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<td><h1><a name="h1" id="h1"></a> Enabling Quality Measurement Through the Use of Health IT </h1>
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<div class="headnote">
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
<h2>Ambulatory Safety and Quality</h2>
<h3>Technical Assistance Call</h3>
<hr />
<p>This document summarizes the technical assistance call for
the Ambulatory Safety and Quality: Enabling Quality Measurement Through the Use
of Health IT <20>funding opportunity announcement (FOA). Select to <a href="http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-07-002.html">access the FOA</a>.</p>
<p>The
technical assistance teleconference was held at the Agency for Healthcare
Research and Quality (AHRQ) conference center in Rockville, MD, on January 4,
2007. If after reading this document you have any questions or comments,
contact <a
href="mailto:qualitymeasurement@ahrq.hhs.gov">qualitymeasurement@ahrq.hhs.gov</a>.</p>
<hr />
<h2>Introductions</h2>
<p>Good morning everybody, or good
afternoon for those of you on the east coast. This is David Meyers. I'm a
Medical Officer at the Agency for Healthcare Research and Quality. And this is
the first of our three technical assistance calls for our Ambulatory Safety and
Quality FOAs.</p>
<p>This call is regarding the quality measurement. At
1:30 p.m., we'll have our call for patient-centered care, and at 3 o'clock,
we'll start our call for the third FOA on improving quality of care through
clinician use of Health Information Technology (Health IT).</p>
<p>Thank you all for joining us. I hope everyone out
there has received a set of the slides. If you haven't, that's okay. We'll be
posting them after the call, along with the transcript of the questions and any
answers that we provide you today.</p>
<p>If we run out of time during today's call before
the start of our next call, we're going to encourage you to continue to submit
questions. And any questions submitted today, we will publish the answers along
with the questions that were answered publicly.</p>
<p>Because we have a large group of over 100 today,
we're not allowing you to ask questions during the session. But if you look at
your slides, you'll see our agenda today.</p>
<p>I'm going to provide you with a brief overview of
the larger program of which this FOA is a part, and then talk about some of the
specifics of this FOA. We'll go through a few frequently asked questions that
we've already received in advance. And at the end, we'll leave time for new
questions from the audience, as well as those questions that have been
pre-submitted to us.</p>
<p>At this time, I'm going to ask the staff here at
AHRQ who are in the room and involved with this program to introduce themselves
to you so you'll have some other voices to associate with the people you'll be
talking with in the future: </p>
<ul>
<li>Jim Battles, here at AHRQ with the Center for Quality Improvement and Patient Safety (CQuIPS) and Patient Safety.</li>
<li>Marge Keyes, Patient Safety team leader here at AHRQ.</li>
<li>Deborah Queenan, Patient Safety team.</li>
<li>Kathy Crosson, Associate Director CQuIPS.</li>
<li>Yvette Davis, Scientific Review Administrator.</li>
<li>Kishena Wadhwani, Director of Division of Scientific
Review.</li>
<li>Skip Moyer. from AHRQ, Coordinator for eSubmission.</li>
<li>Al Deal, from the Grants Office.</li>
<li>Rebecca Roper, AHRQ Scientific Review Administrator.</li>
</ul>
<p>Thank you, everybody.</p>
<p>So what you heard is that you have people in the
room who are from the programmatic side, who are the content staff for this. You
have people in the room to answer questions related to your application
process, and what will happen from letters of intent through the review, and
then some staff from our grants office, for those who are given awards, who
you'll work with in future on budget and financial issues. So we'll cover all
of those today. <a id="slides" name="slides"></a></p>
<h2>Slide Presentation</h2>
<p>We'll be following a set of slides today that was
provided electronically before the call began: (<a
href="taeqmhit.ppt">PowerPoint&reg; file</a>, 110 KB;
<a href="taeqmhittxt.htm">Text Version</a>). Slide presentations can be accessed using a <a href="http://www.microsoft.com/downloads/details.aspx?displaylang=en&amp;FamilyID=048dc840-14e1-467d-8dca-19d2a8fd7485">Free PowerPoint&reg; Viewer</a>. <a href="/exitdisclaimer.htm"><img src="/images/exitdisclaimer.gif" alt="Exit Disclaimer" border="0" align="middle" /></a></p>
<p>Moving on to our slides, to the third slide, the
AHRQ Ambulatory Safety and Quality Program consists of four FOAs with an
overview, an umbrella to improve the safety and quality of ambulatory
healthcare in the United States. And as you know, our country has spent some
time improving quality and safety in the hospital setting, in the inpatient
setting.</p>
<p>This announcement does not take away from that
work but rather expands it, recognizing that there's complexity, increased
