Depending upon the scope of the implementation, it may be important for a project to have its own trained support staff rather than relying solely on vendor resources. This may assist organizational efficiency, while ensuring that patients get the information they need. Another project implemented an interactive voice response (IVR) system that patients can use in their homes. This is particularly true for applications developed for patient use, such as integrated voice response (IVR) and patient portals, which can become so complex that they discourage user adoption. Lesson 4: Securing user buy-in and trust is critical to the success of health IT implementations. Projects should research the availability and cost of vendor technical support. Another project is working with payors who are interested in exploring P4P initiatives by seeking to demonstrate how its quality dashboard for chronic diseases can help providers and payors to measure the quality of care provided to these patients. AHRQ grantees have incorporated the following technologies in their chronic disease management programs: Lesson 2: Significant investments of time and resources are required to configure both off-the-shelf vendor products and internally developed technologies to meet stakeholders' needs. Health information exchanges (HIE) allow organizations to share information across organizational boundaries. Telehealth applications that remotely connect providers and patients in co-management of chronic diseases. One project worked with its State government to develop a pilot project testing the capacity of EHR and clinical decision support systems to report key measures for their Medicaid population. One project set out to convene community stakeholders to form a regional health information exchange. A Case of Diagnostic Error: Delayed Diagnosis of Ebola Virus Infection. The lack of maturity in COTS solutions in this area led one grantee organization to adopt a system in the Beta stage of development. Disease management is defined as "a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant." The computer-generated feedback helps patients better understand what changes in their health status should prompt them to seek advice or treatment from their physician. Testing also revealed that many of the project's remote monitoring devices did not work properly. Several projects discovered and emphasized that testing is of critical importance. The greatest success has been found among programs that use a collaborative team-based approach to care management." Grantees considered their access to technical resources in deciding whether to develop solutions internally or customize vendor solutions. This site complies with the HONcode standard for trustworthy health information: verify here. The system can automatically generate letters to patients from clinics and the Medicaid system, and it can easily notify providers when their patients have been hospitalized for an issue related to their chronic illness. The IHI states that those three goals are: With an aggressive disease management strategy, each one is attainable. Wearable devices are also used for patient management and disease management. This information is transmitted to care managers and health-risk management professionals, who can then respond appropriately. Wearable technologies can be innovative solutions for healthcare problems. The hospital information system alerts the nurse educator when a chronically ill patient is admitted. To sign up for updates or to access your subscriber preferences, please enter your email address below. In late 2007, the first reports on cost control through disease management showed that costs were not being controlled. Standardized templates that have been created in a research environment or larger integrated delivery network could run the risk of being inadequate to secure clinician buy-in and adoption in other settings. Healthcare thought leaders have defined a term that helps break down a strategy to conquer these challenges. Use of multidisciplinary care teams and staff. "Complications can happen down the road and intervention may not pay dividends for years and years," Waitman says. A review of AHRQ-funded CDM projects yielded several preliminary findings about how to incorporate adoption of IT solutions into routine clinical practice. Consequently, few AHRQ grantees implemented COTS systems: only four of the thirteen AHRQ-funded CDM projects purchased COTS solutions. This brief highlights early observations from 13 of these projects that incorporate the use of health IT in their programs and focus on the following implementation considerations: More lessons from the AHRQ telehealth portfolio (PDF, 114 KB, HTML) . 2011). Sustainability of health IT efforts for chronic disease management. In the past, hospitals had disparate information systems that were clumsy in their ability to share and transfer patient records. Non-Clinical Assistants: An integrated delivery network uses non-clinical assistants to review incoming secure messages from patients and to forward them to the appropriate clinical staff for response. Many investigators spoke about the need for continued support for innovative uses of health IT for chronic care, and they advocated that these interventions can target the populations that are the sickest and the neediest and that consume the most health care resources. Cost: The cost varies by organization, but rarely is more than $50. To defeat the challenges faced by society in managing patient illness, many different types of technology and personnel are needed to make a measurable difference. In 2005, the pharmacy profession developed a consensus definition for MTM. For people who can access health care practitioners or peer support it is the process whereby persons with long-term conditions share knowledge, responsibility and care plans with healthcare practitioners … Thomas Eric … In this study, we conducted a literature review of wearable technology applications in healthcare. The U.S. National Library of Medicine recommends that routine screenings … Her medical chart suggests she has been admitted to the hospital multiple times over the span of a few years due to diabetic complications. The project team is now working with the State to implement their process statewide. Nurse Educator: One project sought to improve the project site's performance on CMS core measures for chronic heart failure (CHF) patients by providing IT-enabled patient education. They include public health, computer decision support for antibiotic prescribing, and delivery of up-to-date research results to the point of care. Although the volume of information was still large, it was more manageable and required less input from end users who were often very ill and/or possessed limited computer skills. Grantees recommend that organizations considering COTS systems balance a vendor's claims with the experiences of the vendor's other customers, and that organizations should build penalty clauses into vendor contracts. AHRQ grantees have incorporated the following technologies in their chronic disease management programs: Clinical decision support (CDS) systems help providers to interpret clinical results, document patients' health status, and prescribe medications through the use of alerts, reminders, and customized data entry forms. Another project discovered problems with its clinical decision support algorithm during a pilot test and returned to development to solve the problem. From provider to insurer, disease management technique matters. The Triple Aim was born out of necessity, but now all parties involved see that it not only consists of attainable goals, but that is it highly effective and offers many benefits. Option #1: Disease Management & Technology – Essay As the burden of chronic disease continues to escalate and the use of technology in healthcare becomes more pervasive, healthcare has begun to focus on how different types of technology can be used in chronic disease management programs. The information on this page is archived and provided for reference purposes only. EHRs integrated with laboratory and pharmacy information systems can supply import information to support EHR CDM functions. Financial constraints, a lack of data interoperability, insufficient talent and experience, and low levels of data integrity are among the most significant challenges for many providers. Lesson 5: For both patients and providers, usability and system design are key factors driving the adoption and use of health IT systems to improve CDM. As a result, each of the four grantees that adopted COTS systems needed to modify their systems to support their CDM requirements. What are some of the pros and cons of applying technology in disease managements programs? Facilitating collaboration for patients and providers. However, these systems also can be designed to engage other key members of the health care team in decision-making, such as nurses and case managers. For projects that have focused needs and access to technical resources, open source solutions may provide a cost-effective mechanism for implementing CDM solutions. This move towards chronic disease self-management is accompanied by a shift in focus on integra… Pilot testing with a subset of users enabled several projects to discover problematic issues related to workflow and system functionality. Archive material is no longer maintained, and some links may not work. The wearable … Technology can alert medical staff when a patient needs educational interventions. Several AHRQ-funded projects have achieved sustainability forchronic care initiatives by securing support from community organizations. AHRQ projects that utilized patient-centered applications discovered that it was important to keep the user interfaces and options as simple as possible. Healthcare costs that could be linked to obesity reached $147 billion in 2008. The same assistant can monitor when providers respond to ensure that patient questions are answered in a timely manner. The AHRQ-funded CDM projects are deploying health IT applications to non-physician personnel to assist in the management of patients with chronic diseases. Sally is given nutrition plans that she incorporates into her daily life and attends smoking cessation classes. Many of these organizations are implementing health information technology (health IT) to facilitate their chronic disease management programs. Population health management programs come with plenty of pain points. Pilot testing and post-implementation analysis can offer insights into usability and adoption from a small subset of individuals before undertaking a larger rollout. Through a telephone, the IVR provides health data to a central IT system and sends feedback to the patient based on decision support logic. Many observers have blamed the … Electronic health records (EHRs) with integrated decision support and chronic care management tools help providers manage patient information and monitor health outcomes for patients who are undergoing treatment for chronic diseases. Nurses can play a key role by helping to educate their patients, community, family, and friends on the benefits of routine screenings. None of the COTS technologies purchased by grantees were designed specifically for chronic care. In response, some health care organizations are instituting chronic disease management (CDM) programs to reduce the incidence of preventable hospitalizations and adverse events by more effectively and comprehensively managing the health of patients with chronic conditions. AHRQ-funded CDM projects faced a number of usability challenges. During testing of a template designed to capture pediatric obesity information, the small group of physicians involved reported that, although they loved the template, it