Informatics support for chronic illness care poses important challenges. The prevailing model for effective chronic illness care focuses on healthcare system requirements to enable productive interactions between an informed, activated patient and a prepared, proactive practice team. Informatics support has been discussed as a means of supporting these interactions, but research to date has not yielded definitive answers about the required features of such an informatics system.
The objectives of this project were as follows: to achieve consensus among experts about the informatics support requirements for collaborative chronic illness care and to develop an informatics application to support collaborative care, specifically targeted towards depression and schizophrenia, but modifiable to support other disorders.
The project consisted of three linked phases. The goal of Phase 1 was to produce a document reflecting expert consensus regarding the required structure and content of an informatics module to support collaborative chronic illness care. We conducted a literature review to identify the essential aspects of previously developed informatics systems. We also convened an expert panel, composed of clinical and informatics expert from VA and non-VA settings. Expert panel members responded to a survey and participated in an in-person panel discussion about informatics content and format. The goal of Phase 2 was to apply the consensus achieved in Phase 1 to designing a collaborative care informatics module for depression and schizophrenia. Phase 3 includes evaluation of the software by end-users.
Phase 1: The literature review indicated that the following elements are closely correlated with positive experimental results: connection to an electronic medical record, computerized prompts, population management, specialized decision support, electronic scheduling, and personal health records. The expert panel agreed that informatics should be patient-centered and focused on improving a broad range of outcomes, and should include systems to routinely obtain automated data regarding patients' clinical status. Phase 2: We have completed development of the depression-specific software. The software includes individual patient assessment screens and panel management features as well as graphing progress over time at the patient and panel levels. The development of the schizophrenia-specific portion of the software continues. Phase 3: Usability assessment of the depression software is ongoing. Depression care managers have completed standardized assessments of the software and have provided qualitative and quantitative feedback. We are continuing data collection at present.
Software to support chronic illness care needs to work on multiple levels including assessment of individual patients and management of provider/care manager panels. Ease of use is an important consideration and includes such features as graphical displays and non-text data entry (where appropriate).
The CHIACC software is not currently integrated into the VA medical record. However, the knowledge gained in this project has been disseminated through presentations, publications and through participation of project staff on MyHealtheVet workgroups. Discussions are underway about implementation of a limited version of the software in Mental Health Primary Care Integration sites. Discussions with the Department of Defense (DoD) are underway regarding potential use in DoD efforts to improve mental health care. For schizophrenia, an internet-based, audio, computer-assisted self-interviewing system has been developed that collects routine outcomes data. This "PAS" system has been shown in research to be reliable, valid, and feasible to implement. The CHIACC team worked with the VA mental health informatics group to integrate this self-assessment approach with the VA medical record (VistA). Proof-of-concept software was developed and indicates that this should be possible. Final software development and deployment has been delayed by national informatics reorganizations in VA. Discussions continue to make this integration possible.
- Fortney JC, Pyne JM, Steven CA, Williams JS, Hedrick RG, Lunsford AK, Raney WN, Ackerman BA, Ducker LO, Bonner LM, Smith JL. A Web-based clinical decision support system for depression care management. The American journal of managed care. 2010 Nov 1; 16(11):849-54.
- Young AS, Chaney E, Shoai R, Bonner L, Cohen AN, Doebbeling B, Dorr D, Goldstein MK, Kerr E, Nichol P, Perrin R. Information technology to support improved care for chronic illness. Journal of general internal medicine. 2007 Dec 1; 22 Suppl 3:425-30.
- Dorr D, Bonner LM, Cohen AN, Shoai RS, Perrin R, Chaney E, Young AS. Informatics systems to promote improved care for chronic illness: a literature review. Journal of the American Medical Informatics Association : JAMIA. 2007 Mar 1; 14(2):156-63.
- Bonner LM, Chaney EF, Rubenstein VL, Vivell S, Lysell K, Fortney JC. Informatics Supporting Chronic Illness Care: An Implementation Challenge. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD.
- Young AS. Implementing Recovery-Oriented, Evidence-Based Practices in Schizophrenia. Paper presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2007 Jul 19; Alexandria, VA.
- Bonner L, Chaney EF, Fortney JC, Goldstein MK, Nichol P, Oslin D, Perrin R. Developments in information health technology: Integrating and evaluating IT to improve management of complexity in chronic care (Workshop). Paper presented at: VA HSR&D National Meeting; 2007 Feb 23; Arlington, VA.
- Young AS, Chaney EF, Bonner L, Cohen AN, Shoai R, Dorr DA, Goldstein M, Kerr E, Perrin R. The CHIACC Project: Characterizing Information Technology that Supports Improvement of Chronic Illness Care. Poster session presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.
- Chaney EF. Creating Health Informatics Applications for Collaborative Care of Chronic Illnesses. Paper presented at: AcademyHealth Annual Research Meeting; 2006 Jun 27; Seattle, WA.
- Bonner L, Chaney EF, Young A, Dorr D, Cohen A, Kerr E. Expert Consensus for Chronic Illness Care Informatics Priorities: The CHIACC Expert Panel. Poster session presented at: AcademyHealth Annual Research Meeting; 2006 Jun 26; Seattle, WA.
- Dorr D, Cohen AN, Bonner L, Shoai R, Perrin R, Young AS, Chaney EF. Composition of information systems to support collaborative care of chronic illness. Paper presented at: American Medical Informatics Association Annual Symposium; 2006 May 1; Phoenix, AZ.
- Cohen AN, Young AS, Chaney E, Bonner L, Dorr D. CHIACC: Creating HealtheVet informatics applications for collaborative care. Paper presented at: VA HSR&D National Meeting; 2006 Feb 1; Arlington, VA.
Mental, Cognitive and Behavioral Disorders, Health Systems