scope, increased volume in ambulatory care. And so with this part of the
initiative, we'll be focusing in that arena.</p>
<p>Additionally, this brings together two streams of
work at AHRQ. We're thinking about quality and patient safety, and marrying
that with the role that Health IT <20>can play in this arena.</p>
<p>Next slide, the overall program for 2007 consist
of four funding announcements. And in this call, we're talking about the fourth
one, enabling quality measurement through Health
IT.</p>
<p>Going on, for this announcement, it's important
that you understand the definition we are using of ambulatory care. Traditionally,
ambulatory care refers to all types of health services provided by healthcare
professionals on an outpatient basis.</p>
<p>You'll see a list below of some of the settings
that are included here. And I'd like to call your attention to the fact that
the FOA notes that while home care is often not considered part of ambulatory
care, for the purposes of this FOA, those of you who work in the home care
arena are welcome to apply as part of ambulatory care.</p>
<p>Going on now to what this FOA's focus is, we are
interested in projects that look at new methods or evaluate existing strategies
for using Health IT <20>to assist clinicians and healthcare systems to measure
quality and safety in ambulatory care.</p>
<p>We're encouraging you to develop new safety and
quality measures to:</p>
<ul>
<li>Determine essential data elements as outlined by the
Institute of Medicine priority areas. </li>
<li>Develop Health IT <20>systems to export measures. </li>
<li>Demonstrate the ability of Health IT <20>to provide
measures. </li>
<li>Enable public reporting through health information
exchange and measure the efficiency of the process of quality measurement.</li>
</ul>
<p>At this point, I'm going to digress from the slides
to remind you that all the words from these slides and everything we're talking
about today is grounded in the actual writing of the FOA.</p>
<p>If at any time, anything I say or anyone in the
room says contradicts what's in the FOA, you are now notified that descriptions
in the FOA will supersede our statements provided here. We are just trying
today to clarify what we've already put down on paper for you.</p>
<p>So moving on, the goals of this FOA are outlined
for you. Again, developing safety and quality measures for ambulatory care, and
then there are some specifics that you can read in the slide.</p>
<p>And I'll call your attention to the final part of
this slide, which notes that while this FOA is generally focused on the
marriage of Health IT <20>into the quality and safety of ambulatory care, this FOA
has a special set aside of $1.8 million for projects that are focusing on
quality, which focus on quality and patient safety, although they do not
involve the use of Health IT <20>to do it.</p>
<p>Nonetheless, these projects are held to all of
the same standards of fulfilling the objectives of the FOA in the ambulatory
setting and across settings of care, and we'll talk at the end about what you
need to do if you'd like to be considered for the special funding.</p>
<p>The next two slides are taken directly from the
FOA and list the many areas of interests that AHRQ has in this field. Rather
than go through them, they are here just to point out that we recognize that
people may come in under this funding announcement in many different ways.</p>
<p>They range from the beginning of the process of
identifying measures and determining them all the way through demonstrations of
how, once these measures are implemented in practice, they actually result in
improvement of care and all of the steps in between.</p>
<p>Think for a moment about what you need to do in
your application as you read the next slide. You're expected to:</p>
<ul>
<li>Clearly describe the interventions for these studies.</li>
<li>To place that intervention in context. </li>
<li>To provide an implementation plan along with your
methods. </li>
<li>Project milestones and the timeline. </li>
<li>To describe your analysis and evaluation plan. </li>
<li>And to include a dissemination plan. </li>
</ul>
<p>All of those aspects are required
under this FOA.</p>
<p>I want to highlight that in the FOA, you will see
under a section describing what we would expect under the specific aims, that
when you describe your intervention, it is expected that some aspects of the
intervention, for most applications, will include the use of Health IT. For those who are developing a new measure, it is
important that the new measure will rely on electronic coded data from
electronic health systems or from claims merged with EHR data. We'll talk a little bit more about some of that
in a moment.</p>
<p>Flipping to the next slide, you'll see that if
you are bringing in an application that involves Health IT, the use of American National Standards Institute (ANSI) Health Information Technology Standards Panel (HITSP)
