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

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The authors provide a detailed description of how one large institution leveraged 2 separate clinical information systems to promote improved disease management and integration of care. The patient scenario provides a vivid depiction of how these systems are used to coordinate and improve care management of what would otherwise be a labor intensive case.  
 
The authors provide a detailed description of how one large institution leveraged 2 separate clinical information systems to promote improved disease management and integration of care. The patient scenario provides a vivid depiction of how these systems are used to coordinate and improve care management of what would otherwise be a labor intensive case.  
  
A key element to this study is a defined number of providers (11 nurse care managers and 2 nurse supervisors) utilize the integrated system to manage a relatively small cohort of patients (~1000) and are provided modest support. The scalability of this "dual" system model will certainly be a factor, particularly from a financial and operational perspective.   
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A key element to this study is the defined number of providers (11 nurse care managers and 2 nurse supervisors) who utilize the integrated system to manage a relatively small cohort of patients (~1000). The nurse care managers are also provided modest IT support. The scalability of this "dual" system model is certainly an issue, particularly from a financial and operational perspective.   
  
 
The authors remark how the 2 systems operate independently, an obstacle preventing optimal utilization. Their comments also suggest that early and persistent education could ameliorate issues with regard to adoption and efficient utilization. In general it seems that better integration of disparate systems upfront would minimize many of these issues.
 
The authors remark how the 2 systems operate independently, an obstacle preventing optimal utilization. Their comments also suggest that early and persistent education could ameliorate issues with regard to adoption and efficient utilization. In general it seems that better integration of disparate systems upfront would minimize many of these issues.

Revision as of 18:30, 19 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. They discuss their experience at the Marshfield Clinic, a large, private, multi-specialty health care system in Wisconsin and provide a case study demonstrating how utilization of these systems can lead to improved care management.

Background:

The EMR at Marshfield Clinic has been in use for more than 20 years. Providers across a wide spectrum can access a large volume of clinical and administrative data to help coordinate care. Tools such as the “Medication Manager” and “Dashboard” 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. Care managers access a variety of tools (i.e. clinical decision support, 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 authors state that together both systems have “revolutionized the delivery of health care by providing real-time access to patient data” by facilitating 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.

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 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.

Commentary:

The authors provide a detailed description of how one large institution leveraged 2 separate clinical information systems to promote improved disease management and integration of care. The patient scenario provides a vivid depiction of how these systems are used to coordinate and improve care management of what would otherwise be a labor intensive case.

A key element to this study is the defined number of providers (11 nurse care managers and 2 nurse supervisors) who utilize the integrated system to manage a relatively small cohort of patients (~1000). The nurse care managers are also provided modest IT support. The scalability of this "dual" system model is certainly an issue, particularly from a financial and operational perspective.

The authors remark how the 2 systems operate independently, an obstacle preventing optimal utilization. Their comments also suggest that early and persistent education could ameliorate issues with regard to adoption and efficient utilization. In general it seems that better integration of disparate systems upfront would minimize many of these issues.

Lastly, although the authors provide data with regard to overall provider satisfaction, they do not provide additional "hard" metrics such quality indicators, readmission rates, reductions in redundant test ordering or adverse medication events, etc. They do mention that an evaluation is underway but do not offer details on which preventative and/or disease specific metrics will be utilized.

Anuj K. Dalal, M.D.