Emerging information management technologies and the future of disease management.

Disease management (DM) has become a widely accepted way to support care delivery in the chronically ill patient population. Patients enrolled in these programs have been shown to have better health, fewer complications and comorbidities, and lower health care costs. The development of advanced information management technologies is further enhancing the role DM plays in optimizing outcomes and cost-effectiveness in clinical care. These emerging information management technologies (EIMT) include advances in software, hardware, and networking, all of which share common impact attributes in their ability to improve cost-effectiveness of care, quality of care, and access to care. Specific examples include interactive websites with the ability to engage patients in the self-care management process, the embedding of biometric devices (digital scales, modem-enabled glucose meters in the home, blood pressure monitoring, etc.), workflow and care coordination programs that add intelligence via guideline-directed alerts and reminders to the delivery process, registries that include a summary of personal health data that can be used as a reference point for improved clinical decisions, and the systematic collection of aggregated, de-identified clinical, administrative, and cost data into comprehensive data sets to which predictive modeling analytic tools can be applied. By way of case example, we also present data from a controlled clinical trial utilizing EIMT in the form of home-based weight measurement using a digital scale and linkage to a care coordination center for the management of severe congestive heart failure. Outcome results on 85,515 patient-months of an aggregate commercial and Medicare continuously enrolled population demonstrated an average reduction of care utilization (hospitalization) of 57% and a reduction in related delivery cost (per member per year payments) of 55%. We conclude that EIMT have already begun to offer significant and quantifiable benefits to DM and are likely to become heavily embedded in care management strategies in the future.