standards, where they exist, is required. And we expect that the application will detail
your process for making sure that you've checked to see that if there are
standards for the data elements you propose to use, those standards will be
used when available, and what will happen over time if new standards are
applied.</p>
<p>Additionally, we expect that people will employ
existing measures of quality when they exist whether they've been developed or
adopted by AHRQ, Ambulatory Care Quality Alliance (AQA), or Hospital Quality
Alliance (HQA).</p>
<p>Turning to the next slide, some of the &quot;musts&quot;
that you should remember: </p>
<ul>
<li>Your project application must include a timeline with
specific milestones. </li>
<li>You must document or describe your specific outcome
measures.</li>
<li>And you must describe the future sustainability of your
intervention in your particular institution after the grant period ended.</li>
</ul>
<p>Additionally, you must include a dissemination
plan for your work. It must be included in the budget of your project. I would
like to point out that it may be possible in the future that AHRQ will have
additional funds available, on a limited competition basis, for people awarded
grants under this FOA, to do additional dissemination work. However, your application
cannot count on that funding for its dissemination plan. You must have a
dissemination plan as part of your application.</p>
<p>The next slide describes required measures. In
order to facilitate evaluation across projects in the AHRQ portfolios, AHRQ is
requiring that all applicants measure and report on the following outcomes when
appropriate to their project's specific aims.</p>
<p>There are five specific measures that we're
requesting: </p>
<ol>
<li> The percent of
adoption and use of Health IT , electronic prescribing, and clinical decision
support or patient-specific electronic information for providers delivering
care as part of your intervention.</li>
<li> The percent of
patients in all of the settings you are working with who receive appropriate
care for prevention, treatment, and medication therapy, especially in areas
identified as high priority by the Institute of Medicine (IOM).</li>
<li> The percent of
eligible patients within the practices with which you are working, who have
access to their personal health information.</li>
<li> Patient and
providers' access to and utilization of patient safety and quality measurement
reports. </li>
<li> And finally, the
percent of clinicians&#8212;ambulatory clinicians and the practices with which you
are working&#8212;who are using patient feedback; specifically, we're interested in
the use of AHRQ's CAHPS&reg; clinician and group survey instrument.</li>
</ol>
<p>Moving on to some of the other fine print in the
application, privacy and security is of utmost importance to AHRQ in this
application. All applicants are required to describe how in both the
development and the implementation of their intervention, privacy and security
issues related to the exchange of scientific health information will be both
identified and addressed.</p>
<p>And I call your attention to the larger section
in the FOA that describes this. There's some very good language that explains
to you what we mean by privacy and security, where you can go for more
information and what types of things we'd expect to see in applications to meet
this requirement.</p>
<p>Moving on, who is eligible to apply? You're
eligible to apply if your organization is a public institution or a non-profit
private institution. Those include non-profit healthcare organizations,
universities, and faith-based and community organizations.</p>
<p>Additionally, units of State or local government
who are eligible to apply for Federal funding are welcome as well as Indian and
Native American tribal governments or their designated organizations. Specifically, for-profit organizations are not
eligible to be the lead organization in an application. However, for-profit
organizations may participate in projects as members of consortia or as
subcontractors.</p>
<p>And for-profit organizations that produce Health
IT <20>systems are especially encouraged to apply in partnership with non-profit
organizations in the lead.</p>
<p>Similarly, foreign institutions are not eligible
to apply. However, they may be considered as members of consortia or as
subcontractors.</p>
<p>The principal investigator must be identified in
the application. There are a few other requirements detailed on the next slide.</p>
<p>I'll call your attention to the fact that we
expect a considerable portion of the principal investigator's (PI's) time will
be devoted to this project. If less than 20 percent of his or her time will be
devoted, the application must include an explicit justification.</p>
<p>Moving on to the next slide, on funding
considerations, you'll note that there are two sets represented in this page. The
first is the scientific merit of the proposed project as determined by peer
