A network of academic researchers who focus on the comparative effectiveness of electronic health records has formalized its efforts and will recruit other researchers and chief medical information officers to join the effort.
Led by its executive director, Dean Sittig, Ph.D., a professor at the University of Texas School of Biomedical Informatics in Houston, the nonprofit Clinical Informatics Research Collaborative (Circle) is a network of applied clinical informatics researchers working on issues involved in the design, development, implementation, use and evaluation of health information technology, with an emphasis on EHRs. “We are interested in how we are going to make progress in EHR design in coming years,” Sittig said.
Besides Sittig, other founding members are:
• Allison McCoy, Ph.D., assistant professor of Biostatistics and Bioinformatics at the Tulane University School of Public Health and Tropical Medicine in New Orleans;
• Hardeep Singh, M.D., M.P.H., a general internist and patient safety researcher at the Center for Innovations in Quality, Effectiveness and Safety based at the Michael E. DeBakey Veterans Affairs Medical Center, and an associate professor at Baylor College of Medicine;
• Adam Wright, Ph.D., an associate professor of medicine at Brigham and Women’s Hospital and Harvard Medical School; and
• Aziz Sheikh, M.D., professor of Primary Care Research & Development and co-director of The University of Edinburgh’s Centre of Medical Informatics in Scotland.
I spoke recently with Professor Sittig about the goals for Circle just as the founders were getting ready to launch it officially. “We are working on what it means to be a member of Circle,” he said, adding that 25 members would be great, but he could see membership climbing up to 100.
He said that there are a lot of issues in clinical informatics that providers and researchers don’t have good evidence for. “When you hear a comment that it is too hard to enter an order in this particular system, people don’t even know what that means. So we try to do a study to determine how hard it is to enter an order. Can we come up with a standard task and then get 10 different places to do it?”
Sittig gave an example of a current project examining how different healthcare organizations and EHR vendors have implemented drug-drug interaction warnings. It involved getting demonstrations of 12 different systems to see how they are working. “Our research has taken us to many organizations and there a lot of different ways people do these things,” he said. “So we are interested in how we could learn from different organizations, because right now we don’t see much learning going on across EHR implementations. CMIOs have no real way to share.”
The fact that many leading academic medical centers are abandoning homegrown EHRs for commercial software makes it more difficult to do this type of research, he said. “There is certainly less written about experimentation with new features and functions,” Sittig said. “EHR vendors are developing this stuff, but they do it in isolation at Epic or Cerner. “In science, we have a comparison group. We don’t just say our system is great; we say it is better than some other system. EHR vendors don’t have a way of doing that. We are trying to figure out if some designs are better than others.”
For example, he said, a paper about clinical decision support (CDS) determined that in systems that were the easiest to use, there was a decision support platform, and everyone in the health system used that platform to build CDS items. Other vendors would hard-code the decision support right into the EHR, and when you wanted to build new functionality it was very difficult, he said.
The founding members also have researched how different systems are summarizing data and how they are graphing lab test results.
Sittig noted that the proposed federal Health IT Safety Center shares a lot of goals with Circle, including understanding how to share information across vendors. “But right now it doesn’t look like the federal government is going to fund the safety center,” he said.
It is possible the EHR vendors could fund Circle in the future, he added, “but I am not sure if they see us as a help or a hurt. We think it is necessary work.”