Skip to main content
Top
Published in: Journal of General Internal Medicine 3/2007

Open Access 01-12-2007 | Original Article

Information Technology to Support Improved Care For Chronic Illness

Authors: Alexander S. Young, MD, MSHS, Edmund Chaney, PhD, Rebecca Shoai, MPH, MSW, Laura Bonner, PhD, Amy N. Cohen, PhD, Brad Doebbeling, MD, David Dorr, MD, Mary K. Goldstein, MD, Eve Kerr, MD, MPH, Paul Nichol, MD, Ruth Perrin, MA

Published in: Journal of General Internal Medicine | Special Issue 3/2007

Login to get access

Abstract

Background

In 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.

Objective

To 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.

Results

The 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.

Conclusions

Specific 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.
Appendix
Available only for authorised users
Literature
2.
go back to reference Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141(12):938–45.PubMed Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141(12):938–45.PubMed
3.
go back to reference Lehman AF. Quality of care in mental health: the case of schizophrenia. Health Aff (Millwood, Va). 1999;18(5):52–65.CrossRef Lehman AF. Quality of care in mental health: the case of schizophrenia. Health Aff (Millwood, Va). 1999;18(5):52–65.CrossRef
4.
go back to reference McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.PubMedCrossRef McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.PubMedCrossRef
5.
go back to reference Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288(14):1775–9.PubMedCrossRef Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288(14):1775–9.PubMedCrossRef
6.
go back to reference Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1(1):2–4.PubMed Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1(1):2–4.PubMed
7.
go back to reference Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA 2002;288(15):1909–14.PubMedCrossRef Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA 2002;288(15):1909–14.PubMedCrossRef
8.
go back to reference Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.PubMedCrossRef Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.PubMedCrossRef
9.
go back to reference Bodenheimer T. Interventions to improve chronic illness care: evaluating their effectiveness. Dis Manag. 2003;6(2):63–71.PubMedCrossRef Bodenheimer T. Interventions to improve chronic illness care: evaluating their effectiveness. Dis Manag. 2003;6(2):63–71.PubMedCrossRef
10.
go back to reference Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58(1):55–61.PubMedCrossRef Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58(1):55–61.PubMedCrossRef
11.
go back to reference Doebbeling BN, Chou AF, Tierney WM. Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice. J Gen Intern Med. 2006;21(suppl 2):S50–7.PubMed Doebbeling BN, Chou AF, Tierney WM. Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice. J Gen Intern Med. 2006;21(suppl 2):S50–7.PubMed
12.
go back to reference Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
13.
go back to reference Reid P, Compton W, Grossman J, Fanjiang G, eds. Building a better delivery system: a new engineering/health care partnership. Washington, DC: National Academies Press; 2005. Reid P, Compton W, Grossman J, Fanjiang G, eds. Building a better delivery system: a new engineering/health care partnership. Washington, DC: National Academies Press; 2005.
14.
go back to reference Hillestad R, Bigelow J, Bower A, et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood, Va). 2005;24(5):1103–17.CrossRef Hillestad R, Bigelow J, Bower A, et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood, Va). 2005;24(5):1103–17.CrossRef
15.
go back to reference Bower AG. The Diffusion and Value of Healthcare Information Technology. Santa Monica: RAND; 2005 (report no. M6-272-HLTH) Bower AG. The Diffusion and Value of Healthcare Information Technology. Santa Monica: RAND; 2005 (report no. M6-272-HLTH)
16.
go back to reference Burt CW, Sisk JE. Which physicians and practices are using electronic medical records? Health Aff (Millwood, Va). 2005;24(5):1334–43.CrossRef Burt CW, Sisk JE. Which physicians and practices are using electronic medical records? Health Aff (Millwood, Va). 2005;24(5):1334–43.CrossRef
17.
go back to reference Gans D, Kralewski J, Hammons T, Dowd B. Medical groups’ adoption of electronic health records and information systems. Health Aff (Millwood, Va). 2005;24(5):1323–33.CrossRef Gans D, Kralewski J, Hammons T, Dowd B. Medical groups’ adoption of electronic health records and information systems. Health Aff (Millwood, Va). 2005;24(5):1323–33.CrossRef
18.
go back to reference Perlin JB, Kolodner RM, Roswell RH. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Manag Care. 2004;10(11 Pt 2):828–36.PubMed Perlin JB, Kolodner RM, Roswell RH. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Manag Care. 2004;10(11 Pt 2):828–36.PubMed
19.
go back to reference Dorr D, Bonner LM, Cohen AN, et al. Informatics systems to promote improved care for chronic illness: a literature review. J Am Med Inform Assoc. 2007;14(2):156–63.PubMedCrossRef Dorr D, Bonner LM, Cohen AN, et al. Informatics systems to promote improved care for chronic illness: a literature review. J Am Med Inform Assoc. 2007;14(2):156–63.PubMedCrossRef
20.
go back to reference Andrus RW. Integrating a clinical system. In: Kolodner R, ed. Computerizing Large Integrated Health Networks: The VA Success. Berlin Heidelberg New York: Springer; 1997. Andrus RW. Integrating a clinical system. In: Kolodner R, ed. Computerizing Large Integrated Health Networks: The VA Success. Berlin Heidelberg New York: Springer; 1997.
