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A conversation about behavioral informatics for health

Today, the nation's top behavioral medicine, preventive medicine and medical informatics societies will gather at the National Press Club in Washington, DC to discuss behavioral informatics for health, the ever-changing consumer and professional health IT landscape and two newly released special journal issues dedicated to these topics. A webcast of the briefing can be viewed here beginning at 9:45 a.m. Pacific.

In this Q&A, I asked Randall S. Stafford, MD, PhD, who was involved in organizing the event, to share some details about the event and his previous research on electronic health records.

The event highlights the inaugural issue of Translational Behavioral Medicine: Practice, Policy and Research and a special supplement to the American Journal of Preventive Medicine. What insights can you offer about the specific topics that will be featured in these publications?

There will be discussion of two main uses of IT. The first is IT that impacts the practice of medicine through providing new tools to physicians. Although electronic health records (EHR) are the most prominent example, other technologies are increasingly important, such as smartphone applications. The second is consumer oriented IT applications used on a wide array of platforms (from computers to smartphones). Some of the most exciting developments are around tools that help people initiate and maintain healthy lifestyles around eating and physical activities. In addition, another important area concerns tools for better connecting patients and physicians. Many EHRs are beginning to focus on these interactions.

At the event, two expert panels will address efforts to speed the adoption and effective use of health IT to improve the quality of care and medical information available to consumers seeking to better navigate the health care system. What can you tell us about the types of issues and questions that will be discussed by panel members?

An important topic to be addressed is the potential for electronic health records (EHR), and other health IT, to improve quality of care. Studies in individual hospitals and clinics provide proof that this is possible, but many of these studies have taken place in very special hospitals and clinics. However, what works at one hospital may not be transferrable to your average clinical practice. While the federal government has committed billions of dollars to helping diffuse the adoption of EHRs, some researchers are skeptical about the evidence supporting this magnitude of expenditure.

The issue of patient confidentiality and data portability are also key issues. We need to figure out how to ensure confidentiality without slowing down innovation. One example is how to best share data between EHR systems.

There are also so many consumer applications that is becoming difficult to provide advice on how people should choose among them. As exciting as they are, many applications need to be tested more thoroughly.

How have you seen these issues play out in your research?

My own research has examined national data to look at whether use of EHR in outpatient care is associated with improved quality of care. Surprisingly, there was no relationship. The addition of specific EHR functions designed to provide guidance and advice to physicians (Clinical Decision Support) also had no impact on quality of care. This suggests that we should be cautious about assuming the EHR use will naturally lead to better care. It should also make us focus on all of the other factors that may affect quality of care. EHRs may be a necessary, but not sufficient, component of a comprehensive strategy to improve care that is of mediocre quality. We may need to focus on patient factors (health literacy, self-management of chronic conditions), physician factors (e.g., familiarity and use of clinical guidelines, comfort with Health IT), and organizational factors (e.g., access barriers, cultural competence).

Abby King, PhD, whose research has shown automated calls and specially-programmed smartphones can persuade individuals to exercise more, was also involved in organizing the event.

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