Integrated Electronic Medical Records & Chronic Disease Management Systems

Interest in Electronic Medical Records (EMR) has surged in recent few years. This has been fueled by new healthcare industry regulations and generous grants from the government.  Studies show that providers who expect to see quality improvements from deploying EMR systems alone will be disappointed.

In a 2007 study published in Archives of Internal Medicine, Jeffery Linder, et al, found that use of EMR solution made no difference in performance outcomes, measured using 17 ambulatory quality measures.  Although the technology showed an immediate and direct impact on safety related concerns in an inpatient setting, EMRs were not associated with healthcare quality improvements in outpatient setting.

I believe, to improve quality of chronic care, reduce costs and raising provider productivity the EMR systems need to be integrated with Chronic Disease Management Systems (CDMS) or Disease Registries or Clinical Information Systems (CIS).  EMRs are primarily built to support the documentation of care, and CDMS solutions are built to support improvement of care.

Data collected by EMR systems cannot be very easily used to perform patient population and sub-population analysis and reporting. This analysis is critical for active chronic care management.  Although, EMR vendors are often able to provide custom programming assistance to address these requirements, the changes to the software are expensive and slow.

An integrated EMR & CDM system enables implementation of best practice chronic care management solutions.  The integrated system provides all the essential information about patient’s chronic care and prevention plan. The integrated system utilizes evidence based guidelines and protocols to support in active chronic care management. The integrated system has the ability to capture patient vitals and key indicators in an outpatient setting and trigger appropriate alerts to care team for follow-up care related activities. The integrated system also enables reporting at population level for improvements in delivering chronic care services.

Advantages of having integrated EMR-CDM systems include:

  • Measurable cost savings due to active preventive care management that reduces cost burden across the different healthcare system components (payors and providers)
  • Reduction of frequent visits of patients to clinic and its facilities
  • Reduction in Healthcare aides/Nurses visiting patients to collect patient vital signs records
  • Elimination of paper record keeping and improved workflow automation
  • Lighten the burden on Nurses
  • Effective chronic care management with emphasis on prevention techniques to contain disease escalation
  • Effective/Efficient & Secure collaboration platform for care providers/payor groups to improve quality of care and contain costs
  • Improvement in quality of care due to automatic monitoring of patient vital signs 
  • A reporting platform that enables healthcare policy makers and organization leaders to monitor and improve quality of care while controlling costs

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Active Management of Chronic Care

From my perspective for us to be effective and efficient in utilization of our healthcare resources, we have to engage in active management of chronic care using Healthcare-Information Technology (HIT) solutions.

I provide below key data points to support my view.

Macro Level:

  • Healthcare spend currently is 19% of GDP and with an aging population is expected to climb to 24% by 2015.
  • 70% of healthcare spend is on Chronic disease management.
  • Individual life expectancy continues to increase and currently is estimated to be 79 years for US

Chronic Care:

  • Chronic diseases such as heart disease, cancer, and diabetes are leading causes of disability and death in the United States.
  • More than 133 million Americans or 45% of population have one or more Chronic disease
  • These diseases account for more than 70% of the $1 trillion spent on health care each year in the United States.
  • Every year, chronic diseases claim the lives of more than 1.7 million Americans. These diseases are responsible for 7 of every 10 deaths in the United States.
  • Chronic diseases cause major limitations in daily living for more than 1 of every 10 Americans, or 25 million people.

Healthcare information Technology Industry Trends:  

  • Healthcare Payors & Providers are willing to adopt Information Technology solutions to improve quality of care and contain costs.
  • Maturing Healthcare Technology standards enabling interoperability and increasing adoption of solutions.
  • Supportive government policies to increase adoption of Information technology solutions. For example, subsidized funding to implement technology solutions.
  • A major portion of the information technology components are already implemented in other sectors. For example, alerts are common place in financial industry.
  • Mobile devices are transforming the way we interact with each other and I believe we can use these devices to revolutionize delivery of chronic care services.
  • Wireless technology has matured and can reliably ensure secure delivery of sensitive data for processing.

 In my subsequent posts, I will be presenting how HIT solutions can be used to transform delivery of active chronic care management solutions.

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