3040 — Informatics Supporting Chronic Illness Care: An Implementation Challenge

Bonner LM (Northwest COE for Outcomes in Older Adults), Chaney EF (Northwest COE for Outcomes in Older Adults), Rubenstein LV (Sepulveda COE for the Study of Healthcare Provider Behavior), Vivell S (Sepulveda COE for the Study of Healthcare Provider Behavior), Lysell K (Associate Chief Consultant for Healthcare Informatics), Fortney JC (Center for Mental Healthcare and Outcomes Research)

Objectives:
Evidence-based quality improvement (QI) interventions in VA care depend upon information technology (IT) including reminders, decision support, and panel management tools. IT underpinnings for evidence-based Chronic Illness Care (CIC) Model type approaches, however, have not yet been fully developed. We worked with experts to identify approaches for designing and implementing VA IT support for such models.

Methods:
Experts identified key informatics features, using depression and schizophrenia care models as working examples. We programmed these features and conducted a usability evaluation. We convened a formal Expert Panel using a modified Delphi approach to discuss results and provide strategic guidance on promoting integration into standard VA IT. The panel consisted of representatives of several QUERI groups, Mental Health Patient Care Services staff, care managers and VA OI personnel.

Results:
Usability testing highlighted specific content and design issues. Key IT features for depression care models include: protocol-based assessment logic, tracking of patient status on objective measures over time, panel management, and generation of clinical notes. Key additional content concerns include stigma and caregiver support. Experts recommended linking with national IT development processes to implement informatics innovations, as well as continued local development and testing of specific features. Experts also recommended a business case analysis to more fully assess the potential impacts of the suggested features as part of routine VA IT.

Implications:
Availability of VA IT features supporting evidence-based CIC models is critical for VA QI success, especially for mental health conditions. Implementation and integration will require coordination between researchers and informatics experts. Expert panel methodology combined with local innovation and national cooperation is a potential path to ensure uptake and implementation of informatics developments.

Impacts:
Improved IT support for systematic assessment, follow-up, and coordination of care for mental health conditions is essential if VA goals for achieving high quality mental health care for OEF/OIF and other veterans is to be achieved. Systematic planning for moving researcher-tested IT features into the process of VA IT development are needed.