Using EMRs for Chronic Disease Management

In the past, I have written numerous articles describing the benefits and potential uses for EMRs for the management of patients with chronic diseases such as diabetes and congestive heart failure. In this context, EMRs are very good at performing repetitive tasks in a standardized manner such as reminders for patient recall or electronic tracking of lab results. At the same time, it has become abundantly clear that management of chronic diseases in 2013 is a team-based care process with the need to access or input information into some form of shared care record. This is not a simple task, but certainly can be managed more effectively using an EMR vs. a paper-based record.

One of the challenges with patients who suffer from chronic diseases such as diabetes is the fact that many of these patiens also have multiple additional co-morbid diseases such as chronic kidney disease, peripheral vascular disease, hypertension, etc. Each of these diseases has clinical practice guidelines that have been developed by expert groups (either national or provincial). Many disease states have different expert groups that devise the clinical practice guidelines, creating a great deal of difficulty when translating these rules and recommendations into an EMR system. For example, if the best practice for a patient with two co-morbid diseases is a specific dose of a certain drug for one disease and a higher (or lower) dose for the other disease, which one takes precedent? The same may apply to diet restrictions with variations in dietary guidelines for each of the diseases. Because clinical practice guidelines are developed for single disease states, and because the clinical presentation of each patient may vary, developing a rigid set of rules or guidelines is difficult for multiple disease states in the same patient — particularly when conflicting recommendations may need to be applied via the EMR.

The advantage in Canada is that physicians (particularly in primary care) have now been using EMRs for a number of years to manage these types of patients. How do you manage patients with co-morbid chronic diseases? What types of templates do you use? Have you found a way to manage this problem that could be of use to colleagues?

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