Within 15 years, 45% of the nations population will be elderly, according to a March 2008 report from the Center for Aging Services Technologies, a unit of the American Association of Homes and Services for the Aging in Washington.
Health care organizations, which already are dealing with a shortage of nurses and other clinicians, are devising new ways to use information technology to improve the treatment of chronic medical conditions, aid patients in taking a larger role in managing their conditions and help prevent the onset of chronic diseases. For example:
* Physicians at one Pennsylvania hospital are using electronic health records to target chronically ill patients for interventional treatment.
* An outsourcer of health and wellness services is implementing software to identify patients with chronic diseases or at risk of getting sick.
* An emerging health information exchange in Brooklyn will use the network and personal health records to help manage care of the chronically ill.
* A childrens hospital is using a television in patient rooms to educate patients and their parents on how to manage chronic diseases.
* An organ transplant program in Pennsylvania is speeding treatment for patients with life-threatening chronic conditions by outsourcing some of its records collections functions.
* Three nursing homes in New York are implementing wireless, hands-free communications devices to better coordinate and document care (see sidebar, page 26).
* Medicare and a state Medicaid program are testing technologies that provide daily interaction with cardiac patients in their homes, resulting in major drops in hospitalization rates (see story, page 53.)
Providers, however, must overcome formidable obstacles to increased use of I.T. to facilitate chronic care, says Majd Alwan, Ph.D., director at the Center for Aging Services Technologies.
For example, the slow pace of efforts to make health care software truly interoperable is limiting the ability of I.T. advocates in the chronic care field to demonstrate the value of the technology, Alwan contends.
We see some of the vendors at the table endorsing interoperability, but to get them to adopt standards and implement them is another issue, he says. We need providers to leverage their purchasing power to reward vendors.
And while providers must invest in the technologies, insurers reap most of the cost savings that result from improving the health of the chronically ill, he notes. That may start to change, however, if Medicare decides to give extra payments to providers using I.T. to keep the chronically ill out of the hospital (see story, page 53).
The potential financial benefits of using I.T. to reduce the costs of chronic care are huge. The use of in-home remote patient monitoring technologies alone could save $400 billion annually, according to a March 2008 report from the Deloitte Center for Health Solutions in New York.
The effective application of in-home technologies leads to increased medication adherence, reduced available post-acute complications, and improved self-care management of chronic conditions, the report states.
As electronic health records become more pervasive, physicians are beginning to leverage them to improve care of the chronically ill.
Physicians at Washington (Pa.) Hospital are capitalizing on a recent enhancement in a decade-old ambulatory records system and quarterly analysis of the EHRs data through a vendor-supported user network.
The 40 physicians, 24 of whom are residents, use Practice Partner EHR software from McKesson Corp., San Francisco. Recent software enhancement gave users easier access to important data on patients health status.
When a physician pulls up a patients chart, the first page displayed is a clinical summary. A green light at the bottom of the page indicates a time-sensitive clinical issue, such as preventive care that is overdue. When a physician clicks on the light, the pertinent information pops up, says Jeff Minteer, M.D., associate residency director.
Before the enhancements, physicians had to click through several pages to find this information.
Washington Hospital physicians are members of the Practice Partner Research Network, which offers a data analysis service from the Medical University of South Carolina in Charleston. On a quarterly basis, the hospital sends downloads of specific patient information, which the university analyzes and turns into reports covering about 80 issues across various conditions. In essence, the physicians are getting a quarterly look at HEDIS reports that assess the quality of care given. It is a graphical look at our performance in specific areas, Minteer says.
The reports support specific disease management programs, such as a diabetes project started in 2004. During the first quarter of 2008, 90% of diabetic patients had a hemoglobin A1C test within the past six months, compared with 58% in 2003. We peaked at 92%, so thats a fall-off were trying to address, Minteer notes.
The quarterly reports also have shown improvement in outcomes, but at a more gradual pace. Getting patients to watch their diet and take their medications is a much slower process, he adds.
To speed that process, the hospital hired a quality assurance nurse. The Medical University of South Carolina each quarter also sends spreadsheets of all procedures completed for every patient. The nurse can query the spreadsheets for specific information.
For instance, the nurse creates lists of female patients older than age 40 without a mammogram in the last two years and sends out requests to those patients to schedule an appointment.
Physicians at Washington Hospital meet with other members of the Practice Partner Research Network twice a year and participate in network research projects and blogs.
While some physicians are leveraging electronic records systems to boost preventive medicine for the chronically ill, some case management firms also are ramping up their prevention efforts.