Three Decades of Research on Computer Applications in Health Care:

This review provides a historical perspective on AHRQ investment in medical informatics research. It shows that grants provided by AHRQ resulted in achievements that include advancing automation in the clinical laboratory and radiology, assisting in technology development (computer languages, software, and hardware), evaluating the effectiveness of computerbased medical information systems, facilitating the evolution of computer-aided decision making, promoting computer-initiated quality assurance programs, backing the formation and application of comprehensive data banks, enhancing the management of specific conditions such as HIV infection, and supporting health data coding and standards initiatives. Other federal agencies and private organizations have also supported research in medical informatics, some earlier and to a greater degree than AHRQ. The results and relative roles of these related efforts are beyond the scope of this review. ■ J Am Med Inform Assoc. 2002;9:144–160. J. MICHAEL FITZMAURICE, PHD, KAREN ADAMS, JOHN M. EISENBERG, MD Affiliations of the authors: Agency for Healthcare Research and Quality, Rockville, Maryland (JMF, JME); University of Maryland School of Medicine, Rockville, Maryland. The views expressed in this paper do not necessarily represent those of AHRQ or the U.S. Department of Health and Human Services Correspondence and reprints: J Michael Fitzmaurice, PhD, Agency for Healthcare Research and Quality, 2101 East Jefferson Street, Suite 600, Rockville, MD 20852; e-mail: <Mfitzmau@ahrq.gov>. Received for publication: 9/28/00; accepted for publication: 9/18/01. The focus of AHRQ’s early research funding in medical informatics was on acquiring patient care data and communicating patient care management information. The goal was not only to improve the quality of care, but also to achieve reductions in costs and medical personnel resource use by processing data more efficiently. Research aimed at improving communication of information was targeted at what we would call today “getting the right information to the right place at the right time. ” The promise of this research was its ability to provide findings that would guide reorganization of care delivery, take advantage of the more rapid communication of necessary information, and reduce manpower needs.1 Over time, AHRQ’s funding has emphasized the application of health services research methods to evaluations of information technology used in community health settings. This article highlights key accomplishments emerging from AHRQ’s funding that have improved the quality of patient care in studied sites and have the potential to improve health care in all settings. Other federal agencies (such as the National Library of Medicine, the Veterans Health Administration, and the Department of Defense) and private organizations (such as The John A. Hartford Foundation, The Robert Wood Johnson Foundation, and the American Hospital Association) have supported developments in medical informatics, with some having greater research expenditures and earlier histories than AHRQ. Nevertheless, it is the Agency’s contributions to medical informatics that are the focus of this study. The purpose of this article is to provide a historical perspective for understanding the benefits of past research funded by AHRQ that supports health care applications of information technology today and that foreshadows AHRQ’s medical informatics initiatives for the future.