Department of Veterans Affairs Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202, USA. neale.chumbler@vagov
Med Care. 2011 Dec;49 Suppl:S36-42. doi: 10.1097/MLR.0b013e3181d558f9.
The Institute of Medicine report, Crossing the Quality Chasm, called for significant improvements in 6 elements of healthcare performance: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. To meet the changing care needs of older veterans, many of whom are trying to manage the complexities of their chronic diseases in their own homes, the Veterans Health Administration (VHA) has promoted many of the Institute of Medicine elements by implementing health information technology (health IT), such as telehealth and a personal health record (PHR). To that end, approximately 5 years ago, VHA created the Office of Care Coordination and in particular a patient-centered Care Coordination/Home Telehealth (CCHT) program, which uses telehealth technologies (eg, messaging devices) to coordinate care directly from a patient's home to help self-manage their chronic diseases. VHA has also developed a PHR, My HealtheVet, which is a secure web-based portal that provides veterans the capability to access and manage health information. This article discusses the mechanisms by which these forms of health IT have been implemented to improve access to care and improve health. For telehealth, we present the outcomes from some of the published literature. For PHRs, we outline what is known to date and future research directions. The article also examines some structural, policy-related, and organizational barriers to health IT implementation and offers suggestions for future research.
美国医学研究所的报告《跨越质量鸿沟》呼吁在医疗服务表现的 6 个要素上取得重大改进:安全性、有效性、以患者为中心、及时性、效率和公平性。为了满足老年退伍军人不断变化的护理需求,其中许多人试图在自己家中管理自己慢性病的复杂性,退伍军人健康管理局(VHA)通过实施健康信息技术(health IT),如远程医疗和个人健康记录(PHR),推动了美国医学研究所的许多要素。为此,大约 5 年前,VHA 创建了护理协调办公室,并特别创建了以患者为中心的护理协调/家庭远程医疗(CCHT)计划,该计划使用远程医疗技术(例如,消息设备)直接从患者家中协调护理,以帮助他们自我管理慢性病。VHA 还开发了一个 PHR,即 My HealtheVet,这是一个安全的基于网络的门户,为退伍军人提供访问和管理健康信息的能力。本文讨论了这些健康信息技术的实施机制,以改善护理的可及性并改善健康状况。对于远程医疗,我们展示了一些已发表文献的结果。对于 PHR,我们概述了迄今为止的了解情况和未来的研究方向。本文还研究了健康信息技术实施的一些结构、政策相关和组织障碍,并提出了未来研究的建议。