Information Technology to Support Improved Care For Chronic Illness

BackgroundIn populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as electronic medical records, to varying degrees. However, considerable uncertainty remains regarding the relative impact of specific informatics technologies on chronic illness care.ObjectiveTo summarize knowledge and increase expert consensus regarding informatics components that support improvement in chronic illness care. Design: A systematic review of the literature was performed. “Use case” models were then developed, based on the literature review, and guidance from clinicians and national quality improvement projects. A national expert panel process was conducted to increase consensus regarding information system components that can be used to improve chronic illness care.ResultsThe expert panel agreed that informatics should be patient-centered, focused on improving outcomes, and provide support for illness self-management. They concurred that outcomes should be routinely assessed, provided to clinicians during the clinical encounter, and used for population-based care management. It was recommended that interactive, sequential, disorder-specific treatment pathways be implemented to quickly provide clinicians with patient clinical status, treatment history, and decision support.ConclusionsSpecific informatics strategies have the potential to improve care for chronic illness. Software to implement these strategies should be developed, and rigorously evaluated within the context of organizational efforts to improve care.

[1]  D. Gans,et al.  Medical groups' adoption of electronic health records and information systems. , 2005, Health affairs.

[2]  Robin C. Meili,et al.  Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. , 2005, Health affairs.

[3]  Brian T. Austin,et al.  Organizing care for patients with chronic illness. , 1996, The Milbank quarterly.

[4]  Bradley N. Doebbeling,et al.  Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice , 2006, Journal of General Internal Medicine.

[5]  Sarah Krein,et al.  Advancing evidence-based care for diabetes: lessons from the Veterans Health Administration. , 2007, Health affairs.

[6]  Thomas Bodenheimer,et al.  Interventions to improve chronic illness care: evaluating their effectiveness. , 2003, Disease management : DM.

[7]  Candice Bowman,et al.  The role of formative evaluation in implementation research and the QUERI experience , 2006, Journal of General Internal Medicine.

[8]  M. Legro,et al.  Lessons learned about implementing research evidence into clinical practice , 2006, Journal of General Internal Medicine.

[9]  Rusty Andrus.  Integrating A Clinical System , 1997 .

[10]  A. Young,et al.  Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness , 2000, The Journal of Behavioral Health Services & Research.

[11]  E. Balas,et al.  Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success , 2005, BMJ : British Medical Journal.

[12]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness: the chronic care model, Part 2. , 2002, JAMA.

[13]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[14]  E H Wagner,et al.  Chronic disease management: what will it take to improve care for chronic illness? , 1998, Effective clinical practice : ECP.

[15]  Geoffrey M. Curran,et al.  Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI. , 2006 .

[16]  Janet M. Corrigan,et al.  Key Capabilities of an Electronic Health Record System: Letter Report , 2004 .

[17]  N. Tarrier,et al.  Illness management and recovery: a review of the research. , 2002, Psychiatric services.

[18]  Kurt Bittner,et al.  Use Case Modeling , 2002 .

[19]  Amy N. Cohen,et al.  Review paper: Informatics Systems to Promote Improved Care for Chronic Illness: A Literature Review , 2007, J. Am. Medical Informatics Assoc..

[20]  Bradley N. Doebbeling,et al.  Research Paper: VA QUERI Informatics Paper Information Technology for Clinical Guideline Implementation: Perceptions of Multidisciplinary Stakeholders , 2004, J. Am. Medical Informatics Assoc..

[21]  P. Basch.  Quality of health care delivered to adults in the United States. , 2003, New England Journal of Medicine.

[22]  J. Grossman,et al.  Building a Better Delivery System: A New Engineering/Health Care Partnership , 2005 .

[23]  Judith V. Douglas,et al.  Computerized Large Integrated Health Networks: The VA Sucess , 1997 .

[24]  A. Bower.  The Diffusion and Value of Healthcare Information Technology , 2005 .

[25]  M. Ward,et al.  Classifying the Effectiveness of Veterans Affairs Guideline Implementation Approaches , 2004, American journal of medical quality : the official journal of the American College of Medical Quality.

[26]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness. , 2002, JAMA.

[27]  C. Burt,et al.  Which physicians and practices are using electronic medical records? , 2005, Health affairs.

[28]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[29]  Amy N. Cohen,et al.  Using information systems to improve care for persons with schizophrenia. , 2004, Psychiatric services.

[30]  J. Perlin,et al.  The Veterans Health Administration : Quality , Value , Accountability , and Information as Transforming Strategies for Patient-Centered Care , 2004 .

[31]  P. Shekelle,et al.  Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample , 2004, Annals of Internal Medicine.

[32]  C. Sherbourne,et al.  The quality of care for depressive and anxiety disorders in the United States. , 2001, Archives of general psychiatry.

[33]  B. Burnand,et al.  The RAND/UCLA Appropriateness Method User's Manual , 2001 .

[34]  Mordechai Ben-Menachem,et al.  Writing effective use cases , 2001, SOEN.

[35]  A. Lehman.  Quality of care in mental health: the case of schizophrenia. , 1999, Health affairs.