Marchibroda Janet M
eHealth Initiative and Foundation, 818 Connecticut Ave., NW, Suite 500, Washington, DC 20006, USA.
J Manag Care Pharm. 2008 Mar;14(2 Suppl):S3-11.
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.
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.
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.
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.
慢性病在美国正成为一个日益严重的问题。2000年，超过1.25亿美国人至少患有一种慢性病，预计到2020年这一数字将增至1.57亿。当前慢性病管理方法所面临的一些挑战可通过使用健康信息技术（IT）和健康信息交换来解决。
回顾慢性病管理当前面临的挑战，并探讨如何利用国家、州和地方层面的健康IT及健康信息交换工作来应对其中一些挑战。
有效管理慢性病的工作受到多种因素的阻碍，包括医疗保健系统碎片化以及在整个医疗保健环境中需要更多协调；缺乏可互操作的临床信息系统，而这有助于向提供护理者、管理护理者和接受护理者提供有关患者的随时可得的全面信息；最后，当前主要的按服务收费报销系统鼓励服务量和碎片化，并未有效地使激励措施与慢性病管理目标保持一致。引入健康IT，包括电子健康记录和健康信息交换，有望通过及时、安全地在需要时和需要的地方提供有关患者的重要临床信息，来解决有效慢性病管理的许多障碍。通过国家、州和地方层面的健康IT和健康信息交换随时获取护理过程中的信息，支持慢性病管理过程的关键组成部分，包括与测量、临床决策支持、协作与协调以及消费者参与相关的部分。
从事慢性病管理的人员应寻求利用健康IT和健康信息交换举措，尤其是在地方层面。基于社区的举措在多个利益相关者之间建立了社会资本和信任；能够获取仅存在于本地的护理过程中产生的临床数据；并且在许多情况下围绕跨护理环境调动临床信息调整了激励措施。所有这些要素对于慢性病管理的长期成功至关重要。虽然关于跨学科护理模式有很好的研究，但仍需要更多研究来确定促进和建立从事慢性病管理的人员以及参与电子临床健康信息交换的多利益相关者努力的人员之间合作的政策、实践和策略。
