The use of health information and communications technologies (ICTs) to improve chronic care "is still in its early days," according to research at Health Affairs comparing approaches used in Australia, Canada, Denmark and the U.S.
The study looked at four types of solutions: electronic health records (EHRs), health information exchange (HIE), telehealth, and patient self-management tools.
The next five years will be critical in addressing common issues, the authors say, adding that common challenges present the opportunity for nations to learn from each other.
Australia has comparatively high EHR adoption (92 percent) and moderate health information exchange adoption (27 percent). The U.S. and Canada have comparatively moderate EHR adoption (around 50 percent) and low levels of HIE. Denmark, meanwhile, has high EHR adoption (more than 80 percent among primary care providers) as well as high HIE adoption (90 percent).
All the countries have adopted national strategies, but have yet to scale successful regional pilots, meaning some areas of the countries are doing better than others.
None has achieved seamless HIE across all clinical settings, which is essential for care coordination. All are struggling to make data follow the patient.
Though all are incorporating telehealth into chronic care, those efforts tend not to be integrated with EHR systems, limiting access to tools such as clinical decision support. And while all have improved patient access to their own data, they're still puzzling over how to motivate patients to use that information to improve their health.
Yulun Wang, president of the American Telemedicine Association Board of Directors, recently called telemedicine a "cornerstone" solution to efforts to improve care and cut costs, with chronic care a prime area where improvements can be realized.
The strategies differ. Canada and Australia, for instance, are focusing care-coordination efforts on a single repository for patient data--though that depends on physicians regularly contributing to it. Denmark and the U.S., in contrast, take the point-to-point approach that allows physicians to share data most relevant to a particular care transition.
The optimal solution, according to the authors, might be a hybrid approach. And some stakeholders in the U.S. have told the Office of the National Coordinator for Health IT that there is no perfect architecture for EHRs and data sharing.
Some think adoption of these systems is not the key to better care. Healthcare IT efforts should be focused on how technology can be part of innovative strategies to improve care, according to a recent blog at Health Affairs that criticizes the use of EHRs as just billing tools.
To learn more:
- read the abstract