Assessing the Use of Information Technology in Health Care

Information technology holds potential for transforming health care delivery in important ways. Mathematica is at the forefront of examining how technology is being applied to promote innovation and improvement in the U.S. health care system.

Although the U.S. health care system has a long history of innovation, it currently faces major challenges. Information technology has the potential to improve the quality of three major areas of the system: personal health management, health care delivery, and public health. Mathematica is assessing how technology applications contribute to improve quality of care, reduce medical errors, and lessen administrative costs in these areas. Our research includes:

• Assessing the use of personal health records by underserved populations
• Estimating the cost of physician voluntary quality reporting using health information technology
• Evaluating a pay-for-performance demonstration for small physician practices
• Developing measures of patient use of home telemedicine units
• Evaluating the effects of telemedicine on clinical outcomes
  

Improving Self-Care and Care Management

Interactive technology holds promise for helping people with chronic illnesses better manage their diseases and prevent costly complications. Through health care appliances—such as glucometers, scales, and stethoscopes capable of transmitting readings over the internet to a central repository—and other technologies for self-care management, patients can obtain diagnostic and monitoring information and play a more active role in their care. These tools can also help people overcome barriers to care, such as limited personal mobility or residence in medically underserved areas. For the Centers for Medicare & Medicaid Services, we are conducting a large-scale evaluation in New York State of home-based telemedicine services. These services for Medicare patients with diabetes use communications and information technology to transmit medical diagnostics and monitoring services between patients and health care providers. We are examining whether patients randomly assigned to receive these services experience improved clinical outcomes and greater satisfaction with care. This study is also looking at factors that facilitate patients' use of the technology. We are evaluating the effectiveness of several care coordination and disease management programs, some of which rely on telemedicine technologies. In addition, we are informing policy discussions about the future direction of personal health records—electronic records of an individual's health information that the individual owns and manages in a secure environment—in reducing disparities and empowering consumers living in medically underserved areas.

Changing Incentives to Improve Quality of Care

Aligning health care payments with the quality of care provided is an important objective for policymakers and health plans alike. Yet, reaching this goal requires large investments in new technology as well as changes in existing systems and processes. Mathematica is evaluating whether incentives increase the number of physician practices that adopt electronic health records—technology that has the potential to improve care quality and coordination, patient safety and satisfaction, and reduce costs for employers, insurers, and, ultimately, providers. The incentives being studied include technical assistance and pay for performance. We are assessing whether adopting such technology improves outcomes for Medicare beneficiaries with certain chronic conditions. In another project, we are surveying a national sample of hospital medical directors to assess how they are using health information technologies to enhance quality of care and reduce administrative costs.

Tracking Real-Time Public Health Data

The U.S. public health system plays a vital role in protecting the population against disease outbreaks and potential bioterrorism, in addition to its function in promoting the health of its citizens. Yet, the system is made up of a vast assortment of federal, state, and local agencies providing a multitude of services that affect the lives of millions of people. We have broad experience in assessing the functions and performance of public health systems, and in developing performance indicators and surveillance systems to monitor public health activities. We also have used vital health records for evaluating community-based health interventions in 15 large urban areas across the United States. As electronic health records become more widely available, we can provide technical assistance for linking and analyzing these records and producing real-time data for public health surveillance activities.

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