—care
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`IT Helps Manage Patients
`With Chronic Illness
`
`Technologies leverage extensive informatics infrastructures for patients at home.
`
`
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`By Jeremy J. Nobel, M.D., and Julie 0. Cherry
`
`
`
`‘
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`Giver Deskto
`p355... Managemen’:Tools
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`he U.S. healthcare delivery system is wit-
`
`nessing 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 cata-
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`strophic 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 oc-
`.
`curred because of advances in
`medlcrne and a C0”351”“de 1n-
`crease in the elderly population. As
`a result, more than 90 million Ameri-
`cans now live with, and die from,
`chronic diseases, says the Robert
`Wood Johnson Foundation.
`The cost to the US. healthcare
`system for chronic care is about $400 billion—a sig-
`nificant component of the overall healthcare expendi-
`ture. Furthermore, the financial impact of this rise in
`the number of persons with chronic conditions on th
`Medicare system is potentially devastating.
`
`Health B dd Personal information A l' n e
`Pgtiex:link to provider at point offelfajcacre
`Health Hero°Network is a unique Internet-based communications link hetween
`chronically ill patients at home and their healthcare providers. Working lrom the
`Health Hero°tletwork Website, a healthcare provider. (1) is able to send daily, pre-programmed
`inquiries, (2) to the patient’s Health Buddy, (3iwhieh then prompts the patient to respond.
`The Wehsite's software compiles the Information received back from the patient, (4) and focuses
`the healthcare provider’s attention on those patients whose conditions require attention.
`
`Fortes Affecting Healthcare
`At the same time, three socio—political forces are influ-
`encing our healthcare delivery system as well. These are:
`0 increased managed care penetration, driven by the
`desire for cost conscious medical management;
`
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`38
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`DECEMBER 1999
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`www.healthmgttech.com ' Health ManagementTechnolOQV
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`Management
`
`assess sub-populations, and to develop, measure, and
`track specific strategic interventions.
`
`One obvious
`
`- Growing consumerism among the beneficiaries of the
`care system;
`0 Focus on quality improvement, performance mea-
`surement, 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 sys-
`'
`tematize patient participation, their sup-
`port, and monitoring. We’re seeing the
`impact of these interventions now, as
`evidenced by the following:
`0 Focus on self-care in both prevention
`and management;
`- Extensive use of home healthcare;
`0 Shorter length of hospital stays.
`
`challenge in
`improving patient
`monitoring is
`obtaining timely,
`relevant clinical
`,
`patient data to
`i
`j monitor a patient’s
`i ambulatory health
`%
`status.
`
`Home Monitoring Needed
`Reducing the length of hospital stays
`is expected to increase the number of
`re-admissions, unless better care man-
`agement strategies, including im-
`proved monitoring in the home, are in
`place. One obvious challenge in im-
`proving patient monitoring is obtain-
`ing timely, relevant clinical patient
`data to monitor a patient’s ambulatory
`health status.
`
`’
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`:
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`Leveraging Informatics
`Among emerging technologies leveraging extensive
`informatics infrastructures are Web-database systems,
`interactive voice response (IVR) systems, nurse call cen-
`ters utilizing computerized systems, and
`modem-enabled technologies for trans-
`fer of electronic medical data from pa-
`tients to healthcare providers.
`One care provider, Mercy Heart Insti-
`tute, in Sacramento, CA, has utilized
`; Web—based lT 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 prom-
`ises to translate to dollar savings, as
`well as better patient outcomes, by fa-
`cilitating better monitoring and inter-
`vention to keep patients healthier and
`out of the hospital.
`
`Emergence of IT Programs
`Managed care has increased focus on
`cost control, forcing participants to be-
`come more efficient and trade-off oriented, while also
`demanding more information and increasing administra-
`tive requirements. Performance measurement and qual-
`ity 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 mea-
`suring their performance, a reasonable response from pro
`viders and payers
`bearing risk is to ex—
`plore interventions
`that keep patients
`away from costly
`Continued on page 40
`
`This is no easy task, however, as an estimated 61 per—
`cent 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 pa-
`tient education and compliance, and there is potential
`for major gaps in both information flow and care
`management.
