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Measure the Impact.

Research Web tools that provide opportunity for shared decision-making.

In subtle but significant ways, the Internet has become part of the physician-patient relationship. Moreover, it is changing what each participant brings to the interaction.

For doctors, the ability to immediately tap into a larger body of medical literature is overcoming the constraints of time and location. For patients, the ability to access information once the exclusive domain of doctors is providing a type of parity, as well as a sense of empowerment. For both, it is providing an opportunity for shared-decision making about treatments and interventions.

At the Agency for Healthcare Research and Quality (AHRQ), we are in the unique position of making such Web-based resources available and serving as an advocate for greater use of such tools, while at the same time demanding the evidence for both.

Among our Web-based applications are the National Guideline Clearinghouse[TM] (www.guideline. gov/index.asp), which provides access to more than 850 evidence-based clinical practice guidelines, and our Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST), where users can download data that help them understand and compare measures related to clinical performance.

Additionally, our Clinical Prevention Initiative (www.ahrq.gov/ clinic/ppipix.htm) includes a Web-based component that gives physicians electronic access to the recommendations of the U.S. Preventive Services Task Force. It also provides access to materials specifically geared to patients on child health and tobacco cessation, as well as information on choosing quality healthcare.

Potential Benefits

As part of the interagency group charged with responding to the Institute of Medicine's 1999 report To Err is Human, AHRQ has specifically addressed the potential for Web-based solutions to address a major healthcare issue: the reduction of medical errors. In a report to President Clinton, AHRQ, and other members of the President's Quality Interagency Coordination (QuIC) Task Force discussed the advantages of clinician access to timely knowledge and patient information, as well as the use of diagnostic and therapeutic decision support tools.

To the degree such resources are being used, they are mainly being accessed in large provider organizations' stand-alone systems. The rising popularity of application-service providers may soon make these resources more affordable and manageable to smaller systems and practitioners.

The impact of immediate access to new sources of information and data support tools needs to be measured in a more systematic fashion. In other words: How are these technology-related changes in the physician-patient relationship impacting the cost, quality and outcome of healthcare provided?

Do we know--beyond anecdotal evidence--whether shared decision-making leads to improved outcomes? Can Web-based applications reduce errors? Could they introduce new ones? If a major barrier to the use of these new technologies among physicians is the lack of convincing evidence of their effectiveness, how do we develop the evidence for such use? And, if we are able to demonstrate the effectiveness of these technologies, how do we help physicians translate this research into everyday practice?

Looking Forward

Internet technology is moving quickly into the medical arena. In the not-too-distant future, we are likely to see greater physician-patient communication by e-mail, development of physician portals, greater diffusion of the electronic medical record, and greater efforts to link quality measures and guidelines. We look forward to greater support of research in this area of critical importance. As we develop our research agenda, we welcome your input and partnership in these activities. For further information, please visit our website at www.ahrq.gov.

Helen Burstin, M.D., M.P.H., is director of the Center for Primary Care Research at the Agency for Healthcare Research and Quality. She oversees AHRQ's efforts to promote high quality research in clinical informatics, primary care and special populations.
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Title Annotation:Industry Trend or Event
Author:Burstin, Helen
Publication:Health Management Technology
Date:Feb 1, 2001
Words:613
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