The Chronic Care Technology Project

The Chronic Care Technology Project (CCTP) was developed to improve the quality, efficiency, and safety of care of rural patients with chronic illness by implementing appropriate technology solutions that facilitate the transfer of patient care information among health care providers and between providers and patients. Twenty-eight health care teams, including five nursing homes, seven physician's practices, three hospitals, six rural health centers, one mental health center, one tribal health center, three homecare services, one community action program, one industrial health program, and one pharmacy service participated in this 3-year project.

The CCTP was developed by the Institute for Medical Improvement (IMI) in partnership with the Eastern Maine Healthcare Systems and the Arrostook Medical Center. The IMI was intended to be a collaborate effort involving physicians, employers, payers, hospitals, and patients that would take a proactive approach to ensure the delivery of evidence-based health care services in rural settings. Specific technology solutions were determined though regional learning collaboratives consisting of health care providers and related stakeholders.

Major projects undertaken by the teams included:

1. Hospital electronic health record access by nursing home staff.
2. Electronic Prescribing.
3. Electronic ordering of patient homecare supplies.
4. Fax server implementation, phone system redesign and implementation of secure e-mail in primary care settings.
5. Decision support system implementation for patient care and triage in primary care practices.

In addition, two regional health Web portals were created to provide a source for basic health and wellness and chronic disease self-management information, including a calendar of local health-related educational events and a searchable database of local health and wellness resources.

Participating teams were brought together for three learning sessions over the course of a year, with monthly onsite coaching sessions. One collaborative was run in the Aroostook County area and a second was run in the Penobscot and Piscataquis Counties area. The learning sessions were intended to provide participants with information on the project, to provide them with tools needed to select and implement changes, to facilitate team-building, and to facilitate work across the organizations. Between learning sessions, teams tested and implemented changes at their organizations.

Interviews with team leaders revealed that some perceived changes made during the project as very useful to their organization, citing improvements in practice workflow, patient safety, and provider and staff satisfaction. In other cases, team leaders anticipated that technology and process changes would become more useful as time went on because they had not yet been completed. Other team leaders reported that they would become more useful as they became more widely accepted among external customers. Finally, still other team leaders reported that the changes would have occurred with or without the participation in the collaborative.