Dorr D et al. 2007 "Informatics systems to promote improved care for chronic illness: a literature review."

Dorr D, Bonner LM, Cohen AN, et al. Informatics systems to promote improved care for chronic illness: a literature review. J Am Med Inform Assoc 2007;14(2):156-163.
"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 health care 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."
To "understand the specific information technology components important for success" in supporting and improving care for chronically ill patients.
not applicable
Type of Health IT
Decision support system
Type of Health IT Functions
The functions varied across the articles reviewed.
Workflow-Related Findings
"Decision support was moderately helpful [improving the relationship between system components and study measures] in the form of computerized prompts, but were related to failure when only electronic access to guidelines were provided through the system."
"Decision support's effect on guideline adherence was assessed in 19 studies with 79% (15) positive and 21% (4) neutral assessments. Change in visit frequency ... was assessed in ten studies with 50% in the positive direction and 50% neutral. Documentation ... was assessed in six studies with 83% (five) positive and 17% (one) neutral assessment. Treatment adherence... was assessed in three studies with 67% (two) positive and 33% (one) neutral assessment. Change in referral rate was assessed in two studies; both had neutral results. Screening and testing was assessed in two studies; both had positive results."
Barriers to the adoption of health IT systems "included concerns about the impact of health IT use on the clinical encounter, security issues, and concerns about resources. Failure to consider increased time to use the system or alteration in workflow were also barriers."
Usability recommendations included general workflow suggestions, including "designating one person to handle all on-line messages, enabling real-time data entry for synchronous decision support."
"Reported unintended outcomes [of decision support implementation] were mostly positive and included improved communication and more efficient workflow."
"Alerts and reminders raised some concerns about the ability to ignore them and providers' fears of being overwhelmed by too many messages."
"Although few studies presented a formal usability assessment, many included a discussion of the importance of usability for system adoption and sustained use. Ease of use and respect for providers' time constraints are important usability considerations."
Study Design
Systematic literature review
Study Participants
The authors conducted a search using the following databases: MEDLINE, PREMEDLINE, Business Source Premier, ABI, and the Cochrane Library. Overall, 704 abstracts were found using the authors' search strategy. Of these, 158 were "chosen as highly relevant ... by two reviewers. In all, 16 were reviews and 33 did not meet minimum criteria, leaving 109 articles with 112 system descriptions."