Going beyond healthcare IT inter-operability in chronic disease management

Chronic care consumes the majority of a nation's healthcare costs as it involves more specialists providing care over multiple visits for an extended duration of time. The role of healthcare information technology (HIT) in managing chronic care presents a significant opportunity for improvement. Interoperability has been seen as the stumbling block to HIT for achieving efficiencies in paperless patient care. Yet from a systems perspective, the integration challenge to effective delivery of healthcare appears to go beyond inter-operable HIT, especially in chronic disease management. A great deal of interaction takes place beyond the limited scope of information passed between disparate HIT systems. For example, the chronic patient plays a greater role through self-monitoring which means applications of HIT must extend beyond the premises of the various providers. This paper presents a systems approach to identify the key technologies and people involved in chronic care and more importantly, the likely interactions between them. An understanding of these system elements then become the basis for prioritizing future research and clinical interventions including the necessary scope and scale of inter-operability.