Using Health Information Technology to Prevent and Treat Diabetes

Abstract

IntroductionF or this year's article on information technology, we selected articles that will give the reader a sense of the current state of the art of the field and a hint of where it is going. To help organize thinking about how technology can improve outcomes for people with or at risk for diabetes, it is helpful to frame technology's roles in the range of approaches that are being used to improve outcomes.A new equilibrium is being forged among independent, but overlapping, health-promoting paradigms for which information technology often is at the core of any approach. There are four tried and true approaches that complement each other but also compete for resources as well as attention.Personal health approaches: Those services and supports that are provided by an organized healthcare system primarily for the benefit of the individual receiving the service.Public health approaches: Activities aiming to provide conditions in which people can be healthy that focus on entire populations rather than on individual patients or diseases. Public health is concerned with the total system and not only the eradication of a particular disease.Direct-to-consumer approaches: Goods and services marketed and sold directly to end users and that are usually paid for by the consumer.Population health approaches: Improving health outcomes of one or more subpopulations out of the entire population is the area of focus. It is understood that such population health outcomes are the product of multiple determinants of health. The outcomes are influenced by social, economic, and physical environments; personal health and lifestyle practices; individual capacity and coping skills; human biology; prenatal and early childhood development; and healthcare services.These subpopulations can be geographic regions, such as nations or communities, but they can also be other groups, such as employees, ethnic groups, disabled persons, members of a health plan, patients being served by a healthcare system, or individuals with specific clinical conditions or life circumstances. Often groups are segmented by risk or health status (e.g., stable and well, moderate risk, high risk/high cost). Most of the articles chosen for this chapter would fall into population health approaches that are linked to, or integrated with, personal health approaches.As we think about ways to improve outcomes, there are six key questions that must be answered in order for the chosen approach to have a chance of being successful. How is the target population defined and segmentedfrom the larger population? 2. What are the characteristics of the target population? 3. What are the key modifiable determinants of the health status and healthcare utilization patterns of the target population? 4. What are the evidence-based approaches that have been shown to modify the identified determinants in the target population? 5. Can these approaches be cost-effectively and efficiently provided at a large enough scale to improve the entire population's outcomes? 6. Is there capacity...