The impact of health information technology on collaborative chronic care management.

BACKGROUND: Chronic disease is a growing problem in the United States. More than 125 million Americans had at least 1 chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.1 Some of the challenges associated with current chronic care management approaches can be addressed through the use of health information technology (IT) and health information exchange. OBJECTIVE: To review the current challenges of chronic care management and explore how health IT and health information exchange efforts at the national, state, and local levels can be leveraged to address some of these challenges. SUMMARY: Efforts to effectively manage chronic care have been hampered by a number of factors, including a fragmented health care system and the need for more coordination across the health care setting; the lack of interoperable clinical information systems, which would help provide readily available, comprehensive information about the patient to those who deliver care, those who manage care, and those who receive care, and finally, the current predominantly fee-for-service reimbursement system that rewards volume and fragmentation, and does not effectively align incentives with the goals of chronic care management. The introduction of health IT, including electronic health records and health information exchange, holds great promise for addressing many of the barriers to effective chronic care management, by providing important clinical information about the patient when it is needed, and where it is needed, in a timely, secure fashion. Having information from the care delivery process readily available through health IT and health information exchange at the national, state, and local levels supports key components of the chronic care management process, including those related to measurement, clinical decision support, collaboration and coordination, and consumer activation. CONCLUSIONS: Those engaged in chronic care management should seek to leverage health IT and health information exchange initiatives particularly at the local levels. Community-based initiatives have built social capital and trust across multiple stakeholders; enabled access to clinical data derived from the care delivery process that only resides locally; and in many cases aligned incentives around the mobilization of clinical information across care settings. All of these elements are critical to the long-term success of chronic care management. While there is good research regarding interdisciplinary care models, more research is still needed to identify policies, practices, and strategies for facilitating and building cooperation among those engaged in chronic care management, and those engaged in multi-stakeholder efforts involved in the exchange of clinical health information electronically.

Transforming the future of health together: The Learning Health Systems Consensus Action Plan.

The Learning Health Community is an emergent global multistakeholder grassroots incipient movement bonded together by a set of consensus Core Values Underlying a National-Scale Person-Centered Continuous Learning Health System developed at the 2012 Learning Health System (LHS) Summit. The Learning Health Community's Second LHS Summit was convened on December 8 to 9, 2016 building upon LHS efforts taking shape in order to achieve consensus on actions that, if taken, will advance LHSs and the LHS vision from what remain appealing concepts to a working reality for improving the health of individuals and populations globally. An iterative half-year collaborative revision process following the Second LHS Summit led to the development of the Learning Health Systems Consensus Action Plan.

Health information exchange policy and evaluation.

Concerns about the quality, safety, and cost of healthcare have driven the nation to increase its focus on this issue. A number of states are moving forward-in parallel with federal efforts-to develop and adopt policies for improving health and healthcare through health information technology and electronic health information exchange. Based on the eHealth Initiative's experience providing technical assistance to more than 20 states, and its work related to its coalition of more than 250 state, regional and community-based health information exchange initiatives and organizations, the most difficult challenges facing these initiatives and organizations today is that related to assessing the value of services that emerge from the health information exchange to various stakeholders groups such as providers, payers, and employers, and converting those value assessments to business plans that promote and assure sustainability for these initiatives. The combination of increased federal and state focus and funding and the pace at which regional and community-based health information networks are developing, along with the identification of value and sustainability as some of the most difficult challenges experienced by these efforts, all point to the significant need for evaluation. The most critical evaluation questions focus on the impact of health information technology and health information exchange on quality, safety, efficiency, the value of such efforts for various stakeholders, and assessment of how grant programs can be designed to support positive impact, value, and a sustainable business model, so that efforts continue when the grant funds are fully expended.