Much of the resources of the US health care systems are devoted to the management and treatment of chronic conditions. Managing chronic health conditions such as diabetes, high blood pressure, heart disease, and hypothyroidism is an important part of the work of the most basic health care physician. In the conventional model, the physician sees a patient for a healthcare incident, examines the status of the conditions, makes suggestions, changes medications, and instructs determined testing. Patients are re-counseled when asked to return for follow-up care.
For years, best practices have used a medium to examine some or all of their patients with chronic medical problems using a disease record. In chronic care management services, the patients with a disease, for example diabetes, are registered in a database, either a paper registry file or a digital data store. The database contains some information about the status of the patient. For example, in a diabetes database, the detail could be the last LDL cholesterol, last blood pressure, last diabetic foot exam, last kidney damage test, date of last dilated eye exam, and date, as well as their smoking status.
The database required to enter this data is maintained in the repository each time a new piece of data is obtained and acts as an aid in periodically examining the patients. A digital medical file is used for the treatment of the patient. This documentation contains the finest details of information in a way that can be retrieved electronically, by entering the information into the EHR in such a way that it can be retrieved for future use, and to form a report or system that supports the creating a registry for remote disease management. . This has enabled reform-minded physicians to proactively serve groups of patients with certain chronic medical problems.
The chronic care management companies are an administrative set-up where in the event that a patient needs to visit a follow-up check-up, or if some type of test or service is under treatment, they can more easily and quickly identify, contact and encourage the patient to receive the optimal care. Healthcare providers believe that there are several benefits that can be achieved with this program. With access to the latest, real-time information, doctors and other service professionals can provide better care. They will be less likely to have duplicate tests or procedures. Additionally, it is easier to monitor patients to ensure they are taking medications and recommendations seriously through improved patient monitoring.