Special issue highlights new research into HIT projects for quality improvement

The Veterans Health Administration (VHA) is aiming to become a leader in using health information technology (HIT) to change the way patients experience medical care, to decrease medical mistakes, and to improve health outcomes. A special March supplement of Medical Care highlights new research into the many and varied types of HIT projects being explored to improve the quality of patient care throughout the VHA system. Medical Care is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special issue also maps out key areas for future research to develop and evaluate effective approaches for using HIT for ongoing quality improvement in healthcare. "Our research infrastructure is critical to supporting the type of HIT innovation that can support changes in the way we organize and deliver care," according to an editorial comment by the VHA's Dr. David Atkins, Acting Director of Health Services Research and Development, and Dr. Theresa Cullen, Director of Health Informatics.

VHA Provides Leadership in HIT Research for Quality Improvement

Health information technology' is a loose term describing an ever-increasing range of tools and technologies. "The unifying element is not that they involve technology but that they introduce novel ways to collect and analyze health data and to extract knowledge from the data to inform decisions," Drs. Atkins and Cullen write. Since the early development of health information systems in the 1980s, the VHA has played a leadership role in health informatics.

But the HIT landscape continues to change rapidly, with increased computing power, changing HIT platforms, and changing expectations of patients, health care providers, and payers. "To map out a meaningful research agenda, we must think forward five to ten years," according to Drs. Atkins and Cullen.

From their perspective at the leading edge of HIT, they outline some of the broad trends affecting HIT, now and in the future. These include:

• The emergence of "connected health"-technology will play a central role in medical decision-making, and will supplant an increasing proportion of in-person health care visits.
• Patients' increasing control over their health information and who has access to it.
• The increased role of HIT tools to promote and assist patient behavior change.
• Standardized data allowing the performance of health care systems to be assessed in "real time," for the entire population of patients.

Drs. Atkins and Cullen also identify and discuss "distinct sets of questions that are ripe for research" in using HIT for quality improvement, from the standpoint of patients, health care teams, and health care managers.

New Research on HIT to Improve Quality of Care

The special issue also presents eight original research papers using HIT for quality improvement within the VHA system. The studies "highlight a range of specific HIT approaches, including innovative and interactive uses of the VA's electronic health record, databases, and information systems; and applications of automated systems for intervention, evaluation and tracking patient care," writes Denise M. Hynes, MPH, PhD, RN, Research Career Scientist and Director of the VA Information Resource Center, in an introductory overview.

For example, one study evaluates the use of electronic kiosks as a way to help improve care outcomes for veterans with schizophrenia. Other HIT approaches evaluated include a system for secure messaging between patients and health care providers, a "home telehealth" monitoring intervention for recently homeless veterans, and programs to increase veterans' access to and ability to use their personal health records.

"These articles highlight the value of a systematic approach in incorporating and evaluating HIT as part of quality improvement efforts," Dr. Hynes adds. She is also lead author of a paper exploring the challenges and keys to "sustained effects" of HIT projects in the Quality Enhancement Research Initiative-a major part for the VHA's systemwide quality improvement program.

The authors of the supplement papers hope their efforts will illustrate the scope of what's possible through the use of HIT for quality improvement, and help to set the research agenda for continued efforts in the years ahead. As new and practical research designs emerge, Dr. Hynes writes, "Other healthcare quality improvement efforts that rely on HIT can learn from the VHA experience."