Challenges in Managing Chronic Diseases

EMRs enable better care

Gregory Larkin

Gregory Larkin

Chief Medical Officer Indiana Health Information Exchange USA


The majority of healthcare expenditure worldwide is spent towards treating chronic diseases like diabetes. Electronic Medical Records could prove effective in the management of chronic diseases, facilitating the delivery of quality healthcare to the patients.


In global healthcare industry, it is worth mentioning that incomplete patient information often leads to errors, misdiagnoses, patient safety issues and cost inefficiencies. While serious efforts are made to reduce error rates and increase levels of patient safety, IT solutions such as the Electronic Medical Record (EMR) are emerging as enablers of high-quality, cost-effective healthcare delivery.

But the question is, can EMRs really save money in both transaction-based and non-transaction-based healthcare systems?

Let's start with the landscape of EMR adoption. It's no secret that the EMR adoption of 20 per cent in US is well behind that in most European countries as well as China, Japan and Australia, just to name a few.

Last year, the Wall Street Journal Online / Harris Interactive indicated that a majority of Americans believe that EMRs can reduce healthcare costs while improving patient care. Yet, the number of US physicians using an EMR still hovers below 20 per cent.

Chronic Diseases - A growing concern
The majority of healthcare expenditure worldwide goes towards treating chronic diseases. Chronic diseases such as heart disease, stroke, cancer, diabetes and chronic respiratory disease are responsible for more than 60 per cent of deaths globally and are projected to account for 47 million deaths annually in the next 25 years. One chronic disease that is playing a leading role in complications and deaths is diabetes. Although the US is expected to experience a far more rapid increase in diabetes, according to estimates from researchers at the World Health Organization (WHO) and several European universities, the greatest relative increases will be in the Middle East, Sub-Saharan Africa and India. The economic consequences of the worldwide rise in diabetes are alarming. The WHO estimates that during 2005-2015, income loss (in international dollars) due to diabetes could rise to as much as US$ 558 billion in China, US$ 237 billion in India, US$ 33 billion in Russia and US$ 33 billion in the UK. According to the Milken Institute, the cost of treatment and lost productivity caused by chronic illnesses in the US is more than US$ 1.3 trillion per year and if the similar conditions prevail the costs could reach US$ 6 trillion by 2050.

However, a question still remains unanswered-can EMRs really reduce costs and improve outcomes? In my opinion, an EMR is a partial, but important element in addressing global health costs and concerns.

Implementation of a clinic-based EMR requires significant financial resources and can initially cause significant disruption in an office's established patient flow processes. Additionally, the typical installation of an EMR provides a new medical record system void of historic patient care data (which remains within the replaced paper-based system). To fully realise the potential of EMRs, their complexities need to be reduced, installation costs need to be lowered and historic care data needs to be easily captured.

Health Information Exchange (HIE)

HIE is one way to resolve these complex issues. HIEs serve as a community-wide electronic warehouse, which gathers healthcare information from a broad array of providers: physicians, laboratories, pharmacies, hospitals and imagery centres (Xrays, MRI, CT etc). A HIE securely aggregates and accurately delivers lab results, reports, medication histories, treatment histories in a standardised, electronic format to healthcare providers.

The data thus integrated and presented in a user-friendly standard format, helps physician interpret the patient's medical history easily.

In the US, this ability to provide an integrated patient medical record is considered important. According to the Journal of the American Society for Information Science and Technology (JASIST), 66 per cent of clinical visits in the US have unmet informational needs that are available elsewhere. HIE can help fill these gaps, creating an integrated clinical IT environment.

The technology is feasible and is working in several metropolitan areas in the US. A recent report by the State-Level Health Information Exchange Consensus Project found that more than 75 per cent of states have begun developing some form of HIEs. The Office of the National Coordinator for Health IT is leading the development of the Nationwide Health Information Network, a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers and others involved in supporting health and healthcare. The Center for Information Technology Leadership estimates that a nationally standardised and interoperable HIE can save US$ 77 billion per year in the US.

In addition to being implemented in an affordable and non-disruptive fashion, HIEs must also demonstrate value. In Indianapolis, Indiana, a metropolitan area in the US, it is estimated that the system saves US$ 26 per emergency department visit by not only eliminating duplicate tests, but also allowing the physician to make better and more informed care decisions. For example, the savings could reach US$ 450 billion a year nationally by helping physicians pick optimal therapies and alerting physicians to potential drug interactions.

Other countries, too, are looking at implementing similar HIE solutions. China, Canada and the UK are some of the leading examples of countries that are supporting their national infrastructures to bring in interoperability among their HIEs.

Benefits of implementing HIEs

For patients and physicians across the globe, the benefits of EMR are numerous. The frustration of remembering names of the medicines and doses for patients would be a thing of the past. These records could prevent unnecessary repetition of tests and delay in access to the information related to the test results. The physicians will have information at their fingertips where it is most critical-at the point-of-care. In critical times when the patient may be unable to communicate with the physician or remember key medical information, HIE could provide much needed help to the patient.

In addition to being essential to realising the potential of EMRs (which can be populated with information via a HIE), the greater value in the data within a community. HIE lies beyond simple distribution. HIE may offer the opportunity to utilise these data in new and innovative ways, such as arming physicians with information to proactively reach out to their patients, all without requiring expensive new equipment or software packages to users. This is where the true value of health IT lies and offers the best opportunities for improving outcomes and demonstrating the value of health IT. In other words, the community's long-term benefit of a viable HIE is the identification and improved management of chronic and disabling diseases.

Role of HIEs

HIEs hold the potential to improve community chronic disease management by the integration and transmission of the patient's care history and needs. The concept for one such chronic disease management programme is underway in one US city. Physicians receive monthly reports with the complete details of their patients. They include details of all the patients, chronic disease they are suffering from, the patients who receive care compliant with the best standards and the patients who need care intervention.

From these reports, for instance, physician could know if a patient with diabetes recently had any test to determine the disease control and also whether he needs a more aggressive treatment. Thus, physician could focus on the patients who are in need of better control and improve the diabetic care of all his / her patients. An interesting additional benefit of this HIE-generated report is that the details of the patients with targeted chronic disease are constantly updated automatically. Such dynamic listing of the information in paper-based systems is very problematic

Global healthcare improvements mandate more efficient chronic disease management due to both the high costs and significant subsequent disabilities and death. Chronic illness requires historic medical data to equip the care giver with a complete picture of the patient's needs. HIEs equip both the community and the physician with the tools necessary for a high quality of care and optimum utilisation of healthcare resources.


As a physician, I am keenly aware that healthcare is about decision-making. Improving the speed and accessibility of information allows physicians to operate more efficiently, eliminate uncertainties and make better decisions. Technology by itself doesn't do this, but it does facilitate it.

The adoption of HIEs across the globe cannot be simply viewed as advancement of 21st century's technology. Instead, HIEs will be instrumental in reducing the impact of disease burden on all communities. HIEs do much more than simply sharing medical data; they provide patient's history and treatment no matter where the patient travels and provide community and individual disease care needs. Undoubtedly, as HIEs' databases become expansive, they could play an important role in the discovery of life-saving discoveries.


Gregory Larkin was the Director of Corporate Health Services for Eli Lilly and Company, a global pharmaceutical research and manufacturing company before joining the Indiana Health Information Exchange as its Chief Medical Officer, He is a Fellow of the American Academy of Family Practice, and a Fellow of the American College of Occupational and Environmental Medicine (ACOEM), and the President of the Indianapolis Medical Society.