Use of an Electronic Medical Record in Disease Management Programs: A Case Study in Hyperlipidemia

Abstract Disease management programs seek to improve the health of a population of patients with a disease through a multidisciplinary approach founded in the collection, analysis and feedback of disease-specific outcomes. Currently, the majority of disease management programs have been conducted by insurers or external vendors. Limitations of these programs derive from separation of care from primary care and the inability to rapidly and accurately obtain the necessary clinical data. The utility offered by an electronic medical record allows physician organizations to conduct disease management programs of higher quality at lower cost. Keywords: Medical record systems, computerized; disease management; physician’s practice patterns; hyperlipidemia Introduction In the United States, an estimated 100 million people suffer from one or more chronic health conditions.[1] A chronic illness is defined as a disease that is not self-limited, and creates persistent and recurring health consequences lasting for periods of years. Examples of common chronic diseases include hypertension, diabetes, congestive heart failure, and asthma. An estimated $600 billion dollars are spent on the direct and indirect costs associated with care of patients with chronic illness.[1] The morbidity and mortality associated with these chronic diseases can be decreased or prevented by appropriate care, which generally includes lifestyle modification, pharmacotherapy, and monitoring of disease markers. Appropriate management of chronic illness requires daily patient compliance with dietary recommendations, medication compliance, and adherence to follow up recommendations. Adequacy of management should be ensured through monitoring for optimal outcomes. There is increasing recognition that the predominant healthcare model affords suboptimal care for patients with chronic illness.[2] Patients with chronic illness are principally cared for by primary care physicians. The prevalent healthcare delivery model in primary care has been characterized as “episodic care.” In the episodic care model, primary care providers attend to the healthcare of most patients only as they appear in the office with an appointment. This model of care is driven by patients’ perception of the acuity of their medical conditions. That perception is strongly influenced by a patient’s understanding of their disease process and its associated symptoms, insights that are often absent in chronic illness. Disease management programs have sought to overcome many of the limitations of the episodic care model for patients with chronic illness. Disease management can be defined as a comprehensive, integrated, efficient approach to healthcare delivery with a goal of optimal disease treatment and prevention. The elements of a disease management program include: • Knowledge of the natural history, evidence-based treatment options, and economic implications of a disease process. • Physician decision support. • Identification of the population of patients with the disease. • Measurement and evaluation of clinical, economic, satisfaction, and functional status outcome data. • Feedback of outcome data to the physician, allowing for refinement of treatment guidelines and improvement in the quality of care by encouraging change in physician behavior. The success of such a program is dependent on several factors including the ability to accurately identify populations of patients with a disease, ability to track accurate success measures, and physician buy-in with the process (see figure 1).