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Caring for the Chronically Ill
July 1, 2008
Patients with chronic illnesses account for 75% of U.S. health care spending, and that percentage will grow as the population ages, according to an April report from the Dartmouth Institute for Health Policy and Clinical Practice
Within 15 years, 45% of the nation’s 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 children’s 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.
EHRs’ Role
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 EHR’s data through a vendor-supported user network.
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