Foundation Finds Shortcomings In IT Disease Management

Using information technology (IT) in chronic disease management systems (CDMSs) and electronic medical records (EMRs) offers new ways to combat disease and cut costs, said a new white paper from the California HealthCare Foundation (CHCF).

The foundation analyzed information and saw demonstrations from 10 vendors of 29 requested to participate in its study.

The white paper also evaluated strengths and weaknesses of CDMSs and EMRs. Overall, CDMSs scored higher in the product's ability to support chronic disease management, while EMR vendors provided better support in terms of training and implementation. But that's a mixed positive for EMR, the white paper noted, because EMR also takes longer to implement and requires more support.

During product demos, CDMS vendors "slightly outperformed their EMR counterparts in all respects," the white paper said. However, in real time at the point of care, CDMS capabilities often aren't leveraged to their full potential, the paper added. They also typically rely on manual data entry because they are not linked to other clinical systems.

Vendor Shortcomings

CHCF's survey found a number of shortcomings in vendors' products (see list of participating vendors below). Example: None use algorithms to automatically identify patients who have the same medical condition. "Algorithms based on clinical guidelines could help identify at-risk patients automatically and rank possible treatments in terms of their greatest potential impact on outcomes," said white paper co-authors Laura Jantos and Michelle Holmes, with ECG Management Consultants.

They also found that vendor systems need more-refined tools for treating comorbidities, such as reminders that address a patient's multiple medical conditions, to ensure that care is integrated and complete.

EMRs required bigger investments in terms of money, time and effort compared with CDMSs, the white paper noted. EMRs are often described as an "all or nothing" proposition, because an organization must commit to building all of the necessary data interfaces and ultimately exploiting most or all of the tools in EMRs to reap the rewards. But the rewards are plentiful, including:

More comprehensive, real-time edata; Complete documentation of all patient encounters; and Ability to manage all patients, not just those who are chronically ill, across the entire continuum of care.

In addition, some EMR functions, such as validating evaluation and management codes, may not be available in CDMSs. EMRs can electronically transmit orders for tests, procedures and medications, and they come with advanced tools compared with CDMSs -- including patient and provider portals -- that enable ecommunication among all parties.

EMR vendors typically are large firms with long track records. Most have impressive capital resources and invest heavily in R&D, the white paper noted. By contrast, most CDMS vendors are relatively small and new to the market. -- Michael Causey

Vendors Who Participated In the CHCF Survey

CDMS: DocSite of Winchester, Mass.; i2i Systems of Santa Rosa, Calif.; The Aristos Group of Austin, Texas EMR (standalone CDM): Emdeon Practice Services of Tampa, Fla.; Misys Healthcare Systems of Raleigh, N.C.; Kryptiq of Hillsboro, Ore. EMR (integrated CDM): Allscripts of Libertyville, Ill.; NextGen Healthcare Information Systems of El Dorado Hills, Calif.; Epic Systems of Verona, Wis.; eClinicalWorks of Westborough, Mass.