes management practices at several ambulatory clinics throughout Mississippi when utilizing well-designed, comprehensive health information technology.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: EMR
Principal Investigator: Karen Fox
Grant No.: 1R18HS017233
Applicant Institution: Delta Health Alliance, Inc., Jackson, MS
Estimated dates: 9/30/2007—9/29/2010

eHealth Records To Improve Dental Care for Patients With Chronic Illnesses
Estimated Total Funding: $996,737
Description: Conducts a randomized clinical trial to evaluate the effectiveness of an integrated EHR system that includes an EMR, eDental Record, and a personal health record (PHR) to improve the quality and safety of dental care for patients with chronic illnesses.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: Systems integration, clinical/medication reminders (provider-focused)
Principal Investigator: James R. Fricton
Grant No.: 1R18HS017270
Applicant Institution: Healthpartners Research Foundation, Minneapolis, MN
Estimated dates: 9/30/2007—9/29/2010

Pharmaceutical Safety Tracking (PhaST): Managing Medications for Patient Safety
Estimated Total Funding: $1,156,142
Description: Compares use of PhaST, an automated system for monitoring of medication adherence, side effects, and patient symptoms, to usual care in a large, urban, multispecialty mental health system serving a primarily Medicaid population.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: Clinical/medication reminders (provider-focused), human/machine interface
Principal Investigator: William P. Gardner
Grant No.: 1R18HS017258
Applicant Institution: Children's Research Institute, Columbus, OH
Estimated dates: 9/30/2007­—9/29/2010

RxSafe: Shared Medication Management and Decision Support for Rural Clinicians
Estimated Total Funding: $1,200,000
Description: Uses previously developed technology to support shared medication management for persons with chronic conditions.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings; care for patients with multiple chronic conditions; improved use of effective alert strategies for decision support
Type of Health IT: Clinical/operational decision support (provider-focused)
Principal Investigator: Paul N. Gorman
Grant No.: 1R18HS017102
Applicant Institution: Oregon Health & Science University, Portland, OR
Estimated dates: 9/30/2007—9/29/2010

Improving Posthospital Medication Management of Older Adults Through Health IT
Estimated Total Funding: $1,199,952
Description: Develops and evaluates the value of a health IT-based medication reconciliation system superimposed on the ambulatory EMR to improve the quality and safety of medication management, focusing particularly on the transition from the inpatient to the ambulatory setting for older adults with multiple comorbid conditions who are prescribed high-risk medications.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings; care for patients with multiple chronic conditions; improved use of effective alert strategies for decision support
Type of Health IT: Quality of care decision support
Principal Investigator: Jerry H. Gurwitz
Grant No.: 1R18HS017203
Applicant Institution: University of Massachusetts Medical School Worcester, Worcester, MA
Estimated dates: 9/30/2007—9/29/2010

STEPStools: Developing Web Services for Safe Pediatric Dosing
Estimated Total Funding: $1,157,753
Description: Constructs, pilot tests, and evaluates generally available tools that provide medication-specific knowledge about rounding and extemporaneous formulations necessary for small children.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: Health IT architecture, CDS (provider-focused), electronic prescribing
Principal Investigator: Kevin B. Johnson
Grant No.: 1R18HS017216
Applicant Institution: Vanderbilt University, Nashville, TN
Estimated dates: 9/30/2007—9/29/2010

Electronic Prescribing and Electronic Transmission of Discharge Medication Lists
Estimated Total Funding: $1,187,674
Description: Consists of three studies that will measure the impact of health IT on patient safety in the ambulatory setting.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: E-prescribing, quality of care decision support
Principal Investigator: Rainu Kaushal
Grant No.: 1R18HS017029
Applicant Institution: Weill Medical College of Cornell University, New York, NY
Estimated dates: 9/30/2007—9/29/2010

