Creating HealtheVet Informatics Applications for Collaborative Care

Informatics support for chronic illness care poses particular challenges. The prevailing model for effective chronic illness care focuses on health system requirements to enable productive interactions between an informed, activated patient and a prepared, proactive practice team. These interactions are necessary for high quality care. However, current research is lacking on how to provide informatics support for these interactions. This project has the following objectives: achieve consensus among experts on the informatics support requirements for chronic illness collaborative care and evaluate an informatics support application for collaborative care of depression and schizophrenia.

We hypothesize that although perceived specific informatics support needs will differ somewhat for collaborative care for different chronic illnesses, experts will agree on the necessary components. We further hypothesize that: 1) collaborative care management teams (including patients) treating depression or schizophrenia will rate the usability of an informatics module designed in accord with expert consensus as superior to CPRS without such a module; and 2) team clinicians using the module will experience objective savings in time necessary to complete care management activities.

The project consists of three linked phases. The goal of Phase 1 is to produce a document reflecting the consensus of experts that details the required structure and content of an informatics module to support collaborative chronic illness care. Expert panel consensus will inform this document. This document will discuss commonalities and differences in requirements for different chronic illnesses such as diabetes, CHF, IHD, COPD, depression, schizophrenia and substance abuse. The goal of Phase 2 is to apply the consensus achieved in Phase 1 to designing and prototyping a CPRS-R-compatible collaborative care informatics module or 'plug-in' for depression and schizophrenia. Phase 3 will evaluate the prototype in the ongoing VA Mental Health Quality Enhancement Research Initiative (QUERI) EQUIP schizophrenia and TIDES depression quality enhancement research programs. A project steering committee will assist with selection of expert panel members and will provide direction to the research team throughout the duration of the project. The steering committee will also provide important coordination of effort between the project and other stakeholders in VA.

Representatives of other QUERI groups will be involved in expert consensus activities (during Phase 1) and will assist with dissemination of findings (during Phase 3). A VIReC staff member will provide liaison between the project and VA Office of Information. We will work closely with VHA OI representatives through all phases of the project. Project products will include a prototype HealtheVet-compatible informatics module with specific features for depression and schizophrenia, and consensus recommendations for optimizing collaborative chronic illness care informatics support.