PLoS: Health IT can improve cardiovascular risk management

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IT-based programs can improve cardiovascular disease (CVD) management and patient empowerment, but must be accompanied by supportive social and political environments and active patient and clinician engagement, according to an article published online Aug. 24 in PLoS Medicine.

“Despite good evidence for the effectiveness of CVD management, large gaps between what is known and what is actually done in healthcare remain,” wrote Sue Wells, from the epidemiology & biostatistics department at the University of Auckland in Auckland, New Zealand, and colleagues. “IT has the potential to support clinicians to close these gaps throughout processes of care delivery.”

The authors wrote that three major benefits were found in a systematic review for quality of care (particular in association with preventive care):

  • Increased adherence to guideline-based care;
  • Enhanced surveillance and monitoring; and
  • Decreased medication errors.

The authors suggested that computerized decision support (CDS) systems can rapidly and automatically convert the recommendation from evidence-based syntheses into guidance for clinicians, tailored for an individual patient’s profile. “Systematic reviews have found moderate evidence of CDS effectiveness with respect to provider processes and performance, but the effect on patients outcomes are understudied and, where research has been conducted, inconsistent,” wrote Wells and colleagues.

However, the authors stated that CDS systems, while using e-prescribing and e-referral, can form the basis of shared goal setting and the development of care plans for risk reduction believing that instant electronic access and registration into self-management programs remove barriers and involve the primary care provider to motivate and tailor appropriately to the individual’s risk profile.

According to Wells and colleagues, the benefits of implementing a systematic health IT approach could include improvements in the quality of care, reduced duplication, improving access to services in areas of growing demand and limited resources and improved monitoring and evaluation. “However, while some health IT systems implementations succeed, the majority are likely to fail,” the authors warned. “The greater the personal and organizational change required by a system, the greater the risk of failure.”

Adverse effect of health IT implementation can include increased time for direct and indirect patient care, the loss of privacy and confidentiality and possible changes to the doctor-patient relationship, according to the authors. The time commitment involved with learning and implementing new systems may be substantial. The set-up costs of computerization and implementation of health IT can be large and require ongoing investment.

"Furthermore, IT is a rapidly evolving science," Wells and colleagues wrote. "By the time a large-scale project is completed, technology has often moved on."

CVD management requires partnerships between providers and patients, between staff within an institution, between service providers in the primary care setting and between primary, secondary and tertiary care services, Wells and colleagues stated. “For IT to achieve the potential to close the gap between evidence and practice and translate into positive patient outcomes there needs to be teamwork and a change in the way clinicians and services work together,” the article concluded.

The essay can be found here.