Evaluation of a Computerized Clinical Decision Support System and EHR-Linked Registry To Improve Management of Hypertension in Community-Based Health Centers
Estimated Total Funding: $1,132,569
Description: Analyzes the efficacy of office-based electronic decision support and provider feedback in improving hypertension control in CHCs.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: Registries (hypertension), CDS
Principal Investigator: Helene Kopal
Grant No.: 1R18HS017167
Applicant Institution: Primary Care Development Corporation, New York, NY
Estimated dates: 9/30/2007—9/29/2010

Optimizing Medication History Value in Clinical Encounters With Elderly Patients
Estimated Total Funding: $1,199,989
Description: Conducts a randomized clinical trial to test geriatric specific algorithms and compliance triggers for improved medication management at the point of care.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: E-prescribing, CDS (provider-focused)
Principal Investigator: Kate L. Lapane
Grant No.: 1R18HS017150
Applicant Institution: Brown University, Providence, RI
Estimated dates: 9/30/2007—9/29/2010

Improving Quality Through Decision Support for Evidence-Based Pharmacotherapy
Estimated Total Funding: $1,198,429
Description: Seeks to improve care quality and safety in an ambulatory care setting through CDS for evidence-based pharmacotherapy delivered as point-of-care reports to clinic-based practitioners and as population health-based alerts to care managers.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: Health information exchange (HIE), CDS (provider-focused)
Principal Investigator: David F. Lobach
Grant No.: R18HS017072
Applicant Institution: Duke University, Durham, NC
Estimated dates: 9/30/2007—9/29/2010

Using Health IT To Improve Ambulatory Chronic Disease Care
Estimated Total Funding: $1,192,603
Description: Conducts a phased implementation of selected ambulatory care health IT systems and functions to: (1) improve providers' access to information, allowing individual providers to compare and improve their clinical performance against standardized performance targets and peers' performance and (2) enhance patient-provider connectivity and communication to improve clinical decisionmaking, patient participation in the care process, and, ultimately, patient outcomes.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: EMR, telehealth (patient-focused), quality of care decision support
Principal Investigator: David R. Mehr
Grant No.: 1R18HS017035
Applicant Institution: University of Missouri-Columbia, Columbia, MO
Estimated dates: 9/30/2007—9/29/2010

VA Integrated Medication Manager
Estimated Total Funding: $594,582
Description: Studies a new technology called the Integrated Medication Manager that facilitates improved decisionmaking by helping clinicians to consider more relevant data and to better plan patient care.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: CDS
Principal Investigator: Jonathan R. Nebeker
Grant No.: 1R18HS017186
Applicant Institution: Western Institute for Biomedical Research, Salt Lake City, UT
Estimated dates: 9/30/2007—9/29/2010

Medication Safety in Primary Care Practice—Translating Research Into Practice
Estimated Total Funding: $1,183,549
Description: Develops a set of medication safety measures relevant for primary care, incorporates these measures in practice performance reports sent quarterly to participating practices, and assesses the impact of the intervention on the incidence of medication errors.
Focus Area(s): Relationship between health IT and workflow redesign; Improved use of effective alert strategies for decision support
Type of Health IT: Quality of care decision support
Principal Investigator: Steven M. Ornstein
Grant No.: 1R18HS017037
Applicant Institution: Medical University of South Carolina, Charleston, SC
Estimated dates: 9/30/2007—9/29/2010

A Partnership for Clinician EHR Use and Quality of Care
Estimated Total Funding: $1,184,765
Description: Studies the effectiveness of a partnership that shares resources and utilizes a data-driven approach to promote full clinician use of an EHR in three nurse managed health centers and three CHCs to improve the quality of care in areas of preventive care, chronic disease management, and medication management for vulnerable populations.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: Quality of care decision support
Principal Investigator: Joanne M. Pohl
Grant No.: 1R18HS017191
Applicant Institution: Michigan Public Health Institute, Ann Arbor, MI
Estimated dates: 9/30/2007—9/29/2010

