Effective use of information technology is essential for identifying patients who should be entered into a disease management program. … This information is for reference purposes only. 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. AHRQ-funded CDM projects faced a number of usability challenges. A personalized care plan is then developed based upon what the case manager uncovers during her interaction with Sally, enabling the case manager to create a custom treatment plan based on Sally’s history, assessments and medications. Below are some examples of how projects plan to continue activities after the end of their AHRQ awards. A Case of Diagnostic Error: Delayed Diagnosis of Ebola Virus Infection. Chronic Disease Self-Management Program. Health IT adoption and change management. The AHRQ projects received limited-term funding, and thus needed to identify mechanisms for sustaining their health IT applications. The educator then scheduled time to work with the patient's care team and to educate the patient directly about self-management. “Technology connects patients to their disease processes,” she said. More features and equipment do not always translate to better care. One project worked with physicians, the provider organizations, and local payors to reach agreement on the reimbursement process for physicians' use of secure messaging. Another project discovered problems with its clinical decision support algorithm during a pilot test and returned to development to solve the problem. 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 hospital information system alerts the nurse educator when a chronically ill patient is admitted. Health information exchanges (HIE) allow organizations to share information across organizational boundaries. AHRQ projects that utilized patient-centered applications discovered that it was important to keep the user interfaces and options as simple as possible. 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 Community relationships take time to build, and they require energy to sustain. 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. One grantee had initially planned to develop a custom solution but then determined that the amount of resources required to develop and maintain the product exceeded the cost of purchasing a vendor solution. Similar issues are faced by insurers, with slightly different goals in mind. The CDC released how much chronic diseases cost and the numbers are astonishing. 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. The committee on professional development of AHIMA states that health information management (HIM) professionals are responsible for improving “the quality of healthcare by insuring that the best information is available for making any healthcare decision” by managing healthcare data and information resources.12 The professionals can be in charge of the services in “planning, collecting, aggregating, analyzing, and disseminating individual patient and aggregate clinical data.”13In summary… 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. 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. Through a telephone, the IVR provides health data to a central IT system and sends feedback to the patient based on decision support logic. Format: This course is offered as an in-person workshop. Telehealth also can be used to provide education directly to patients if providers choose to integrate this technology into their clinical workflow. The lack of maturity in COTS solutions in this area led one grantee organization to adopt a system in the Beta stage of development. 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. Types of health IT applications used in CDM programs. 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. Another project implemented an interactive voice response (IVR) system that patients can use in their homes. 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. In this model, affected individuals are expected to comply with physician-ordered regimens for care, such as the taking of daily medications (Gellad et al. Better Choices, Better Health® Better Choices, Better Health® (Online CDSMP, Asynchronous) is an on-line interactive version of the Chronic Disease Self-Management Program (CDSMP). Aligning health IT projects with stakeholders' priorities is also crucial to their success. Grantees experienced discrepancies between COTS system vendor promises and delivery in both system functionality and delivery schedules. Testing also revealed that many of the project's remote monitoring devices did not work properly. “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. Rockville, MD 20857 Of all health IT applications used by the AHRQ-funded CDM projects, clinical decision support systems required the highest degree of customization. Physicians also can interact with other primary care physicians and specialists at the closest academic medical center to discuss complex cases. 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The project narrowed the list of medications to be included in the application to those most frequently prescribed. Treatment of patients with chronic diseases account for about 86% of America’s healthcare costs. The same project partnered with school nurses to support asthma treatment for children and received funding from the CDC to do additional research on this chronic condition. Such systems enable all participating providers in a community to access patient information, thereby helping them to provide better patient care. Nurses can play a key role by helping to educate their patients, community, family, and friends on the benefits of routine screenings. A more comprehensive support agreement may be needed to ensure after-hours access. This move towards chronic disease self-management is accompanied by a shift in focus on integra… Because the cost of healthcare is skyrocketing, disease management is more important than ever. Investigators worked closely with the EHR system staff to better integrate access to the template into existing patterns of EHR use. This term is often associated with self-care and includes an array of activities needed to effectively manage one or more chronic conditions. Short-term health IT solutions may be put in place to fill a need while long-range system design plans are under development. 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. Canary Health is a leading digital health self-management platform that has demonstrated success in helping people achieve improved health while lowering healthcare costs. 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. Chronic diseases--such as heart disease, cancer, and diabetes--are placing a growing burden on the U.S. health care system. One project faced a huge task of incorporating information on thousands of medications into its patient-focused application. 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. States also target other conditions, including high-risk obstetrics and, more recently, mental health and obesity. Aligning HEDIS (Healthcare Effectiveness Data and Information Set) and CMS measures with health IT projects allowed several grants to demonstrate that health IT systems can impact these measures to improve health care quality. Archive material is no longer maintained, and some links may not work. 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. Facilitating collaboration for patients and providers. 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. From provider to insurer, disease management technique matters. They include public health, computer decision support for antibiotic prescribing, and delivery of up-to-date research results to the point of care. This failure to achieve the primary goal of instituting these programs was alarming. As programs and technology evolve, disease management could become more effective and efficient at helping people with chronic conditions. Health systems around the world are under increasing strain because of the rising prevalence of chronic conditions, including diabetes, heart disease, and asthma. encourage and support the goals of disease management. Telehealth applications that remotely connect providers and patients in co-management of chronic diseases. Wearable technologies can be innovative solutions for healthcare problems. Sally is then assigned to a case manager who contacts Sally to learn more about her lifestyle habits. The U.S. National Library of Medicine recommends that routine screenings … Effective and measurable disease management is an integral component of the care coordination toolbox and has quickly gained merit for its capabilities. The project team is now working with the State to implement their process statewide. Grantees resourced customization efforts with both IT staff and clinicians, with one grantee dedicating 50 percent of a physician's time to the effort. Sustainability of health IT efforts for chronic disease management. Her medical chart suggests she has been admitted to the hospital multiple times over the span of a few years due to diabetic complications. Patients at the project's renal practice took on average 11 different medications. 