was hard to find within the organization's electronic health record (EHR) system. Below are some examples of how projects plan to continue activities after the end of their AHRQ awards. As programs and technology evolve, disease management could become more effective and efficient at helping people with chronic conditions. Instead of purchasing a commercial solution, the project used available internal development resources to build an appropriate HIE infrastructure using open source software and information from the published literature. In this podcast, we discuss the role of technology in chronic disease management with Adam Kaufman, CEO of Canary Health. The CDC states that chronic diseases account for 7 out of 10 deaths every year. Her smoking habit and poor diet causes her blood sugar to skyrocket. A more comprehensive support agreement may be needed to ensure after-hours access. The pilot project demonstrated that the system was more efficient and timely in its reporting of CMS measures than the current State reporting process. This is where a tech-run chronic disease management model can help to meet the need. In addition, this project had limited access to technical staff in its geographic area. This term is often associated with self-care and includes an array of activities needed to effectively manage one or more chronic conditions. Health IT solutions need to be tailored for the end user to improve usability and avoid "information overload." Healthcare costs can be used towards Sally in the event of an emergency, necessary testing and regular provider appointments instead of Sally’s frequent readmissions. The Role of Information Technology in Disease Management: A Case for Heart Failure Teresa De Peralta, MSN, APN-C ... What programs will help deliver good ... disease management • Use of information systems to access key data on individuals and Lesson 1: Grantees are using a variety of health IT applications -- and combinations of applications -- to address different aspects of CDM. Regardless of which approach is taken, a significant investment of time and resources is required to configure IT systems to perform the functions desired by stakeholders. Disease Management Partnering with Technology, By clicking "Continue" or continuing to use our site, you acknowledge that you accept our, The MedCompass Approach: Comprehensive Care Management, AssureCare® Develops New Medication Therapy Management Module, Part 3, AssureCare® Develops New Medication Therapy Management Module, Part 2, AssureCare® Develops New Medication Therapy Management Module, Part 1, Who We Serve – Government Health and Human Services Organizations, Who We Serve – Specialty and Retail Pharmacy, Who We Serve – Auxiliary Settings of Care, Thank You for Signing up for our Newsletter, Reducing the per capita cost of healthcare. When a patient continues to be readmitted for the same issues, especially when those issues stem from a manageable illness or disease, insurers look for new and innovative ways to lower patient costs and improve health. “Technology connects patients to their disease processes,” she said. Medication Therapy Management (MTM) Services Medication therapy management, also referred to as MTM, is a term used to describe a broad range of health care services provided by pharmacists, the medication experts on the health care team. The Chronic Disease Self-Management Program is an interactive workshop for people with all … Instead of sending alerts and reminders to physicians, the CDS system sends the messages to nurse case managers who help sort through issues that are not an immediate priority, such as non-emergency alerts. Chronic Disease Self-Management Program. The Role of Case Management In Value-based Health Care | Page 2 The Evolution Towards Value-based Care In recent years, rising costs, the growing prevalence of chronic disease, and an aging population have strained the healthcare system. Clinical decision support (CDS) systems help providers to interpret clinical results, document patients' health status, and prescribe medications through the use of alerts, reminders, and customized data entry forms. Persons with disabilities having difficulty accessing this information should contact us at: Current Digital Healthcare Research Priorities, Health IT-Enabled Quality Measurement (2012-2013), Electronic Data Methods Forum (2010 - 2017), Ambulatory Safety and Quality Program (2007-2013), Health Information Security and Privacy Collaboration Toolkit, Impact Analysis of the Privacy and Security Solutions for Interoperable Health Information Exchange Project, Interim Assessment of Variation of Business Practices, Policies, and State Law, Outcomes from the Privacy and Security Solutions for Interoperable Health Information Exchange Project, State and Regional Demonstration Projects (2004-2011), Transforming Healthcare Quality through Health IT (2004-2010), AHRQ Digital Healthcare Research Publications Database, Consumer Health IT Human Factors Design Guide, Guide for Consumer Health IT Developers and Designers, Guide to Evaluating Health Information Exchange Projects, Health IT Evaluation Toolkit and Evaluation Measures Quick Reference Guides, Workflow Assessment for Health IT Toolkit, Implementation Toolsets for E-Prescribing, Children's Electronic Health Record (EHR) Format, Weight and Nutritional Counseling Template, United States Health Information Knowledgebase (USHIK), Trial of Decision Support to Improve Diabetes Outcomes, Improving Pediatric Safety and Quality with Health Care IT, Santa Cruz County Diabetes Mellitus Registry, Statewide Implementation of Electronic Health Records, Evaluating Smart Forms and Quality Dashboards in an EHR, The Chronic Care Technology Planning Project, New Mexico Health Information Collaborative, Showing Health Information Value in a Community Network, Home Heart Failure Care Comparing Patient-Driven Technology Models, Patient-Provider