21.
go back to reference Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144(10):742–52.PubMed Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144(10):742–52.PubMed
22.
go back to reference Institute of Medicine. Key Capabilities of an Electronic Health Record System. Washington, DC: National Academies Press; 2003. Institute of Medicine. Key Capabilities of an Electronic Health Record System. Washington, DC: National Academies Press; 2003.
24.
go back to reference Lyons SS, Tripp-Reimer T, Sorofman BA, et al. VA QUERI informatics paper: information technology for clinical guideline implementation: perceptions of multidisciplinary stakeholders. J Am Med Inform Assoc. 2005;12(1):64–71.PubMedCrossRef Lyons SS, Tripp-Reimer T, Sorofman BA, et al. VA QUERI informatics paper: information technology for clinical guideline implementation: perceptions of multidisciplinary stakeholders. J Am Med Inform Assoc. 2005;12(1):64–71.PubMedCrossRef
25.
go back to reference Bernstein SJ. VA health services research: lessons for the world’s healthcare organizations. Am J Manag Care 2004;10(11 Pt 2):825–7.PubMed Bernstein SJ. VA health services research: lessons for the world’s healthcare organizations. Am J Manag Care 2004;10(11 Pt 2):825–7.PubMed
26.
go back to reference Kupersmith J, Francis J, Kerr E, et al. Advancing evidence-based care for diabetes: lessons from the Veterans Health Administration. Health Aff (Millwood, Va). 2007;26(2):w156–68.CrossRef Kupersmith J, Francis J, Kerr E, et al. Advancing evidence-based care for diabetes: lessons from the Veterans Health Administration. Health Aff (Millwood, Va). 2007;26(2):w156–68.CrossRef
27.
go back to reference Hagedorn H, Hogan M, Smith JL, et al. Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI. J Gen Intern Med. 2006;21(suppl 2):S21–4.PubMed Hagedorn H, Hogan M, Smith JL, et al. Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI. J Gen Intern Med. 2006;21(suppl 2):S21–4.PubMed
28.
go back to reference Young AS, Forquer SL, Tran A, Starzynski M, Shatkin J. Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness. J Behav Health Serv Res. 2000;27(3):321–33.PubMedCrossRef Young AS, Forquer SL, Tran A, Starzynski M, Shatkin J. Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness. J Behav Health Serv Res. 2000;27(3):321–33.PubMedCrossRef
29.
go back to reference Fitch K, Bernstein S, Aguilar MD, et al. RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, Calif: RAND; 2001. Fitch K, Bernstein S, Aguilar MD, et al. RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, Calif: RAND; 2001.
30.
go back to reference Cockburn A. Writing Effective Use Cases. New York: Addison-Wesley; 2001. Cockburn A. Writing Effective Use Cases. New York: Addison-Wesley; 2001.
31.
go back to reference Bittner K, Spence I. Use Case Modeling. New York: Addison-Wesley; 2003. Bittner K, Spence I. Use Case Modeling. New York: Addison-Wesley; 2003.
32.
go back to reference Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330(7494):765.PubMedCrossRef Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330(7494):765.PubMedCrossRef
34.
go back to reference Mueser KT, Corrigan PW, Hilton DW, et al. Illness management and recovery: a review of the research. Psychiatr Serv. 2002;53(10):1272–84.PubMedCrossRef Mueser KT, Corrigan PW, Hilton DW, et al. Illness management and recovery: a review of the research. Psychiatr Serv. 2002;53(10):1272–84.PubMedCrossRef
35.
go back to reference Young AS, Mintz J, Cohen AN. Using information systems to improve care for persons with schizophrenia. Psychiatr Serv. 2004;55(3):253–5.PubMedCrossRef Young AS, Mintz J, Cohen AN. Using information systems to improve care for persons with schizophrenia. Psychiatr Serv. 2004;55(3):253–5.PubMedCrossRef
36.
go back to reference Goldstein MK, Hoffman BB. Graphical displays to improve guideline-based therapy of hypertension. In: Izzo J, Black H, eds. Hypertension Primer. Baltimore: Williams & Wilkins; 2003. Goldstein MK, Hoffman BB. Graphical displays to improve guideline-based therapy of hypertension. In: Izzo J, Black H, eds. Hypertension Primer. Baltimore: Williams & Wilkins; 2003.
37.
go back to reference BootsMiller BJ, Yankey JW, Flach SD, et al. Classifying the effectiveness of Veterans Affairs guideline implementation approaches. Am J Med Qual. 2004;19(6):248–54.PubMedCrossRef BootsMiller BJ, Yankey JW, Flach SD, et al. Classifying the effectiveness of Veterans Affairs guideline implementation approaches. Am J Med Qual. 2004;19(6):248–54.PubMedCrossRef
38.
go back to reference Bates DW, Kuperman GJ, Wang S, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10(6):523–30.PubMedCrossRef Bates DW, Kuperman GJ, Wang S, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10(6):523–30.PubMedCrossRef
39.
go back to reference Stetler CB, Legro MW, Wallace CM, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21(suppl 2):S1–8.PubMedCrossRef Stetler CB, Legro MW, Wallace CM, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21(suppl 2):S1–8.PubMedCrossRef
Metadata
Title
Information Technology to Support Improved Care For Chronic Illness
Authors
Alexander S. Young, MD, MSHS
Edmund Chaney, PhD
Rebecca Shoai, MPH, MSW
Laura Bonner, PhD
Amy N. Cohen, PhD
Brad Doebbeling, MD
David Dorr, MD
Mary K. Goldstein, MD
Eve Kerr, MD, MPH
Paul Nichol, MD
Ruth Perrin, MA
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue Special Issue 3/2007
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-007-0303-4

Other articles of this Special Issue 3/2007

Journal of General Internal Medicine 3/2007 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.