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The Value of Health Information Technology in the Management of Chronic Disease

Good morning. My name is Charles Cutler, MD. I’m a practicing internist in Montgomery County and a trustee of the Pennsylvania Medical Society. I’m also a member of the Society’s Task Force on Health Information Technology.

I’d like to thank Chairman Wonderling for giving me the opportunity to share with you the value of health information technology in the management of chronic disease and all the benefits that both patients and doctors gain from this technology as they work together for better outcomes.

The profile of diseases contributing most heavily to death, illness, and disability among Americans has changed dramatically during the last century. Today, chronic diseases are the major cause of illness, disability, and death in the United States, even though much is known about how to prevent chronic disease and how to delay or avoid many related complications.

Seven of every 10 Americans who die each year, or more than 1.7 million people, die of a chronic disease. As importantly, more than 90 million Americans live with chronic illnesses. The medical care costs of those with chronic diseases account for more than 75 percent of the nation’s $1.4 trillion of medical care costs.

In the context of Medicare spending, 20 percent of Medicare beneficiaries have five or more chronic diseases and account for 66 percent of total Medicare spending. Six percent of the sickest Medicare beneficiaries account for 53 percent of spending. The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases.

The optimal management of patients with chronic diseases requires tracking patients over time to monitor progress of the disease, compliance with treatment, and preventive care. Multiple studies have shown that patients with chronic disease only receive appropriate care for their conditions approximately 55 percent of the time.

There are many reasons for this alarming statistic. In our current system, patients are routinely seen for an acute episode of care related to an isolated complaint. With time constraints, lack of availability of all relevant and timely clinical information, and lack of an organized process to track the elements of chronic disease and preventive care, patients often leave the encounter with their chronic disease not addressed. Once out of the office, there is no process to alert the physician that the patient has not had appropriate follow up or treatment for an ongoing chronic disease.

Most experts agree that better use of information technology is key to improving chronic disease care. Having office-based health information technology systems, such as a fully integrated electronic medical record, or EMR, can aid in providing effective chronic disease in the following ways:

• An EMR identifies which patients have the disease. Paper-based systems, currently in use in most physician offices, do not allow the physician to identify which patients have a particular disease. This is the first requirement in beginning to think about population-based care.
• Second, an EMR will support outreach to those with a given disease who are missing aspects of their care. As mentioned earlier, patients with chronic diseases who are actually seen in the office receive about 55 percent of the appropriate care for their conditions. In most practices, there is no process in place to identify which patients in a practice are in need of follow-up.
• Third, an EMR has the functionality to track one or more process measures that indicate whether patients are receiving appropriate evidenced-based care for their conditions. An EMR can also identify which patients and which providers are outliers.
• Fourth, an EMR system provides appropriate decision support incorporated into the workflow, which prompts the provider to observe evidenced-based management protocols, take the required measurements, and perform the needed actions. For decision support to be truly effective and accurate, the prompts must be tailored specifically to that patient, based on the patient’s prior history of receiving elements of care and on the patient’s individual laboratory results.
• Fifth, an electronic health record, or EHR, which pulls together EMRs from various providers, must span the continuum of care from the patient’s home to the lab, pharmacy, office visits, and any other sites of care. The EHR should be accessible by the entire health care team, not just a single provider.

Most experts agree that promoting patient self-management and active involvement is crucial to improving chronic disease care. Health information technology can greatly facilitate this movement to greater patient involvement.

The Pennsylvania Medical Society envisions health information technology systems that include patient portals through which patients may access appropriate portions of their records. Patients can even make appropriate entries into their records. These integrated records provide for secure electronic messaging between patients and their providers, educational materials about their conditions, and tools that help patients comply with their treatment protocols.

Other technologies can aid patient self-management and the ability for patients to monitor many of their conditions from home, avoiding unnecessary visits to the doctor’s office or even hospital emergency rooms. Motivated, educated patients enabled by new forms of technology can interact more efficiently with the health care system, resulting in better compliance with evidenced-based disease management protocols proven to reduce complications and cost.

These new technologies take many forms. Telehealth is a rapidly growing industry which can be as simple as a nurse having regularly scheduled phone contact with patients. The nurse asks about changes in patients’ symptoms and helps to fully integrated home data collection systems. These home-based systems can transmit electronic data directly to an electronic medical record, which can be viewed by the provider in the context of the full clinical record.

Examples of data collection systems include electronic scales where patients with congestive heart failure can weigh themselves daily with results transmitted directly to their provider. If the weight change is significant, an electronic alert is sent directly to the provider so that immediate action can be taken. Other examples of information which can be collected at home and electronically transmitted include blood pressure, pulse rate, and blood sugar levels.

In some cases telehealth applications include video transmission, which can allow the provider to better evaluate and even perform a limited examination of the patient remotely. In this way, patients can have the status of, for example, wound healing assessed. In rural areas of the commonwealth, where specialist physicians are not immediately available, video telehealth can provide the means for a patient to be evaluated remotely without having to travel long distances, thereby making specialty care more accessible.

The ultimate goal of all health information technology efforts should be to improve the quality of care for patients. For the Pennsylvania Medical Society, advocating for health information technology and making every effort to facilitate its adoption are natural extensions of our long-held commitment to preserving and fostering the patient-doctor relationship.

Thank you again for this opportunity to testify before this committee.