Electronic Messenger in Chronic Illness, Project ECHO Extension for Community Healthcare Outcomes, U.S. Department of Health & Human Services. The resources and expertise needed for implementing CDS systems should be carefully considered so that clinician and staff time is effectively utilized. With a disease management program powered by an actionable care management software solution, she is flagged as someone who can benefit from some additional care management. “We have a pilot with a Bluetooth glucometer that gives that patient immediate feedback and that information also goes electronically to a centralized location where a text message can come back to that patient,” she added. Grantees resourced customization efforts with both IT staff and clinicians, with one grantee dedicating 50 percent of a physician's time to the effort. As any student of health informatics knows, the movement toward electronic health records is a huge evolution in the medical field, and one that can facilitate countless advances in medical diagnostics and treatment. The AHRQ projects received limited-term funding, and thus needed to identify mechanisms for sustaining their health IT applications. Overall, both case management (CM) and disease management (DM) are vital to reduce healthcare costs by helping beneficiaries control their disease and prevent excessive utilization. She is a smoker who was diagnosed with diabetes a few years ago. Health IT opens up many more avenues of exploration and research, which allows experts to make healthcare more driven and effective than it has ever been. Grantees experienced discrepancies between COTS system vendor promises and delivery in both system functionality and delivery schedules. Upon working through the "kinks" of the initial implementation during a pilot, a project also must validate that the pilot group accurately represents the majority of end users on a project from technology-savvy individuals to those less familiar with computers. There are few commercial off-the-shelf (COTS) solutions that provide comprehensive functionality to support CDM programs. In this approach to healthcare, the more the patient becomes an equal partner in his or her own care team, the more efficiently and effectively programs are likely to run. An HIE project secured support from public health agencies, as better CDM provides value beyond a single organization. Telehealth also can be used to provide education directly to patients if providers choose to integrate this technology into their clinical workflow. Such systems enable all participating providers in a community to access patient information, thereby helping them to provide better patient care. In 2008, Medication Therapy Management Core Elements … Effective use of information technology is essential for identifying patients who should be entered into a disease management program. Some examples of the ways that the projects are using IT to educate patients and providers are described below. Case History. In deciding on the appropriate population for their care management programs, States can choose to include members diagnosed with specific chronic diseases, the most common being asthma, diabetes, congestive heart failure (CHF), coronary artery disease (CAD), and chronic obstructive pulmonary disorder (COPD). Several projects used an iterative design process to help eliminate major workflow and system issues before rolling their projects out to large groups of clinical staff. This information is for reference purposes only. The alert prompts her to attend bedside meetings with other members of the care team and to educate the patient directly about how to perform self-care after being discharged from the hospital. Due to the consistent rise of healthcare costs, patient count, and chronic disease diagnoses, we must face these issues head on with all three goals in mind. The project narrowed the list of medications to be included in the application to those most frequently prescribed. For pilot-testing, it is important to select a pilot group of enthusiastic and IT-ready end users who are willing to work through the early phases of implementation and provide valuable feedback. Providers and insurers alike strive to meet the ultimate goals of the Triple Aim, not only because they feel it fiscally necessary, but also because they have seen that it truly works. Specifically, the system identifies patients who miss appointments or have not had a hemoglobin A1-C (HbA1C) test in over a year, (HbA1C is a recommended marker for the effective management of diabetes over time). To defeat the challenges faced by society in managing patient illness, many different types of technology and personnel are needed to make a measurable difference. Lesson 3: Chronic disease management health IT applications may enable the re-distribution of patient management tasks to non-physician personnel. Effective and measurable disease management is an integral component of the care coordination toolbox and has quickly gained merit for its capabilities. Telephone: (301) 427-1364, Informing Improvement in Care Quality, Safety, and Efficiency. Because the cost of healthcare is skyrocketing, disease management is more important than ever. States also target other conditions, including high-risk obstetrics and, more recently, mental health and obesity. Alerts are then tailored to Sally, with real-time notifications of changes to her critical values. Some grantees are working with payors in their area to investigate opportunities for Health IT-based reimbursement policies and pay-for-performance (P4P) initiatives. By utilizing enhanced care team models within the payer environment, and coupling these models with care management software, patient lives improve and costs are reduced. It made this discovery after soliciting bids for a system to share clinical data relevant to chronically ill patients among community providers.