IT Helps Manage Patients With Chronic Illness - Industry Trend or Event

Health Management Technology, Dec, 1999 by Jeremy J. Nobel, Julie C. Cherry

Technologies leverage extensive informatics infrastructures for patients at home.

The U.S. healthcare delivery system is witnessing several trends that are forcing pro-viders of acute and post-acute care to re-evaluate their care processes. Among the emerging trends is a shift in focus from catastrophic management to longitudinal care management, matched by a shift from management of the critically or catastrophically ill individuals to the management of chronically ill populations.

This new model of care has occurred because of advances in medicine and a corresponding increase in the elderly population. As a result, more than 90 million Americans now live with, and die from, chronic diseases, says the Robert Wood Johnson Foundation.

The cost to the U.S. healthcare system for chronic care is about $400 billion--a significant component of the overall healthcare expenditure. Furthermore, the financial impact of this rise in the number of persons with chronic conditions on the Medicare system is potentially devastating.

Forces Affecting Healthcare

At the same time, three socio-political forces are influencing our healthcare delivery system as well. These are:

* Increased managed care penetration, driven by the desire for cost conscious medical management;

* Growing consumerism among the beneficiaries of the care system;

* Focus on quality improvement, performance measurement, and outcomes assessment.

The convergence of these trends has, among other things, heralded the emergence of care protocols that are being established as essential tools at the patient level, including guided templates to systematize patient participation, their support, and monitoring. We're seeing the impact of these interventions now, as evidenced by the following:

* Focus on self-care in both prevention and management;

* Extensive use of home healthcare;

* Shorter length of hospital stays.

Home Monitoring Needed

Reducing the length of hospital stays is expected to increase the number of re-admissions, unless better care management strategies, including improved monitoring in the home, are in place. One obvious challenge in improving patient monitoring is obtaining timely, relevant clinical patient data to monitor a patient's ambulatory health status.

This is no easy task, however, as an estimated 61 percent of the population between the ages of 70 and 79 will experience two or more chronic conditions and, as a result, have complex clinical data management requirements. Add to this the challenges faced in patient education and compliance, and there is potential for major gaps in both information flow and care management.

Thankfully, recent developments in information technology (IT) have enhanced communication, helping healthcare providers manage patients with chronic illness. Such technology includes the use of information management and decision support tools to identify and assess sub-populations, and to develop, measure, and track specific strategic interventions.

Leveraging Informatics

Among emerging technologies leveraging extensive informatics infrastructures are Web-database systems, interactive voice response (IVR) systems, nurse call centers utilizing computerized systems, and modem-enabled technologies for transfer of electronic medical data from patients to healthcare providers.

One care provider, Mercy Heart Institute, in Sacramento, CA, has utilized Web-based IT for a disease management program for patients at home suffering from congestive heart failure (see sidebar). Mercy's disease management platform is an example of how IT promises to translate to dollar savings, as well as better patient outcomes, by facilitating better monitoring and intervention to keep patients healthier and out of the hospital.

Emergence of IT Programs

Managed care has increased focus on cost control, forcing participants to become more efficient and trade-off oriented, while also demanding more information and increasing administrative requirements. Performance measurement and quality improvement programs are now common in managed care and hospital settings, and care providers are often benchmarked internally.

Faced with driving efficiencies into healthcare and measuring their performance, a reasonable response from providers and payers bearing risk is to explore interventions that keep patients away from costly healthcare services while maintaining healthcare quality--a trend known as disease management.

Disease management programs may typically involve the use of a wide array of information management and decision support tools to identify and assess sub-populations and to develop, measure and track specific strategic interventions. They also may rely on technologies that leverage extensive hardware and software infrastructures, that is, Web-database systems and modem-enabled technologies.

Communication Facilitated

Of particular note, Internet-based technology is making it easier for consolidated entities to operate within increasingly large and complex organizations. The Internet creates an ideal platform for disease management applications that improve outcomes and population management by facilitating communication between patients and providers.