Difference between revisions of "Implementing Health Information Technology to Improve the Process of Health Care Delivery: A Case Study"

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(Article Review)
(Article Review)
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'''Results of Provider Satisfaction Survey:'''
 
'''Results of Provider Satisfaction Survey:'''
  
67% “strongly agreed or agreed” with the 2 systems’ positive impact on care management. Specifically, 69.6% “strongly agreed or agreed” the service improved the self-care behaviors of patients; 71.8% “strongly agreed or agreed” the system resulted in timely and appropriate and communication; 60.8% “strongly agreed or agreed” the service improved practice efficiency and clinical outcomes; 67.4% “strongly agreed or agreed” the service is helpful in managing patients.  
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67% “strongly agreed or agreed” with the 2 systems’ positive impact on care management. Specifically, 69.6% “strongly agreed or agreed” the service improved the self-care behaviors of patients; 71.8% “strongly agreed or agreed” the system resulted in timely and appropriate communication; 60.8% “strongly agreed or agreed” the service improved practice efficiency and clinical outcomes; 67.4% “strongly agreed or agreed” the service is helpful in managing patients.  
  
 
'''Summary of patient scenario illustrating how integration of EMR and CDMS promotes improved delivery of care:'''
 
'''Summary of patient scenario illustrating how integration of EMR and CDMS promotes improved delivery of care:'''
  
A 67 year-old male diagnosed with congestive heart failure (CHF) is discharged from an affiliated Marshfield Clinic hospital. The admission and discharge documents are entered directly into EMR. The patient’s care manager accesses CDMS and creates a “task” to contact the patient. She reviews the EMR’s “Dashboard” for medications, diagnoses, follow-up appointments, etc. She learns about the patient’s frequent issues with fluid imbalance resulting in repeat admissions, financial-reasons for non-adherence to the medication regimen, and non-compliance with follow-up appointments. She contacts the patient to review these issues, administers a heart failure questionnaire, and initiates an online referral to a social worker to find resources to cover the medications. She then adds a note in the EMR to communicate this information to the patient’s providers. In essence she provides a better understanding of the patient’s complex functional status from a clinical, behavioral, and psychosocial perspective.
+
A 67 year-old male diagnosed with congestive heart failure (CHF) is discharged from an affiliated Marshfield Clinic hospital. The admission and discharge documents are entered directly into the EMR. The patient’s care manager accesses the CDMS and creates a “task” to contact the patient. She reviews the EMR’s “Dashboard” for medications, diagnoses, follow-up appointments, etc. She learns about the patient’s frequent issues with fluid imbalance resulting in repeat admissions, financial-reasons for non-adherence to the medication regimen, and non-compliance with follow-up appointments. She contacts the patient to review these issues, administers a heart failure questionnaire, and initiates an online referral to a social worker to find resources to cover the medications. She then adds a note in the EMR to communicate this information to the patient’s providers. In essence she provides a better understanding of the patient’s complex functional status from a clinical, behavioral, and psychosocial perspective.
  
 
'''Conclusion:'''
 
'''Conclusion:'''

Revision as of 15:15, 18 October 2007

Article Review

Follen, M., Castaneda, R., Mikelson, M., Johnson, D., Wilson, A., Higuchi, K. Implementing Health Information Technology to Improve the Process of Health Care Delivery: A Case Study. Disease Management. 2007, 10(4): 208-215.

Introduction & Purpose:

The authors discuss how the implementation of an electronic medical record (EMR) and a chronic disease management system (CDMS) could promote improved delivery of medical care. To illustrate, they discuss their experience at the Marshfield Clinic, a large, private, multi-specialty health care system in Wisconsin.

Background of Health Information Technology at the Marshfield Clinic:

The EMR at Marshfield Clinic has been in use for more than 20 years. Providers across a wide spectrum (physicians, physician extenders, pharmacists, nurses, care managers, social workers) can access a large volume of clinical and administrative data to help coordinate care. The “Medication Manager” and “Dashboard” are useful tools which provide prompts and reminders to track and monitor patient health information.

The Marshfield Clinic also utilizes a commercially available CDMS (InformaCare) to manage information as part of its Diabetes and Community Health Access programs. This system is used exclusively by nurse care managers to manage patients with chronic disease. Care managers access a variety of tools (i.e. clinical decision support tools, a registry of patient data storing clinical and behavioral information, system alerts, online documents, a medication database, a problem-list) to achieve patient care goals. The CDMS facilitates patient-related communication to primary providers.

The authors point out that together both systems have “revolutionized the delivery of health care by providing real-time access to patient data” and that the ease of movement between system applications facilitates care planning, care coordination, and communication amongst providers.

Results of Provider Satisfaction Survey:

67% “strongly agreed or agreed” with the 2 systems’ positive impact on care management. Specifically, 69.6% “strongly agreed or agreed” the service improved the self-care behaviors of patients; 71.8% “strongly agreed or agreed” the system resulted in timely and appropriate communication; 60.8% “strongly agreed or agreed” the service improved practice efficiency and clinical outcomes; 67.4% “strongly agreed or agreed” the service is helpful in managing patients.

Summary of patient scenario illustrating how integration of EMR and CDMS promotes improved delivery of care:

A 67 year-old male diagnosed with congestive heart failure (CHF) is discharged from an affiliated Marshfield Clinic hospital. The admission and discharge documents are entered directly into the EMR. The patient’s care manager accesses the CDMS and creates a “task” to contact the patient. She reviews the EMR’s “Dashboard” for medications, diagnoses, follow-up appointments, etc. She learns about the patient’s frequent issues with fluid imbalance resulting in repeat admissions, financial-reasons for non-adherence to the medication regimen, and non-compliance with follow-up appointments. She contacts the patient to review these issues, administers a heart failure questionnaire, and initiates an online referral to a social worker to find resources to cover the medications. She then adds a note in the EMR to communicate this information to the patient’s providers. In essence she provides a better understanding of the patient’s complex functional status from a clinical, behavioral, and psychosocial perspective.

Conclusion:

An EMR and CDMS can be integrated in a large, multi-specialty healthcare system to improve overall efficiency and quality of care by providing useful tools for monitoring clinical and behavioral data, assessing chronic disease symptoms, and promoting collaboration amongst multiple providers.

The authors point out several operational issues with regard to implementation:

1) There was a small cohort of providers who were reluctant to adapt their clinical management styles initially. However, use of persistent communication and education helped to overcome this barrier. 2) At the onset there was lack of awareness among care managers about how to use the 2 systems efficiently. 3) The EMR and CDMS are not linked electronically. 4) An evaluation of the system to accurately measure effectiveness and clinical outcomes of the Marshfield Clinic operation is lacking but is underway; it will include preventative as well as disease specific metrics.

Finally, the authors discuss the need for more efforts to promote adoption and utilization of such systems. They make reference to the recent Wired for Healthcare Quality Act and financial initiatives such as pay-for-performance.

Anuj K. Dalal, M.D.