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. An initial question that every health organization must answer in implementing projects for emerging areas of health IT-enabled care is whether to buy a commercially available product or build a customized application. It was current when produced and may now be outdated. The hospital created a new staff position, a full-time nurse educator, to help coordinate care and educate patients with CHF and other conditions about self-management. 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. An HIE project secured support from public health agencies, as better CDM provides value beyond a single organization. In late 2007, the first reports on cost control through disease management showed that costs were not being controlled. The wearable … The IHI states that those three goals are: With an aggressive disease management strategy, each one is attainable. Summary: Objective: In order to alleviate the pressure on health care systems exerted by the growing prevalence of chronic diseases, information and communication technologies (ICT) are being introduced to enable self-management of chronic diseases by supporting partnerships between patients and health care professionals. What are some of the pros and cons of applying technology in disease managements programs? Pilot testing and post-implementation analysis can offer insights into usability and adoption from a small subset of individuals before undertaking a larger rollout. Some projects are planning to complete implementation, transitioning into an operations and maintenance mode. Disease Management is an enormous task for payers and providers. Chronic disease management requires individuals to be knowledgeable about the trajectory of their disease so that the patient and family members are able to identify abnormal symptoms. One project set out to convene community stakeholders to form a regional health information exchange. Many payors are interested in innovative approaches to chronic disease care because of its impact on health care costs. Projects should research the availability and cost of vendor technical support. Case Manager: Another project uses case managers, employed by the State's Medicaid office, to triage CDS alerts for some patients. Many of these organizations are implementing health information technology (health IT) to facilitate their chronic disease management programs. For projects that have focused needs and access to technical resources, open source solutions may provide a cost-effective mechanism for implementing CDM solutions. 1 Self-management support and education is defined as assistance provided by clinicians and public health practitioners to enhance an individual’s self … 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. Technology can alert medical staff when a patient needs educational interventions. The CDC states that chronic diseases account for 7 out of 10 deaths every year. There are few commercial off-the-shelf (COTS) solutions that provide comprehensive functionality to support CDM programs. As 77 percent of all U.S. adults own smartphones and around half own tablet computers, “mobile technology has the potential to make a huge impact on the management of chronic disease… Cost: The cost varies by organization, but rarely is more than $50. 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. Consequently, few AHRQ grantees implemented COTS systems: only four of the thirteen AHRQ-funded CDM projects purchased COTS solutions. Another project learned that, to be successful, it is important to engage clinicians who are directly involved in the delivery of patient care in the development of practical electronic templates. Alerts are then tailored to Sally, with real-time notifications of changes to her critical values. The information on this page is archived and provided for reference purposes only. 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. 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. 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. About the Program. A comprehensive disease management program in which an individual sees many members of a team can pay off in the long run, says Jonathan Waitman, MD, of NewYork-Presbyterian/Weill Cornell Medical Center in New York City. Many health IT solutions for chronic disease management are intended primarily for physician use. In this podcast, we discuss the role of technology in chronic disease management with Adam Kaufman, CEO of Canary Health. 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. Disease Management is an enormous task for payers and providers. This site complies with the HONcode standard for trustworthy health information: verify here. Many of the examples below illustrate issues grantees faced when working with off-the-shelf solutions to implement their chronic disease management programs. The same assistant can monitor when providers respond to ensure that patient questions are answered in a timely manner. This is where a tech-run chronic disease management model can help to meet the need. The resources and expertise needed for implementing CDS systems should be carefully considered so that clinician and staff time is effectively utilized. As a result, each of the four grantees that adopted COTS systems needed to modify their systems to support their CDM requirements. None of the COTS technologies purchased by grantees were designed specifically for chronic care. 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. Explore these proven chronic disease self-management education programs. One grantee found that the costs and capabilities for the standard technology components for an HIE exceeded the project's scope and budget. 5600 Fishers Lane 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. 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. However, integration of one innovative project has led to possible expansion statewide to provide greater quality to a larger population. 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. It made this discovery after soliciting bids for a system to share clinical data relevant to chronically ill patients among community providers. Her smoking habit and poor diet causes her blood sugar to skyrocket. Grantees considered their access to technical resources in deciding whether to develop solutions internally or customize vendor solutions. 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. Some grantees are working with payors in their area to investigate opportunities for Health IT-based reimbursement policies and pay-for-performance (P4P) initiatives. The AHRQ -funded projects listed below are measuring the impact of health IT on health care quality, safety, and efficiency in managing patients with chronic disease. Healthcare thought leaders have defined a term that helps break down a strategy to conquer these challenges. 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. With the advent of EHRs, many systems have been connected, allowing for fast… In the past, hospitals had disparate information systems that were clumsy in their ability to share and transfer patient records. Lesson 7: To obtain additional funding from health care executives, payors, or through grants, health IT projects will need to demonstrate return on investment or alignment with potential funders' strategic goals. 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). Two projects learned through initial testing that the first versions of their health IT systems did not integrate well into clinical workflow. The AHRQ-funded CDM projects are deploying health IT applications to non-physician personnel to assist in the management of patients with chronic diseases. Case History. One project employed a clinical decision support system to notify a nurse educator when a chronically ill patient was admitted to the hospital. Sally is given nutrition plans that she incorporates into her daily life and attends smoking cessation classes. A review of AHRQ-funded CDM projects yielded several preliminary findings about how to incorporate adoption of IT solutions into routine clinical practice. The AHRQ CDM projects have used health IT to help both providers and patients access up-to-date information concerning clinical practice, medications, and treatment options. 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.