Systems methodology, telemedicine and clinical decision support: their role in the management of chronic disease

Movement of health care delivery towards the primary care sector and the home setting can result in substantial benefits in terms of health outcome, social provision, cost effectiveness and resource utilisation. In order that the maximum benefit can be gained from such a distributed approach, however, it is necessary to ensure that there is a full and proper understanding of the roles of all those involved in health care delivery as well as making available the best possible support for clinical decision making. This is a classic situation where appropriate adoption of sound systems practice, coupled with the use of the advanced technologies of telemedicine and clinical decision support, can be applied to good effect. This paper highlights the need for adopting a sound systems methodology if information technology is to be applied to best effect in the management of chronic disease. This is true whether IT takes the form of local clinical decision support or a wider telemedicine configuration. Modelling activity is essential if designs are to be achieved that take full account of all the user requirements. Evaluation must form an integral part of the systems methodology, rather than being merely an additional post hoc activity after system implementation. These issues have been illustrated in the contexts of diabetes and the management of end-stage renal failure, though they have general applicability across the spectrum of chronic disease management and beyond.