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First published January 9, 2007 as JAMIA PrePrint; doi:10.1197/jamia.M2255
Journal of the American Medical Informatics Association 2007;14(2):156-163
© 2007 American Medical Informatics Association

A more recent version of this article appeared on March 1, 2007
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Submitted on August 24, 2006
Accepted on December 12, 2006

Informatics systems to promote improved care for chronic illness: A literature review

David Dorr MD, MS1*, Laura M. Bonner PhD2, Amy N. Cohen PhD3, Rebecca S. Shoai MPH, MSW3, Ruth Perrin MA4, Edmund Chaney PhD2, and Alexander S. Young MD, MSHS5

Affiliation of the authors: 1 Oregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology, Portland, OR ; 2 VA VISN 20 Health Services Research and Development Center, Seattle, WA ; 3 VA Desert Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), Los Angeles, CA ; 4 VA Information Resource Center (VIReC), Hines, IL; 5 VA Desert Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), Los Angeles, CA; University of California, Los Angeles (UCLA)

* To whom correspondence should be addressed.

Objective To understand information systems components important in supporting team-based care of chronic illness through a literature search.

Design Systematic search of literature from 1996-2005 for evaluations of information systems used in the care of chronic illness.

Measurements The relationship of design, quality, information systems components, setting, and other factors with process, quality outcomes, and healthcare costs was evaluated.

Results In all, 109 articles were reviewed involving 112 information system descriptions. Chronic diseases targeted included diabetes (42.9% of reviewed articles), heart disease (36.6%), and mental illness (23.2%), among others. System users were primarily physicians, nurses, and patients. Sixty-seven percent of reviewed experiments had positive outcomes; 94% of uncontrolled, observational studies claimed positive results. Components closely correlated with positive experimental results were connection to an electronic medical record, computerized prompts, population management (including reports and feedback), specialized decision support, electronic scheduling, and personal health records. Barriers identified included costs, data privacy and security concerns, and failure to consider workflow.

Conclusion The majority of published studies revealed a positive impact of specific health information technology components on chronic illness care. Implications for future research and system designs are discussed.




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