Use of Digital Tools to Support Care Delivery

Assessing the Effect of Telemedicine on Physician EHR Work, Cognition, and Process Outcomes (ASPIRE)
Sponsor: National Library of Medicine

The COVID-19 pandemic has dramatically altered healthcare delivery, rapidly shifting the primary modality of ambulatory care delivery to telemedicine-based virtual encounters that are persisting at high levels. In partnership with Washington University in St. Louis’s Institute for Informatics, CLIIR received an R01 grant from the National Library of Medicine to measure EHR activities in telemedicine encounters using novel measures of task switching derived from audit log data. Data will be compared across pre- and COVID-19-periods to characterize the differences in EHR-based activities between face-to-face and telemedicine encounters. Findings will be used to develop design guidelines and translate them into actionable strategies to improve EHR support for telemedicine.

Moving Health Systems Towards Excellence: Development and Dissemination of a Diagnostic Feedback Toolkit
Sponsor: Gordon and Betty Moore Foundation

Assessing diagnostic performance and delivering feedback to diagnosticians and healthcare organization leadership is vital to reducing diagnostic errors and improving patient outcomes. Our aims are first to assemble and evaluate existing diagnostic feedback tools and then to disseminate an early version of a publicly available web-based toolkit that will become a national, centralized repository for diagnostic feedback instruments. This toolkit is meant to aid health systems and healthcare providers in their identification and implementation of tools to promote diagnostic excellence through continuous feedback cycles.

Health Information Exchange to Improve Outcomes in Complex Older Patients
Sponsor: National Institute on Aging

It is critical to ensure that prior health information follows patients across care delivery settings in order to avoid poor outcomes from missing information. Older adults, particularly those with dementia and multimorbidity, are at disproportionate risk of poor outcomes from missing information and therefore should disproportionately benefit from efforts to increase electronic health information exchange. Our project will generate evidence that speaks to whether the nation is pursuing electronic health information exchange in ways that improve clinical outcomes for these populations and will thereby inform ongoing policy and practice-based efforts to help healthcare providers coordinate their services to older adults to optimize health status.

Health Information Exchange to Improve Outcomes in Complex Older Patients
Sponsor: National Institute on Aging

To improve information sharing across healthcare delivery organizations, there has been a substantial effort over the past eight years to promote adoption of electronic health records and the ability to share patient data between them (“health information exchange” or HIE). However, there is surprisingly little evidence about whether HIE is occurring in ways that will benefit older adults, both in terms of ensuring that the healthcare organizations that treat the same patient populations are able to engage in HIE with each other and, when they are, that they use HIE in ways that improve clinical outcomes (e.g., reduce repeat testing and hospitalization). This project will provide a national picture of the extent to which healthcare delivery organizations that routinely treat the same older patients are able to share patient information electronically with each other, and the impact of that connectivity on patient outcomes. 

Implementation, Scaling and Impact of the 4Ms in an IT-enabled Healthcare System
Sponsor: The John A. Hartford Foundation

The Age-Friendly Health System (AFHS) movement aims to transform our delivery system by advancing adoption of evidence-based priorities that improve care for older adults, focusing on What Matters, Medication, Mentation, and Mobility (4Ms). Our project will used mixed methods to understand contributors to implementation and scaling of the 4Ms in four diverse health systems as well as study the impact on outcomes for older adults.