review. That's the aspect that you have the most control over, and we'll talk
specifically about what the peer reviewers will be looking for. But you then can see there are several other
factors that will go into funding decisions made by AHRQ, including the
availability of funds, the relevance of projects to the larger portfolio, the
balance of projects funded in the portfolio, as well as in larger HHS
initiatives.</p>
<p>If you skip ahead two slides for a moment, there are
the specific review criteria that this FOA includes: </p>
<ul>
<li>The significance and impact of your project.</li>
<li>Its usefulness and generalizability&#8212;that's language
that some folks may have not seen before and I call your attention to it.</li>
<li>Your general approach. </li>
<li>The investigators involved and the partnerships brought
forth by the application. </li>
<li>The settings involved.</li>
<li>Your budget.</li>
</ul>
<p>Additional considerations are that the peer
review group will assess how responsive you were to the goals of the FOA, your
attention to privacy and security protection for all involved, the extent to
which you have addressed the protection of human subjects from research risk
and the inclusion of priority populations.</p>
<p>Going back now to the non-Health IT <20>funding
preference (this was mentioned earlier), you may specifically request to be
considered for funding preference in an area of quality and patient safety that
does not directly involve Health IT. Applicants requesting this consideration are
exempt from the Health IT <20>requirements and Health IT <20>aspects of the review
criteria for this FOA, but all other review criteria apply. Specifically, everyone applying under this FOA
should include an Appendix 1, which either describes why you would like to be
considered for funding under this funding preference or in which you state no
funding preference requested.</p>
<p>Finally, for the last nitty-gritty things, this
is an R18 mechanism which is for research demonstration and dissemination
projects. And it's useful to note that the goal of this type of funding
mechanism is to provide support designed to develop tests and evaluate health
service activities.</p>
<p>This is a one-time solicitation. You should not
expect&#8212;though it could be possible&#8212;you should not expect future re-release of
this application. AHRQ plans to commit up to $6.8 million in FY '07
for this project. All projects can go up to a maximum of 24 months in duration. The budget is a total budget and may not exceed
$1 million in total costs over the 24 months or less period. Total costs again
include your direct and your indirect expenses. This is different from some
other Federal funding agencies.</p>
<p>The budget for any single year may not exceed
$500,000, again, in total costs. And we recognize and hope that projects will use
that flexibility to apply for between 12 to 24 months of funding and for
different funding amounts as well.</p>
<p>Flipping to the next page, AHRQ does not accept
modular budgets. For those who haven't applied to AHRQ before, let me say it
again, AHRQ does not accept modular budgets. We only use detailed research and
related budgets. Do not use the PHS 398 or the 424 modular budget forms. Any
application submitted in modular budget format will be returned without review.</p>
<p>As you heard, we have somebody here involved in
the electronic application process. If you have questions about that, the SF
424 R&amp;R must be used for this application and the application must be
submitted electronically.</p>
<p>Please look at the FOA for instructions on how to
obtain electronic forms you'll need and how to register both your institution
and the principal investigator, all of which need to be accomplished before
your application can be submitted. If you have not begun this process, it can take
up to 6 weeks to register both your institution and then register the PI. And
so that's important to get started on now.</p>
<p>On the next page, you'll see the key dates. An
opening date for an FOA means the first date in which an electronic application
can be submitted. That will be on <strong>January 13</strong>. We request a letter of
intent be sent to AHRQ by <strong>January 19</strong>. You can submit them through email,
by fax, or by regular mail.</p>
<p>All applications are due on <strong>February 13, 2007</strong>.
We anticipate a peer review meeting in April or May of this year so that you should
figure the earliest possible date for a successful application would be July
2007.</p>
<p>Moving on now, we have a few questions that have
been asked in the past that we would like to address. We'll go through this
quickly.</p> <h2>Questions and Answers</h2>
<h3>Prepared Questions</h3>
<p><strong>Question: Are hospitals allowed to apply? </strong></p>
<p><strong>Answer:</strong> Public and non-profit health care institutions, including hospitals, are
eligible to apply. For-profit organizations, including for-profit healthcare
