Systems methodology, telemedicine and clinical decision support:their role in the management of chronic disease

摘要

Movement of health care delivery towards the primary care sectorand the home setting can result in substantial benefits in terms ofhealth outcome, social provision, cost effectiveness and resourceutilisation. In order that the maximum benefit can be gained from such adistributed approach, however, it is necessary to ensure that there is afull and proper understanding of the roles of all those involved inhealth care delivery as well as making available the best possiblesupport for clinical decision making. This is a classic situation whereappropriate adoption of sound systems practice, coupled with the use ofthe advanced technologies of telemedicine and clinical decision support,can be applied to good effect. This paper highlights the need foradopting a sound systems methodology if information technology is to beapplied to best effect in the management of chronic disease. This istrue whether IT takes the form of local clinical decision support or awider telemedicine configuration. Modelling activity is essential ifdesigns are to be achieved that take full account of all the userrequirements. Evaluation must form an integral part of the systemsmethodology, rather than being merely an additional post hoc activityafter system implementation. These issues have been illustrated in thecontexts of diabetes and the management of end-stage renal failure,though they have general applicability across the spectrum of chronicdisease management and beyond