What Are The Potential Health Benefits Of Electronic Medical Record Systems? ( Part 2 )

Using Health Information Technology for short term/long term disease management

Using Health Information Technology for near-term chronic disease management. The U.S. burden of chronic disease is extremely high and growing. In one study, fifteen chronic conditions accounted for more than half of the growth in health care spending between 1987 and 2000, and just five diseases accounted for 31 percent of the increase. Disease management programs identify people with a potential or active chronic disease; target services to them based on their level of risk (sicker patients need more-tailored, more-intensive interventions, including case management); monitor their condition; attempt to modify their behavior; and adjust their therapy to prolong life, minimize complications, and reduce the need for costly acute care interventions.
Electronic Medical Record systems can be instrumental throughout the disease management process. Predictive-modeling algorithms can identify patients in need of services. Electronic Medical Record systems can track the frequency of preventive services and remind physicians to offer needed tests during patients’ visits. Condition-specific encounter templates implemented in an Electronic Medical Record system can ensure consistent recording of disease-specific clinical results, leading to better clinical decisions and outcomes. Connection to national disease registries allows practices to compare their performance with that of others. Electronic messaging offers a low-cost, efficient means of distributing reminders to patients and responding to patients’ inquiries. Web-based patient education can increase the patient’s knowledge of a disease and compliance with protocols.
For higher-risk patients, case management systems help coordinate workflows, including communication between multiple specialists and patients. In what may prove to be a transformative innovation, remote monitoring systems can transmit patients’ vital signs and other biodata directly from their homes to their providers, allowing nurse case managers to respond quickly to incipient problems. Health information exchange via RHINs or personal health records promises great benefits for patients with multiple chronic illnesses, who receive care from multiple providers in many settings.
We examined disease management programs for four conditions: asthma, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes (Exhibit 4 ) and estimated the effects of 100 percent participation of people eligible for each program. By controlling acute care episodes, these programs greatly reduce hospital use at the cost of increased physician office visits and use of prescription drugs. As shown, the programs could generate potential annual savings of tens of billions of dollars. Keeping people out of the hospital is, of course, a health benefit, but we can also expect important outcomes such as reductions in days lost from school and work and in days spent sick in bed.

Exhibit 4 also highlights an important disincentive for health care providers to offer these kinds of services or to invest in Health Information Technology to effectively perform them: The savings come out of provider receipts, as patients spend less time in acute care. This key misalignment of incentives is an important barrier to Electronic Medical Record adoption and, more generally, to health care transformation.
Using Health Information Technology for long-term chronic disease prevention and management. A program of Electronic Medical Record enhanced prevention and disease management should change the incidence of chronic conditions and their complications. We considered cardiovascular diseases (hypertension, hyperlipidemia, coronary artery disease/acute myocardial infarction, CHF, cerebrovascular disease/stroke, and other heart diseases), diabetes and its complications (retinopathy, neuropathy, lower extremity/foot ulcers and amputations, kidney diseases, and heart diseases), COPD (emphysema and chronic bronchitis), and the cancers most strongly associated with smoking (cancers of the bronchus and lung, head and neck, and esophagus, and other respiratory and intrathoracic cancers). Using our MEPS-based model, we estimated how combinations of lifestyle changes and medications that reduced the incidence of these conditions would affect health care use, spending, and outcomes (Exhibit 5 ).
Savings are evenly divided between the populations under age sixty-five and those age sixty-five and older, despite the fact that the older population constitutes only 13 percent of the total. Since chronic diseases are, by and large, diseases of the elderly, a large fraction of the long-term savings attributable to prevention and disease management would accrue to Medicare. Yet, to realize these benefits, people would have to begin participating in these programs as relatively young adults.
We combined the effects of the reduced incidence attributable to long-term prevention and management and reduced acute care due to disease management. We estimated the potential combined savings, again assuming 100 percent participation, to be $147 billion per year.
Realizing the potential of these interventions. Realizing the benefits of prevention and disease management requires that a substantial portion of providers and consumers participate. Since, on average, patients comply with medication regimens about half the time, it is plausible to assume that about half of the chronically ill would participate in disease management programs and, therefore, the health care system would reap about half of the estimated short-term benefits, assuming that Electronic Medical Records systems and community-based connectivity were operational.
Patients comply with their physician’s lifestyle recommendations only about 10 percent of the time. We assumed that in a future with Electronic Medical Records -based reminders and decision support and patient-physician messaging, we could realize at least 20 percent of the long-term benefits shown in Exhibit 5 .
Under these assumptions, the net savings would be on the order of $40 billion per year. We varied the participation in disease management and prevention activities parametrically to show the potential beyond these estimates.

Richard Hillestad