organizations and Health IT <20>vendors, can be included on applications as
members of consortia or as subcontractors if the application is submitted by an
eligible lead organization.</p>
<p><strong>Question: Do we accept modular applications? </strong></p>
<p><strong>Answer:</strong> No. Enough said.</p>
<p><strong>Question: Are emergency rooms considered ambulatory care
sites? </strong></p>
<p><strong>Answer:</strong> For the purposes of this FOA, yes. Again, ambulatory care settings
include healthcare clinician offices, both large and small practices,
outpatient clinics, community health centers, emergency departments, urgent
care centers, and ambulatory surgery centers. For the purpose of this program,
home care entities are included as well and may apply as the lead organization.</p>
<p><strong>Question: What if you're interested in focusing on the
transition between health care settings?</strong></p>
<p><strong>Answer:</strong> The FOA specifically defines healthcare transition as the movement of
patients between healthcare providers and settings as their conditions and care
needs change during the course of a chronic or acute illness. This program includes a focus on transitions
between ambulatory care settings and hospitals, assisted-living centers, and
other non-ambulatory settings. We recognize that improving patient safety and
quality during a transition is critical to the success of ambulatory care for
many elderly and chronically ill populations.</p>
<p>Non-ambulatory institutions or those that represent
settings with a strong interest in fostering safe, high-quality ambulatory care,
and transitions are welcome to apply in partnership with an ambulatory
organization.</p>
<p><strong>Question: Can there be co-PIs?</strong></p>
<p><strong>Answer:</strong> No. AHRQ requires that the lead institution designate one and only one
individual as the project's principal investigator. However, how you define the
roles of the full team of people is up to the individuals in your application. But
for the purpose of the FOA, one person must be designated as the principal
investigator.</p>
<p>Okay, that brings us to the end of our prepared
questions so we're going to move in to open questions from the audience.</p>
<h3>Open Question Period for Conference Call
Participants</h3>
<p>I'd like to note that we have
approximately ten questions that were submitted electronically previously. If
your question wasn't answered on the slide so far and you've already listed
your question, we have that and we'll try to go through them.</p>
<p>At this time, I'm going to ask the operator to
come on to ask anybody who has a question to let us know now. Rather than going
through question-answer, question-answer, what we're going to do now is get as
many questions as we can.</p>
<p>All additional questions, we're going to ask that
you supply them to us online at <a
href="mailto:qualitymeasurement@ahrq.hhs.gov">qualitymeasurement@ahrq.hhs.gov</a>.
You can do that even while you're listening right now, and we will include the
answers to those questions in the final transcript. But recognizing the time, we're going to go&#8212;we're just going to ask for questions and then we'll prioritize those combined
notes and as a group, try to answer them for you.</p>
<p><strong>Question: In the FOA, I noticed that in eligible
organizations, it eliminates 501(c) 4s; my question is regarding trade
associations with 501(c) 6s, are they eligible?</strong></p>
<p><strong>Answer: <20></strong>501(c) 6 organizations are eligible. 501(c)4 organizations that lobby
are not eligible.</p>
<p><strong>Question: Would an application using non-coded Electronic Health Record (EHR) data be eligible?</strong></p>
<p><strong>Answer:</strong> And the answer in the FOA is yes, non-coded data may be used. However,
the applicant should be aware that when HITSP standards exist, those standards
must be used for data. In the application, applicants should describe
the process of how they've identified what is non-coded and does not have a
standard, how they're going to use and represent that data, what's non-coded,
and then how they are going to apply HITSP standards where they exist.</p>
<p><strong>Question: How much technical assistance is going to be
available? It sounds like a lot may be needed.</strong></p>
<p><strong>Answer:</strong> For this period, this is the only formal technical assistance available
and the questions and answers will be written and posted on the AHRQ Web site
so that you can review what was said today. On the last page of the slide, as well as in the
FOA, we have included specific people you may contact for clarification
regarding budget matters, peer review matters, or an explanation of an unclear
part of the FOA.</p>
<p><strong>Question: Will the grant fund the implementation of EHRs in community
health centers or are you assuming that EHRs are already in place?</strong></p>
<p><strong>Answer:</strong> Can you use money from this grant to fund EHR implementation?
