Interoperability and the Future of Disease Management

By Marybeth Regan, Ph.D., for HealthLeaders News, September 28, 2006

A trip to the emergency room has the potential to turn out one of two ways. Scenario one: A woman is taken to the ER where clinicians have knowledge of her medications and recent surgery. As a result, the doctors know precisely what they should and should not prescribe. Scenario two: A man is transported to the ER following a car accident. His family is unavailable. His physician recently changed his prescription for hypertension medication. His employer just switched his drug benefit plan, and the prescription history has yet to be transferred. He hasn't felt well for several days. The ER has no history of these past events.

What is the likelihood that the preferred scenario will occur in any given ED? Both disease management--the proactive management or prevention of chronic conditions like diabetes and asthma through the deployment of practice guidelines focused on proven treatments--and access to patient information are missing in the second ER example. Without access to care history, patients' lives are at risk.

The healthcare community’s ability to deliver the best possible care relies on the expertise of caregivers coupled with access to information about the patient. Today, however, an unacceptable disconnect exists between the caregiver and the patient’s medical record. As long as it continues, this disconnect will delay the progress of disease management as an invaluable aspect of patient care.

System connectivity supports disease management efforts in several ways:

• Reduced variability in access to care


• Increased consumer engagement


• Strengthened privacy and data protection


• Promotion of public health and preparedness


• Avoidance of medical errors


• More efficient use of resources


• Accelerated diffusion of knowledge

Unfortunately, the system is nowhere near the point of having the kinds of communication capabilities that will make these benefits possible. Interoperability--enabling communication across software and hardware from multiple sources--is hard to attain and won’t happen quickly, but is the future of care and disease management.

Connecting the disease management dots

Disease management engages physicians and support-service providers in devising and maintaining a plan of care for a patient. The basis for disease management is the exchange of information between practitioner and patient. Over the past few years, the majority of payors in the United States have adopted disease management programs, which actively monitor and manage the treatment of the chronically-ill based on their case history.

Disease management rests on four main tenets:

• Enhancing communication among populations with conditions in which patient self-care efforts are significant


• Supporting the physician or practitioner relationship to the patient and the plan of care


• Emphasizing prevention of disease exacerbations and complications by using evidence-based practice guidelines and patient empowerment strategies


• Evaluating clinical, humanistic and economic outcomes on a going-forward basis with the goal of improving overall health

Each of these aspects of care could be supported and advanced with increased interoperability in several ways:

• Connectivity increases communication and enhances self-care


• Through better exchanging of information that can be gathered as a result of interoperability, communication is more efficient and more complete.


• The consolidation of medical information allows clinicians to see the full picture of the patient's care which can prevent complications.


• With the exchange and consolidation of information, the patient is empowered to be a partner in their care.

The collection of data is important to evaluate all aspects of disease management. Required data can be used on a patient-specific basis and also be accumulated in aggregate. Just as costs have skyrocketed to achieve the quality of healthcare everyone expects and demands, the amount of information available has also increased. Disease management cannot be successful without data to manage the full continuum of care. Only by putting consolidated information in a useable format can a patient be managed across the full care spectrum.

Missing parts

Despite all the potential efficiency it could produce and lives it could save, no access to medical information on individuals is available nationwide. Recent events, like Hurricane Katrina, the World Trade Center disaster, the Pentagon attack, anthrax threats and fears of the spread of avian flu, have further underscored the need for a National Health Information Infrastructure. After Hurricane Katrina, many people walked into pharmacies and were only able to tell pharmacists the color of the pills they took. In one hospital, a physician reconstructed chemotherapy regimes for 80 children from New Orleans. Such dire situations have crystallized the need to respond effectively and rapidly in a coordinated fashion when disaster strikes, but this kind of information should be made available at any time.

Only when healthcare achieves interoperability will the system be able to provide comprehensive and accurate patient information in an electronic health record that can be put to effective use by disease management programs. Ideally, the infrastructure to produce this level of connectivity should be in the form of an integrated, patient-directed, seamless, portable, nationwide health support system--a comprehensive knowledge base that is capable of providing information to all parties that might need it to support healthcare decisions. Emergency care, personal health, clinical research and public health should all be supported through a national network. As a consequence, the positive results disease management programs are able to produce will no doubt increase.

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Marybeth Regan, Ph.D. , is an expert in disease and care management and author of numerous articles on strategies for care and disease management. She may be reached at Drmarybethregan@aol.com.