A study of eHealth enhanced Chronic Disease Management in a large regional health service

Abstract

Background The health care system is a dynamic environment undergoing constant change, and it has been greatly influenced by modern information and communication technology. Implementing health information technology interventions has become a priority in policy agendas internationally. Healthcare practice supported by digital technologies usually comes under the broad name of “eHealth”. Policy makers around the global have endorsed the use of eHealth technologies to improve health and health care systems. However, despite these best intentions, implementing sustainable and effective e-Health interventions within clinical settings, and in alignment with the existing health education and technology enterprises, remains a challenge. Aim Since the development of the Chronic Care Model (CCM) by Wagner in 1998, numerous information management systems have emerged and communication and technology advances have been established. Information and Communication Technology to support clinical care for people with chronic conditions is a particular challenge. The CCM places chronic care "in the context of the community where the person will receive health care services and with the health systems involved in that care" (Wagner 1998). This thesis focused on the adoption of eHealth enhancements of chronic care delivering to achieve effective use of eHealth tools, in a context where both health and efficiency matter. By considering the clinical information systems to accomplish easy data, information and knowledge exchange needed to improve health, and identifying good implementation strategies for eHealth interventions in chronic disease management. This thesis takes up the challenge by examining the impact of the current establishment of eHealth interventions in chronic care to improve the CCM with clinically efficacious eHealth tools. This study investigates the use and development of certain commonly rewired eHealth tools in a regional health service. The objective is to study the implementation of eHealth enhanced chronic disease management located in a well-funded regional health service committed to the chronic care model in order to generate insights into the more meaningful use of eHealth tools in chronic care. Setting and method ACT Health is the largest health service provider in the ACT. The research was conducted in ACT Health and based in the Chronic Disease Management Unit (CDMU). This research project uses three interlinked case studies to address the research questions and combines observations from the case studies with the literature findings. Qualitative methods including participant observation, interview and documentary review have been used. Results The study gained insights into implementation of eHealth tools and consider their impact on chronic care management in the regional health service. A number of key findings emerged from this research. The findings from each of the case studies were as follows: Case Study 1: The implementation of a Chronic Disease Management Register (CDMR) in ACT Health illustrates the user of eHealth interventions for chronic care management. Key enablers included: active support from ACT Health; technological readiness and patient- centered database design. However, the CDMR is only able to contribute to improve care coordination in a limited way. Key barriers involve: low quality and incomplete datasets; poor technical governance; human resource constraints; inefficient data sharing and limited access; incomplete reports with limited value and a lack of communication for improvement. Case Study 2: Integration of health care services is bound up with the eHealth transition trajectory over time. The Chronic Care Program with its goal of integrating care is dependent on transformation. The user of electronic clinical forms is an early step towards the proposed fully integrated electronic health record in ACT Health under the Australia National eHealth strategy. This development is still in its preliminary stage, so there has been limited meaningful use of data, and lack of evaluation for services performance and outcome measurement. EHealth tools that are used by the clinical team for data capture, storage and utilization require further design and development. The first step is to develop a person-centered database which is capable of electronic sharing of data within the service, to be followed in due course by integration of records within and between the primary, community and hospital service which supporting multidisciplinary care planning and shared care for chronic disease patient. Case Study 3: There is a need to improve the use of information technology in Obesity Care in the local health service. This will allow the forthcoming suite of eHealth applications to relieve the overwhelming administrative side burden and best support the patient care they provide. The eHealth interventions demanded by clinicians involve formalization of clinical forms and patient handouts; development of an electronic filing system and development of a case management recall system. Looking across the case studies to consider the insights gained for the broader aim of the study, we have identified the rationales behind the slow adoption of eHealth implementation in current health care settings, the eHealth innovation impacts on people, environment and contexts in which they exist, and necessary steps for preparing the future IT innovations in a similar healthcare setting. While these findings are specific to Chronic Disease Management in the ACT Health Service, they are applicable to other similar setting regional health care services from national to local, and to all public health domains. Conclusion Healthcare is complex due to its nonlinear, dynamic, and unpredictable nature. As it changes and progresses, it is likely to implement smaller and more networked systems. Implementing new applications and specific services must be needs driven. In most cases, eHealth innovations that are introduced into health care need to interact with pre-existing systems that are likely to be site specific and particular with limited flexibility. A useful eHealth intervention needs to be tailored to local contexts if it is to be effective in implementing a sustainable eHealth solution. The research provides detailed insights and recommendations to further strengthen chronic care management processes. Show more