Technically, absolutely, yes, that is an allowable expense. However, your application will be reviewed based
on the review criteria, which are about the measurement and your outcomes. This
is not an implementation-focused grant.</p>
<p>Additional staff members wanted to me to point
out that the FOA clearly states that one of the criteria you'll be evaluated on
is the sustainability of your projects. So if you are planning to use funding or if you
proposed to use funding to implement an EHR and can't show that it would be
sustainable without this grant funding, that would not be in keeping with the
requirement of the grants and would not be reviewed favorably by a review
committee.</p>
<p>In short, yes, you may use funds for
implementation, but that is not the focus of this FOA.</p>
<p><strong>Question: Would consortia of ambulatory care organizations
as opposed to single organizations be given preference?</strong></p>
<p><strong>Answer:</strong> Consortia are encouraged. There still needs to be an institution which
meets the federal requirements to receive federal funds, that is the lead
organization. It could be a consortium, but often it's one of the members of
the consortia. There is no special preference, however, for the
consortia per se. However, we do indicate that there are other things that
consortia can do, such as bringing an interdisciplinary team together or
testing measures in multiple settings, both of which are explicit review
criteria.</p>
<p>For a clarification on that, just
remember what we talked about earlier about what the eligible applicant has to
be. The eligible applicant is the lead consortia member. Please direct any additional
questions related to that specific topic to Al Deal.</p>
<p><strong>Question: My question is regarding the timeline. Since the
grant lasts for 24 months, if you have a year to implement EHR, and then
following that you would have to show your results, in what kind of time period
are you expected to show results of quality measurement?</strong></p>
<p><strong>Answer:</strong> We told you when to start your budgeting process, but there was
a question about when you're going to be doing measurement activities. If you
need to implement and then measure, you should discuss in your application
about when data will be available. For this, we refer you back to the FOA: What are
your specific aims? How are you meeting the goals? What are the specific
outcomes that you are proposing? Then at the end of 24 months, you must be able
to demonstrate that you've met those aims or that you're able to give data to
answer your outcomes; so what you've set out for yourself, how you divide it
up, what part is implementation versus what part is measurement, is up to your
discretion. But you will be evaluated on whether the methods that you propose
are feasible, as described in the review criteria the committee will use.</p>
<p><strong>Question: If we apply for the special set aside that doesn't
involve Health IT, do we need an evaluation component with patients and
therefore need to do an IRB?</strong></p>
<p><strong>Answer:</strong> Regarding the need for IRB reviews, specifically in the context of people
who are not using Health IT, all applications will be reviewed, with specific
review criteria regarding your human subjects protection planning. All
applications will need to meet Federal requirements to address Protections of
Human Subjects and have that plan specified in the application. That plan will
be reviewed and assessed by the peer review group.</p>
<p>However, you do not need to have your IRB
approval when you submit your application. If your application is selected for
funding, you will need to provide IRB approval prior to issuance of the grant
award. And if you have additional questions about that,
there are some citations in the FOA or you can contact us about that process.</p>
<p><strong>Question: If we are developing a new measure&#8212;a new quality measure but
applying for the non-IT portion of the grant, does that measure have to be
taken from electronic data or can it be from clinical data?</strong></p>
<p><strong>Answer:</strong> The next question had to do with folks who are choosing to develop new
quality measures and looking to do that in the realm outside of Health IT. <20>They
are therefore requesting special funding preference and for projects that then
use clinical data. Those that say they want to be considered in
Appendix A under the special funding preference of non-Health IT quality
measure development are not required to meet the Health IT-specific
requirements in the FOA.</p>
<p><strong>Question: Yes. Is the indirect costs rate the institution's
federally approved indirect cost rate or a separate flat fixed rate?</strong></p>
<p><strong>Answer:</strong> No, this is a federal grant opportunity and the institution, if it has
one, uses its own predetermined negotiated rate.</p>
<p><strong>Question: Does the applicant organization need to be an
ambulatory care provider?</strong></p>
<p><strong>Answer:</strong> No. They do need to meet the requirements of a lead organization, such
as, they must be a public or government or Native American organization. However, if a non-ambulatory lead organization
applies, it is expected that they will act in partnership with an ambulatory
setting or group that is a partner in this application. But the lead can be
either the ambulatory or the non-ambulatory organization, as long as they meet
the other requirements.</p>
<p><strong>Question: If no IT measures exist presently those that were
mentioned several times earlier are the ones that may be used. By &quot;mentioned
earlier,&quot; I mean that in reading over the grant opportunity materials, on
several occasions a site would mention where one could go to look for existing
