September 22, 2003
 

 
TODAY' S GREAT IDEA -- THE CONTINUITY OF CARE RECORD

While attending the Mobile Healthcare Alliance meeting earlier this month in Minneapolis, I was introduced to a brilliant, yet simple concept -- the Continuity of Care Record (CCR). 

The usefulness of the CCR struck me like a BFO -- a blinding flash of the obvious.  Two speakers  -- Peter Waegemann, CEO of the Medical Records Institute, and Claudia Tessier, Executive Director of the Mobile Healthcare Alliance -- eloquently described and advocated for the CCR.

The CCR is a concept quietly being developed by ASTM International, the Massachusetts Medical Society (MMS), the Health Information Management and Systems Society (HIMSS), and the American Academy of Family Physicians (AAFP).    The CCR holds great promise to improve disease management (DM).
 

CONTINUITY OF CARE CHALLENGES IN DISEASE MANAGEMENT

Today’s reality: DM is done primarily using stand-alone information technology software.  Patients with chronic conditions usually have multiple care providers, most of whom have minimal current information about what the others are doing to provide care for the patient.

Tomorrow’s vision:  DM will be one of many applications that will revolve around standardized electronic medical records (EMRs).  Disease managers will be able to draw patient information from EMRs, and in turn will feed information back into EMRs.

The path from today’s reality to tomorrow’s vision is not an easy one: 

• Diverse, incompatible information technology (IT) systems are currently used by physicians, hospitals, disease management companies and others
• Standards to exchange information among these IT systems are just beginning to emerge
• Any DM organization that would like to integrate information today among its partner physicians and other local caregivers is faced with an overwhelming and bewildering IT interface challenge.
• The primary information sharing tools among health care providers today are still paper, phone, and fax.

  
THE CONTINUITY OF CARE RECORD (CCR)

The CCR offers tremendous great opportunities to improve disease management processes for patients and disease management organizations. You can read all about it:

Continuity of Care Record (CCR) Concept Paper

The goal is to create a CCR that will enable the next provider to easily access information at the beginning of a first encounter and easily update the information when the patient goes on to another provider, in order to support the safety, quality, and continuity of patient care.

The CCR is intended to be technology neutral and vendor neutral in order to maximize its applicability. It is being developed on an XML platform in order to offer multiple options for its presentation, modification, and transmittal, e.g., in a browser version, as an HL7 message, in a secure email, as a Word document (electronic or paper).

The CCR could have a great impact on the quality of care, on the reduction of medical errors, and on the containment of costs.  The potential benefits include:

• The next healthcare provider will not have to search for or guess about a patient’s allergies, medications, or current and recent past diagnoses and other pertinent information. 
• The next healthcare provider will be informed about the patient’s most recent healthcare assessment and services.
• The next healthcare provider will be informed about recommendations of the caregiver who last treated the patient. 
• As patient demographics will be provided, time and effort will be saved by not having to repeatedly ask a patient for demographic information in detail.  Rather, this information can be more quickly and easily verified.
• A patient’s insurance status will more easily be established.  Over time, this can be expanded within the system.
• Costs associated with the patient’s care will be reduced, for example through avoiding repetitive tests and basic information gathering.
• The effort required to update the patient’s most essential and relevant information, will be minimized

If you would like to discuss the CCR concept and/or express your support, you can contact Claudia Tessier, Executive Director of the Mobile Healthcare Alliance and co-chair of the CCR Workgroup -- (202) 452-0889, ctessier@mohca.org.

ASTM, MMS, HIMSS, and AAFP are hosting a series of consensus-building and content development meetings on the CCR, in order to involve government agencies, medical societies, other professional societies, state departments of public health, and others who may be interested in contributing to its development and adoption.  

The CCR promises dramatic improvements for disease management -- quality improvements for the patients we serve, and efficiency improvements for disease managers.  Please support the development and implementation of the CCR!

By Vince Kuraitis
Principal, Better Health Technologies, LLC

TODAY’S SHOPPING LIST FOR RADIO SHACK.... 

ü    Batteries

ü    Tape recorder

ü    Heart monitor

Heart monitor?  Yes.

Check out http://www.lifewiseonline.com/, then read the press release.

GROWING INTEREST IN TELEHEALTH TECHNOLOGIES

Progress and Possibilities: State of Technology and Aging Services 2003
Center for Aging Services Technologies, 2003

Caregiver Tech Slowly Evolves 
Wired; September 14, 2003

Keeping Patients at Home
Telemonitoring technologies help chronic disease patients receive care at home
Health Data Management, July 2003

Home monitoring gives health care by modem
Telemedicine: Heart patients are checked using devices that transmit over phone lines.
Baltimore Sun; September 22, 2003

Computer-Based Technology and Caregiving of Older Adults: Exploring the Range of Possibilities and Beyond
SPRY Foundation, 2002

Monitoring Mom
As population matures, so do assisted-living technologies
MIT Technology Review, July/August 2003

Repurposing Broadband: Home Health Technologies for the Worldwide Age Wave
Sandy and Dave’s Report on The Broadband Home; July 15, 2003