Harnessing Health IT To Prevent Medication-Induced Birth Defects
Estimated Total Funding: $1,199,370
Description: Develops and evaluates ways computers may be able to help doctors counsel women about preventing birth defects caused by use of certain medications.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: CDS (provider-focused), human/machine interface
Principal Investigator: Eleanor B. Schwarz
Grant No.: 1R18HS017093
Applicant Institution: University of Pittsburgh at Pittsburgh, Pittsburgh, PA
Estimated dates: 9/30/2007—9/29/2010

Can Risk Score Alerts Improve Office Care for Chest Pain?
Estimated Total Funding: $687,539
Description: Implements and evaluates electronic risk alerts to risk stratify outpatients with chest pain and present this information to primary care clinicians within the context of an EHR.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: Clinical/operational decision support (provider-focused)
Principal Investigator: Thomas D. Sequist
Grant No.: 1R18HS017075
Applicant Institution: Brigham and Women's Hospital, Boston, MA
Estimated dates: 9/30/2007—9/29/2010

Improving Laboratory Monitoring in Community Practices: A Randomized Trial
Estimated Total Funding: $990,640
Description: The Massachusetts e-Health Collaborative (MAeHC) will conduct a trial of computerized point-of-care alerts in the EHR to prevent errors related to laboratory monitoring at the initiation and continuation of drug therapy and a results management system to prevent errors related to the delay in followup of abnormal laboratory testing.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: Community health network (CHN), results reporting, clinical/medication reminders (provider-focused)
Principal Investigator: Steven R. Simon
Grant No.: 1R18HS017201
Applicant Institution: Harvard Pilgrim Health Care, Inc., Boston, MA
Estimated dates: 9/30/2007—9/29/2010

A Systems Engineering Approach: Improving Medication Safety With Clinician Use of Health IT
Estimated Total Funding: $1,200,000
Description: Modifies and implements an IT-based Crew Resource Management tool called ACORN to examine the impact of the intervention on reducing selected adverse drug events among geriatric patients in a primary care setting; examines the impact of the intervention on improving monitoring for geriatric patients on Persistent Medications; and evaluates office staff use and application of the tool for improving geriatric medication safety by examining utilization of the IT tool and changes in safety attitude constructs.
Focus Area(s): Impact of health IT on outcomes in ambulatory settings
Type of Health IT: Quality of care decision support
Principal Investigator: Gurdev Singh
Grant No.: 1R18HS017020-01
Applicant Institution: State University of New York at Buffalo, Buffalo, NY
Estimated dates: 9/30/2007—9/29/2010

Using Information Technology To Provide Measurement-Based Care for Chronic Illness
Estimated Total Funding: $1,196,703
Description: Tests the implementation of measurement-based care in an ambulatory care setting with an integrated CDS system and an EHR.
Focus Area(s): Improved use of effective alert strategies for decision support
Type of Health IT: CDS (provider-focused)
Principal Investigator: Madhukar H. Trivedi
Grant No.: 1R18HS017189
Applicant Institution: University of Texas Southwest Medical Center at Dallas, Dallas, TX
Estimated dates: 9/30/2007—9/29/2010

Electronic Prescribing and Decision Support To Improve Rural Primary Care Quality
Estimated Total Funding: $1,181,866
Description: Examines whether, in rural ambulatory care settings, the use of an e-prescribing system with CDS related to medication management increases patient prescription adherence, improves health outcomes in hypertensive patients, and improves the medication management process.
Focus Area(s): Systemic barriers to health IT adoption; improved use of effective alert strategies for decision support
Type of Health IT: CHNs (rural communities), e-prescribing, clinical/medication reminders (provider-focused)
Principal Investigator: James Thomas Veline
Grant No.: 1R18HS017149-01
Applicant Institution: Avera Health, Sioux Falls, SD
Estimated dates: 9/30/2007—9/29/2010

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