electronic measures.</strong></p>
<p><strong>Answer:</strong> If there is no Health IT measurement in existence, is it okay to use a
new measure. This brings up several different possible answers that everyone
should hear.</p>
<p>The first is for measurement. <20>The application
has two different buckets. Some people may want to measure the use of Health IT
or the processes of using Health IT to measure quality. So their focus is on
harnessing the Health IT tool. For those, it is encouraged, but not required,
that the measures for clinical quality are the AQA, AHRQ developed or HQA
measure sets.</p>
<p>Our second bucket of applications, we expect, are
people who are not looking at the process of Health IT, but the measurement
itself of clinical quality and ambulatory safety and care. Those folks, if
there's no measure in existence, of course they're encouraged to develop new
measures. At other times they may be looking at new settings, in which case,
they are, again, encouraged to use the starter measures have already been
proposed.</p>
<p>A third group to think about in measuring the
project: AHRQ has required that, where applicable, you look at five specific
measurements. And if your project touches on them, we expect that you will show
us in your application how you will measure and collect that information.</p>
<p>If you are not doing a Health IT project and
therefore are not in the Health IT sphere, you would say these are not
applicable to your application.</p>
<p>That was a complicated question with a
complicated answer. Feel free to write to <a href="mailto:qualitymeasurement@ahrq.hhs.gov">qualitymeasurement@ahrq.hhs.gov</a> if
you need further clarification.</p>
<p><strong>Question: Can the funds be used to lease an EHR system and
should the budget start from July 1? </strong></p>
<p><strong>Answer:</strong> Leasing of an EHR is an acceptable, budgetable expense and can be
included in your budget. We recommend that you don't propose a
budget that begins before July 1, 2007, because that's the earliest anticipated
start date. As these are FY 2007 grants, we expect that all
programs will have a budget that starts sometime during the fiscal year 2007,
which means before October 1, 2007. So it is up to you. You do not need to start on
July 1. You propose when your project will start.</p>
<p><strong>Question: I have a question about the transitions. Would transition provisions
between providers within the same setting (ambulatory care) be considered a
transition, for example, at a clinic with a staff of rotating physicians?</strong></p>
<p><strong>Answer:</strong> Yes, as long as you are in the ambulatory care setting.</p>
<p><strong>Question: The FOA lists nine priority areas for national
action; however, the actual IOM report has about 20 areas, including major
depression, screening and treatment, and severe and persistent mental illness. I
was wondering whether an application submitted under these additional areas
would be considered?</strong></p>
<p><strong>Answer:</strong> Regarding IOM priority areas, the caller is absolutely correct. The IOM
has a much larger list. We provided nine as examples. <20>Any other IOM priority
condition is also encouraged for study.</p>
<p><strong>Question: I was wondering where it says that the use of
certified products is highly encouraged. If our system that we're putting in
does not use a product on that list, how much of a deterrent is that going to
be?</strong></p>
<p><strong>Answer: </strong>The FOA encourages the use of these products, but it is not a
requirement for application.</p>
<h3>Responses to Presubmitted Questions</h3>
<p> <strong>Question: What type of staffing and research capabilities do you expect
applicants to propose. We have discussed the PI being an implementation person,
is that okay?</strong></p>
<p><strong>Answer:</strong> Please refer to the FOA. We understand that the project's PI may not
have the expertise in all of the areas that your project touches on. And it is acceptable that if that person is the
facilitator and lead and has one area of expertise, then, you would demonstrate
how the rest of the team brings the other skills. That's encouraged and
expected. As the FOA states, we expect the project team to
be appropriate to conduct the proposed work.</p>
<p><strong>Question: Is there some proportion of the budget that can be
used for purchasing applications versus staffing?, and specifically, therefore,
hardware and technology.</strong></p>
<p>The FOA does allow for the purchase of hardware
or, as we said, the leasing of software and/or the leasing of technology. It is important for everybody applying to
remember that one of the criteria you will be reviewed on is the reasonableness
of your budget. The reviewers will look at your proposed budget and say, Is the
proportion that you have submitted that is going for staff versus research and people
appropriate? And the peer reviewers will make that determination.</p>
<p><strong>Question: Out of the two programs, Enabling Quality Measurement
Through Health IT, which we're discussing now, and Improving Quality Through Clinician
Use of Health IT, does one program have a greater academic or research focus
than the other?</strong></p>
<p><strong>Answer:</strong> No. These are both R18 mechanisms. However, let me point out, these are
both research mechanisms and are not designed, as the criteria described, to be
simple implementation projects.</p>
<p><strong>Question: What characteristics or qualifications is AHRQ
looking for in the principal investigator?</strong></p>
<p><strong>Answer: </strong>For our answer to that, we will bring you back to our slides and to the
FOA itself for the criteria of what we expect in the PI. Again, I will point out that the PI is expected
to spend a significant portion of his or her time, and, if it is less than 20
