title: Information technology to support improved care for chronic illness.
abstract: BACKGROUND
  In populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as electronic medical records, to varying degrees. However, considerable uncertainty remains regarding the relative impact of specific informatics technologies on chronic illness care.
  
  
  OBJECTIVE
  To summarize knowledge and increase expert consensus regarding informatics components that support improvement in chronic illness care.
  
  
  METHODS
  A systematic review of the literature was performed. "Use case" models were then developed, based on the literature review, and guidance from clinicians and national quality improvement projects. A national expert panel process was conducted to increase consensus regarding information system components that can be used to improve chronic illness care.
  
  
  RESULTS
  The expert panel agreed that informatics should be patient-centered, focused on improving outcomes, and provide support for illness self-management. They concurred that outcomes should be routinely assessed, provided to clinicians during the clinical encounter, and used for population-based care management. It was recommended that interactive, sequential, disorder-specific treatment pathways be implemented to quickly provide clinicians with patient clinical status, treatment history, and decision support.
  
  
  CONCLUSIONS
  Specific informatics strategies have the potential to improve care for chronic illness. Software to implement these strategies should be developed, and rigorously evaluated within the context of organizational efforts to improve care.
authors.affiliation: West Los Angeles VA Healthcare Center, VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), 11301 Wilshire Blvd. (210A), Los Angeles, CA 90073, USA. ayoung@ucla.edu
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Young
authors.forename: Edmund
authors.initials: E
authors.lastname: Chaney
authors.forename: Rebecca
authors.initials: R
authors.lastname: Shoai
authors.forename: Laura
authors.initials: L
authors.lastname: Bonner
authors.forename: Amy N
authors.initials: AN
authors.lastname: Cohen
authors.forename: Brad
authors.initials: B
authors.lastname: Doebbeling
authors.forename: David
authors.initials: D
authors.lastname: Dorr
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
authors.forename: Eve
authors.initials: E
authors.lastname: Kerr
authors.forename: Paul
authors.initials: P
authors.lastname: Nichol
authors.forename: Ruth
authors.initials: R
authors.lastname: Perrin
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D007256:Information Systems; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs