Informatics Systems to Promote Improved Care for Chronic Illness: A Literature Review
- David Dorra,
- Laura M Bonnerb,
- Amy N Cohenc,
- Rebecca S Shoaic,
- Ruth Perrind,
- Edmund Chaneyb,
- Alexander S Youngc,e
- aOregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, Portland, OR
- bNorthwest HSR&D Center of Excellence, VA Puget Sound Healthcare System, Seattle, WA
- cVA Desert Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), Los Angeles, CA
- dVA Information Resource Center (VIReC), Hines, IL
- eUniversity of California Department of Psychiatry, Los Angeles, CA
- Correspondence and reprints: David A. Dorr, 3181 SW Sam Jackson Park Rd, Mailcode:BICC, Portland, OR 97239; (e-mail: <dorrd{at}ohsu.edu>)
- Received 24 August 2006
- Accepted 12 December 2006
Abstract
Objective To understand information systems components important in supporting team-based care of chronic illness through a literature search.
Design Systematic search of literature from 1996-2005 for evaluations of information systems used in the care of chronic illness.
Measurements The relationship of design, quality, information systems components, setting, and other factors with process, quality outcomes, and health care costs was evaluated.
Results In all, 109 articles were reviewed involving 112 information system descriptions. Chronic diseases targeted included diabetes (42.9% of reviewed articles), heart disease (36.6%), and mental illness (23.2%), among others. System users were primarily physicians, nurses, and patients. Sixty-seven percent of reviewed experiments had positive outcomes; 94% of uncontrolled, observational studies claimed positive results. Components closely correlated with positive experimental results were connection to an electronic medical record, computerized prompts, population management (including reports and feedback), specialized decision support, electronic scheduling, and personal health records. Barriers identified included costs, data privacy and security concerns, and failure to consider workflow.
Conclusion The majority of published studies revealed a positive impact of specific health information technology components on chronic illness care. Implications for future research and system designs are discussed.
Footnotes
-
This work was supported by the Department of Veterans Affairs through the Health Services Research & Development Service Quality Enhancement Research Initiative (MHS-03-218), and the Desert Pacific Mental Illness Research, Education and Clinical Centers (MIRECC); and by the John A. Hartford Foundation and National Library of Medicine (K22 LM 8427-01).
-
The funders did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. David A. Dorr had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Any opinions expressed are only those of the authors and do not necessarily represent the views of any affiliated institutions.
