November 2008
Health IT Assessment Report

The Agency for Healthcare Research and Quality (AHRQ) has released its latest evidence report and technology assessment through its Evidence-based Practice Centers. The report, entitled "Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved," focuses on the factors influencing the use of interactive consumer health IT systems for these groups across multiple conditions ranging from diabetes, asthma, heart failure, hypertension, HIV/AIDS, physical disabilities and osteoarthritis. The technology varied from Web-based systems and PDAs to touch-screen computers or kiosks designed for home monitoring of conditions or interactive reminder systems.

The report utilized some 8,522 abstracts and 563 full-text articles for its broad assessment and focused on highly interactive technologies intended primarily for use by patients or consumers that incorporated both patient interaction and patient-specific feedback. Technologies included self-management and monitoring systems with tailored health advice; personal medical records or access to personal data in a provider electronic medical record; health games that adapt to patient conditions; interactive online support or chat groups; and sites with storage, indexing, retrieval, display, or advanced features such as summarization and decision support. The positive conclusion of the report was that complete feedback loop systems worked best. These systems included monitoring, data interpretation, management adjustments based on data and timely communication of recommendations to the patient followed by continual repeat of the process.

The extensive assessment found a number of barriers to greater use, which included a lack of perceived benefit and trust of the system/technology. If the system's recommendation did not fit with the patient's mental model or perception of the situation, the patient was unlikely to comply with the advice. Many of the technology interventions being studied suffered from usability and technology problems that prevented intended routine use. Common technology problems included unreliable Internet access, system crashes and battery issues. Many of the systems required updates to fix confusing user displays. Common user problems cited were: finding a convenient time to use or interact with the system; cumbersome and time-consuming data entry; and reminder system interfaces that discouraged continual use due to implementation difficulty.

In summary, the report states that the most pressing need is for a defined system of classification for interactive consumer health IT and related interventions; the goal being better interpretation of the results by understanding effects of the various components. Consequently, the report finds that future research is needed to understand best practices for the design and implementation of these interactive health technologies for patients.

The AHRQ assessment report was compiled by the Oregon Evidence-based Practice Center with the help of five peer reviewers with a range of personal, clinical, and professional interests in the use of health IT to assess the evidence report draft. Four federal organizations and four professional societies were also asked to review the draft report. Many of the reviewed studies that make up the assessment measured system usage via logins, Web clicks, or time within a session. Ultimately, the findings showed that the varying measures and differing system-use expectations made meaningful system comparison difficult. However, the conclusion is that measurement of health technology usage going forward may gain greater importance as a proxy for intervention exposure or "dose." Click here to download the study.

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