percent, that needs to be justified. We expect it to be a senior person with
expertise. But that person does not necessarily have to have all of the
expertise necessary; they can count on the members of their teams.</p>
<p>The next question referred to looking at the FOA
and what was spelled out to be in the different sections of the SF 424 R&amp;R,
versus the instructions one gets from the SF 424 R&amp;R. Specifically, the FOA
doesn't mention the preliminary study.</p>
<p>The FOA is your guiding principle. Anything that is
stated here is required. Things not mentioned in the FOA that are then described
and asked for in the SF 424 should be placed in their correct location.</p>
<p>If at any time you believe there is a conflict of
information, you are free to contact AHRQ staff to clarify. But in general, our
answer is that the FOA trumps the SF 424, but we have worked hard to make sure
that there are not any contradictions.</p>
<p><strong>Question: What percent of funded projects will be for EHR or
PHR interventions, or what percent of funded projects will be other IT
interventions?</strong></p>
<p><strong>Answer:</strong> There is no specific percentage in the FOA. On a related but not
exactly the same question, we plan to have a funding preference for $1.8
million for the non-Health IT.</p>
<p><strong>Question: Are there any limitations with working with the Department of Veterans Affairs (VA) as an ambulatory partner?</strong> </p>
<p><strong>Answer:</strong> This is a very good question with a difficult answer. Federal funds cannot be used to pay the salaries
of the VA employees. That means they cannot be included in the budget. However, if your research is to be conducted in
the setting of an ambulatory VA center, it would be acceptable that the VA is
your partner.</p>
<p>Specifically, we strongly recommend that anyone
working with a VA partner work closely with the VA medical center, not just the
investigator. Individuals who work for the VA who you'd like to
involve may have the ability to be a consultant in their time outside of their VA
employment. Again, you'll have to talk with that person and their VA employer.</p>
<p><strong>Question: Do we have to have an ambulatory center as a partner if we
are working with the analysis of quality measures across many organizations?</strong></p>
<p><strong>Answer:</strong> Yes. The ambulatory partner may be the lead or may be a partner, but an
ambulatory care provider must be included in your application.</p>
<p>The next question had to do with the fact that while this is
an Health IT-focused solicitation, there is a part of it in measurement that
is non-Health IT-focused, and that's the special funding. And for those who
applied for it under Appendix A, they are not required to meet the Health IT requirements
of the FOA.</p>
<p>There is an additional FOA that also has a non-Health
IT component, and that is the risk assessment in ambulatory care FOA. People who are interested in these two are
eligible to apply under one or the other or both. There will be a technical assistance
call for those interested in the Risk Assessment in Ambulatory Care FOA. </p>
<p><strong>Question: The final question on our list today was whether you could
develop a new quality measure and test it across transitions from ambulatory to
hospital, to nursing home. </strong></p>
<p><strong>Answer: </strong><EFBFBD>That would generally be acceptable in the ambulatory care to hospital
setting. In general, just looking at hospital to nursing
home transition would be considered a non-ambulatory transition to a
non-ambulatory setting, and that would not be the main focus of this FOA. However, the focus on ambulatory quality, developing
new quality measures for transitions from ambulatory to in-patient or
in-patient to ambulatory, is the focus.</p>
<p>You know, as a final point and thinking about the
question we answered a moment ago, we recommend that those who are interested
in this FOA consider looking at the notes of the technical assistance calls
from other FOAs because it is possible somebody will bring up a clarifying question
that will clarify this FOA in the context of the other calls. All of them will
be available on the AHRQ Web site after the call.</p>
<p>Thank you all for your patience. And one final word of advice that was passed
along from the staff is that everyone should pay special attention to the other
review criteria, which include: </p>
<ul>
<li>Your description of the proposed human subjects
protection plan.</li>
<li>Your addressing of privacy and security participants or
patients' records. </li>
<li>And your addressing of the plan for inclusion of priority
populations.</li>
</ul>
<p>Your application should make it easy for the
reviewers to understand how you are addressing those three requirements.</p>
<p>With that last bit of advice, we thank you all
for joining us. We will be back at 1:30 for our second technical assistance call.
And for those interested in the transcripts, we will be posting these at a later
date on the Web site. And I believe we'll attempt to email those of you
who registered for the conference call at your E-mail address when it is
available.</p>
<p>Thank you so much.</p>
<p class="size2"><em>Current as of February 2007</em></p>
<!-- <hr />
<p class="size2"><strong>Internet Citation:</strong></p>
<p class="size2"><em>Enabling Quality Measurement Through the Use of Health IT</em>.
Technical Assistance Conference Call Summary. February 2007. Agency for
Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/fund/taeqmhit.htm</p>
<hr /> -->
<p>&nbsp;</p>
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<p> The information on this page is archived and provided for reference purposes only.</p></div>
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