RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 1 Session Overview & Workgroup Background QUERI National Meeting December 12, 2008

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 2 Roles of Facilitators –Moderator: Denise Hynes, PhD, MPH, RN –Case Study 1: Katharine Bradley, MD, MPH Presenters Carol Achtmeyer, MN, ARNP Daniel Kivlahan, PhD –Case Study 2: Mary Goldstein, MD Presenters Ruth Cronkite, PhD –Panelists: Kathleen Lysell, Psy.D James Breeling, MD Jim Demetriades

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 3 Purpose –Describe and discuss approaches for developing sustainable HIT innovations through the identification of useful resources, collaborations, and strategies.

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 4 Session Overview –Case Study 1 –Case Study 2 –Panel Response and Group Discussion –Facilitated Group Consensus Building –Recap for Working Group Presentations

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 5 Previous VA Meetings and Projects Addressing Health Information Technology –QUERI National Meeting “Informatics Strategies to Support Healthcare Quality Improvement,” December 2003 –Patient Care Services Retreat “Implementation Research and VHA’s Clinical IT Strategy,” November 2004 –State-of-the-Art Conference on “Implementing the Evidence: Transforming Practices, Systems, and Organizations,” December 2004 –State-of-the-Art Conference on “ Managing Complexity in Chronic Care,” Informatics for Complex Chronic Care Workgroup, September 2006 –VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects ”

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 6 QUERI National Meeting “Informatics Strategies to Support Healthcare Quality Improvement,” December 2003 –Discussion of lessons learned from three QUERI informatics projects Decision support for chronic hypertension management Collaborative care for chronic schizophrenia management Tele-care for chronic diabetes management –Discussion of barriers and facilitators in clinical reminder use in the VA –Presentation on future plans for VistA

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 7 Patient Care Services Retreat “Implementation Research and VHA’s Clinical IT Strategy,” November 2004 –Local Innovation and National Standardization –Identified 3 goals for best possible business case for rolling out local innovations Workflow efficiency from the provider’s perspective Improved decision-making and better outcomes from the patient’s perspective Optimal health from the target population’s perspective

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 8 Patient Care Services Retreat “Implementation Research and VHA’s Clinical IT Strategy,” November 2004 –Need for Systematic Evaluation of Processes and Outcomes of Implementation –Criteria How well applications meet needs of users How well applications impact outcomes How well applications improve the health of patients –Recommendations Improved communication and collaboration among OI, PCS, and HSR&D –Center for informatics implementation?

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 9 State-of-the-Art Conference on “Implementing the Evidence: Transforming Practices, Systems, and Organizations” December 2004 –Identified attributes of an ideal health information system Supports knowledge-based decisions Evaluation/reporting capability Evolves with health care system Accurate/correct content Standardized/compatible Defined accountability: organization vs. provider Equitable: “No service/facility left behind” Sustainable Secure Usable – – integrated – – all electronic – – flexible – – transparent to users – – non-intrusive – – easily up-datable

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 10 State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006 –Key Issues Discussed How can information systems be used: –To improve care for complex chronic illness during patient visits? Between visits? –To promote communication and information sharing among clinicians treating patients with complex chronic illness? –To improve patient self-management? –To encourage patients with complex chronic illness to share information with their providers between visits? What type of aggregate information should be captured to help improve quality of care at the provider and system levels? What are the evidence-based practices in informatics that systems should begin to implement?

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 11 State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006 –Opportunities Relationships with the Office of Information –QUERI provides a way to bring OI and research together Collaboration –Need more strategic-level dialogue between operations and research about informatics –Who should develop informatics? VA’s comprehensive, longitudinal EMR provides starting place for future innovations: –MyHealthevet patient portal –CPRS interface

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 12 State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006 –Barriers Relationship with Office of Information: reorganization poses challenges Need for a new model to fund operations and implementation development, informatics development. Legal/privacy issues with communication/medical records sharing Variability in provider comfort with informatics- training opportunity Need more resources to support clinicians- time and staffing Academic vs. operational timeline- technology moves faster than research Lack of data on care outside VA

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 13 State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006 –Recommendations Identify where the intellectual capital is in informatics: –OI –Researchers –Patient care –Outside VA Centralize work on informatics –Resource center on clinical informatics? –Informatics QUERI?

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 14 VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects ” *32 projects out of 86

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 15 VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects ” –Synthesis of findings Databases and information technology developed through QUERI implementation research aids VA research in general Databases and information technology developed through QUERI implementation research aids VA healthcare quality improvement QUERI centers have continuing problems maintaining relationships with OI QUERI centers lack overall strategy for data and information technology development and improvements

RESEARCHERS’ GUIDE TO VA DATA Health Information Technology Development Strategies Working Group 16 VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects ” –Recommendations Improve the processes and support for moving data and information systems from proof of concept to national implementation Provide constancy of purpose for QUERI database and systems development by coordinating QUERI and VHA national leadership priorities, identifying funding sources, and including informatics strategies in QUERI annual strategic plans Promote the demonstration of economic value in QUERI projects Develop a nucleus of information on the use of clinical decision support in implementation research

Health Information Technology Development Strategies Working Group

Funding HIT Development –within VistA/CPRS –outside of VistA/CPRS Clinical Buy-in Institutional Buy-in Technical Buy-in Usability Testing

Bring a “QUERI voice” to OI, OQP, ONS and PCS regarding EHR implementation, iterative system evaluation and re-design Improve ways for new and experienced investigators to find each other i.e. communities of science –Expand opportunities to connect Continued/expand collaboration between research and OI, OQP, ONS and PCS –IDMC—QUERI/HSR&D –Engage ESMs in QUERI/R&D Need to create a shared vision for EHR development –Needs input from many stakeholders, including R&D Incorporate evaluation analytics in the evolution of CPRS/VISTA –R&D working together with OI could offer methods/resources to do so R&D participation in enterprise architecture development Expand opportunities for development of communities of science across services/institutions/organizations –Open/clinical WIKI to enhance communication among specific communities; explore use of sharepoint –Eg. CPRS redesign input –Needs ways for developers to get feedback from users and vice versa Expand and promote training opportunities