`Thankfully, recent developments in information tech-
`nology (IT) have enhanced communication, helping
`healthcare providers manage patients with chronic ill—
`ness. Such technology includes the use of information
`management and decision support tools to identify and
`
`fl
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`Health ManagementTechnology ' www.healthmgttech.com
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`DECEMBER 1999
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`39
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`2
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`Managed '2 are
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`
`healthcare services while maintain-
`ing healthcare quality—a trend
`known as disease management.
`Disease management programs
`may typically involve the use of a
`wide array of information manage-
`ment 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,
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`efits of using innovative com-
`munication technologies are
`innumerable.
`
`Cost Reduction and
`Outcomes Improved
`The provision of healthcare
`in the United States is in the
`process of becoming a more
`efficient operation as health-
`. care providers and payers ex-
`plore new ways to reduce
`,
`,
`I;
`,,
`WW costs while maintaining ac-
`Health Hero? Gare Director”enables care managers
`ceptable clinicaloutcomes.
`Web~databasesystems and modem—
`to view patient responses to the Health Buddy by
`Technology-driven disea5§
`enabled technologies.
`question and liy graphical representation.
`management and care man-
`agement systems provide
`Communication Facilitated
`many key value components, including cost~effective ap-
`Of particular note, Internet-based technology is mak—
`proaches in managing large populations, reliable out-
`ing it easier for consolidated entities to operate within
`increasingly large and complex organizations. The
`comes assessment and management tools, centralized
`Internet creates an ideal platform for disease manage-
`data management and retrieval, and patient follow-up and
`ment applications that improve outcomes and popula—
`case management by exception.
`;
`
`Utilization of technology—driven disease manage—
`ment facilitates a case manager‘s ability to pro-
`vide proactive healthcare at a low cost by foster-
`ing management by exception; this allows the care
`manager to concentrate efforts on those patients
`who are most in need, and identify possible prob
`lems before a patient requires expensive interven-
`tion.
`
`Active patient monitoring and-self-
`management of chronic conditions
`have been shown to dramatically affect
`chronic disease outcomes.
`
`
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`In the future, the healthcare
`system will be one in which in-
`formation flows more quickly,
`accurately, and cost-effectively
`through electronic networks.
`Along these lines, chronic disease
`tion management byfacilitating communication between
`management may include a network
`patients and providers.
`,approach that affords the patient easy
`Active patient monitoring and self—management of
`access to all resources necessary to
`chronic conditions have been shown to dramatically af—
`fect chronic disease outcomes and provide a basis for monitor and maintain a healthy Jeremy J. Nobel,
`the establishment and maturation of case management
`lifestyle.
`M-D-. MPH
`at the patient level and disease management at the popu- K
`lation level.
`Jeremy J. Nobel, MD, MPH, is in the
`As a result, there is an active, connected community
`department ofHealth Policy andMan-
`of disease managers in the U.S., most of whom are rec-
`agement, Harvard School of Public
`ommending a population-based approach in which pa—
`Health; Boston, M4. Julie C. Cherry, RN,
`tients with costly chronic conditions, such as diabetes,
`MSN, is with Health Hero Network Inc,
`congestive heart failure, and asthma, are identified at Mountain View, CA. Also contributing
`the time of initial diagnosis or plan enrollment, rather
`to the article were Richard R. Miller,
`than when the patient’s claims data indicate that the pa— MD, FACP, FACC, and Michael A.
`tient received treatment for a particular illness.
`O’Connell, PhD.
`"MT
`With consolidation ofhealthcare services, an increased
`focus on management of the chronically [11, rather than
`critically ill patients, an increased focus on disease man-
`agement and case management, and the need for mea-
`surement of clinical and financial performance, the ben-
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`‘1‘
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`‘
`Julie 3_ Cherry,
`nu, msu
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`
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`40
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`DECEMBER 1999
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`www.healthmgttech.com - Health ManagementTechnologY
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