Telecommunications technology makes its mark on healthcare delivery
Managed Healthcare Executive, August 2003

Study Shows Patients Decrease Hospital Visits with Home Monitoring Equipment
ATSP Online; August 29, 2003

The Doctor Is In
Predicting and treating disease will get a whole lot easier when monitors are implanted
Forbes; September 1, 2003

DEPRESSION DM MOVES FRONT AND CENTER

Depression is a clinical condition that affects millions of people.  From a clinical perspective, it is highly amenable to disease management approaches.  The challenge has been creating the right business models for depression DM programs to take root.  As innovative companies continue to explore depression DM approaches, the business case for depression DM is growing stronger:

• Total productivity losses resulting from mental health disorders, of which depression is the most common, accounts for an average total work time lost of around 13 hours per week.
• 70 percent of all healthcare visits are driven by a behavioral factor.
• 66 percent of patients with depression never receive treatment.

New Program Illustrates Growing Interest in Depression Management
Disease Management News; August 25, 2003

Disease Management for Depression
The National Pharmaceutical Council, June 2003

EMPLOYER PERSPECTIVES

2003 Employer Health Benefits Survey
Kaiser Family Foundation & Health Education & Research Trust; September 9, 2003

Private health insurance premiums increased 13.9% in 2003, a larger increase than last year and the third consecutive year of double-digit increases. This annual survey tracks trends in employer health insurance coverage, the cost of coverage, and other topical health insurance issues.

Few respondents view current cost containment strategies as highly effective for reducing premium increases. When asked which cost containment strategies they thought were very effective, 22% of firms cited disease management; 14% said consumer-driven health plans (e.g., high-deductible plans with a health savings account); 10% listed ‘higher employee cost sharing;’ and 6% said ‘tighter managed care networks.’ Each of these strategies, however, was viewed as somewhat effective by about half of the respondents. (p. 141)
 

Other perspectives....

Californians Respond to Changing Health Benefits
Ready or Not: Consumers Face New Health Insurance Choices
California Healthcare Foundation/Harris Interactive; July 10, 2003

Employers push to change health behaviors
Employee Benefit News, August 2003

Employers come to terms with disease management contracting
Opinions vary about whether to call on vendors directly for DM services or to go through health plans
Managed Healthcare Executive, August 2003

STUDIES DESCRIBE IMPACT OF THE WEB ON PHYSICIAN-PATIENT RELATIONSHIPS

The Impact of Health Information on the Internet on Health Care and the Physician-Patient Relationship: National U.S. Survey among 1,050 U.S. Physicians
Journal of Medical Internet Research, September 2003

Results:  Eighty-five percent of (physician) respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician's feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship, in the quality of health care, or health outcomes. Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate, or the physician felt challenged.

The Impact of Health Information on the Internet on the Physician-Patient Relationship
Archives of Internal Medicine; July 28, 2003

Results  Of the 3,209 (patient) respondents, 31% had looked for health information on the Internet in the past 12 months, 16% had found health information relevant to themselves and 8% had taken information from the Internet to their physician. Looking for information on the Internet showed a strong digital divide; however, once information had been looked for, socioeconomic factors did not predict other outcomes. Most (71%) people who took information to the physician wanted the physician's opinion, rather than a specific intervention. The effect of taking information to the physician on the physician-patient relationship was likely to be positive as long as the physician had adequate communication skills, and did not appear challenged by the patient bringing in information.

UPDATES TO THE CHRONIC CARE MODEL

The Chronic Care Model is the most widely referenced framework for implementing chronic care management in local delivery systems.  Improving Chronic Illness Care, a national program of the Robert Wood Johnson Foundation, recently updated the model.

You can view the changes at the Improving Chronic Illness Care website. Minor changes and updates were made in the following areas:

• Patient Safety
• Cultural competency
• Care coordination
• Community policies
• Case management

WORTH REVIEWING!

The State of Health Care Quality 2003
National Committee for Quality Assurance; September 18, 2003

Weight Management and Obesity Symposium
The Permanente Journal, Summer 2003

Clinical Transformation:
Cross-Industry Lessons for Health Care
Deloitte Research, July 2003

Population-Based Disease Management Under Fee-For-Service Medicare
Health Affairs; July 30, 2003

Creating Better Systems of Care for People with Chronic Conditions: A Building Block Approach
California Center for Long Term Care Integration, July 2003

Declaring War on Chronic Illness
Health care providers need tools, technology, and the right incentives to provide patients state-of-the-art care.
Progressive Policy Institute BluePrint; June 30, 2003

Health searches and email have become more commonplace, but there is room for improvement in searches and overall Internet access
Pew Internet Project; July 16, 2003

Theme Issue -- Chronic Illness
Medical Journal of Australia; September 1, 2003

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC <http://www.bhtinfo.com/>.

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding initial customers, and developing key partnerships.

 Disclosure -- No clients were mentioned in this issue.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2003, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com, (208) 395-1197 or Harry Leider MD, MBA at harryl@bhtinfo.com, (410) 252-7361.