A special edition of Health Affairs focuses on how electronic health records and other IT tools could accelerate medical advances and help physicians make faster and more informed decisions about patient treatment. Summaries of several articles from the issue appear below:
- "A Rapid-Learning Health System": This paper examines how EHR databases could advance the scientific knowledge of clinical care and help policymakers revamp the U.S. health care system. The author identifies as the short-term issues key to pursuing a rapid-learning strategy: "leadership, developing specific research programs and funding." A longer-term goal could be for the country's health care system to study the best uses of new technologies at the same rate that those new technologies are developed (Etheredge, Health Affairs, 1/26).
- "Linking Electronic Medical Records to Large-Scale Simulation Models: Can We Put Rapid Learning on Turbo?": This paper explains how EHR data could help create and validate large-scale, physiology-based simulation models that could help answer a variety of questions on topics such as physiological pathways, clinical trials and cost-effectiveness. Currently these models are limited by the availability of quality data to build and validate them, according to the paper's author. "Together, the linkage of data from [EHRs] and large-scale physiology-based models could open up a promising new way to improve the quality and efficiency of medical care," the author writes (Eddy, Health Affairs, 1/26).
- "Federal Initiatives To Support Rapid Learning About New Technologies": The value of federal initiatives aimed at increasing the amount of reliable data on the benefits and risks of health IT will be dependent on coordination among the public and private sectors; clarity about focus, purpose and priorities; better staffing; and adequate and reliable long-term funding, according to the paper. The authors write that the "federal government is in a position to generate large amounts of information essential to improving the appropriateness of decisions and the quality of care." The authors add that the information needs of policymakers should influence research priorities and study design (Tunis et al., Health Affairs, 1/26).
- "Advancing Evidence-Based Care for Diabetes: Lessons From the Veterans Health Administration": This paper discusses how the Veterans Health Administration's EHR system has helped improve care, especially that of veterans with diabetes. However, the authors note that many factors in addition to the EHR system -- including the participation of clinician-investigators; accountability through performance measurement; a population health-focused delivery system; and favorable external economic conditions -- contributed to the quality improvements. "'Off-the-shelf' technology is unlikely to generate similar benefits if these attributes are not in place," the authors conclude (Kupersmith et al., Health Affairs, 1/26).
- "Bridging the Inferential Gap: The Electronic Health Record and Clinical Evidence": This paper explains how EHRs could help close the inferential gap -- a product of "how knowledge is created, the limits to gaining access to such knowledge and the variable ways in which knowledge is translated into decisions" -- by expediting the discovery of evidence related to everyday practice needs and facilitating real-time use of knowledge. "We recognize that numerous challenges exist in the widespread application and effective use of EHRs," the authors write, adding, "We expect that these challenges will be minimized as the technology, the data and their application in practice evolve" (Stewart et al., Health Affairs, 1/26).