Supporting Chronic Disease Care Quality: Design and Implementation of a Health Service and Its Integration with Electronic Health Records

Chronic medical conditions take a huge toll on lives of a growing number of people and are a major contributor to the rising costs in healthcare. As patients are increasingly willing to take an active part in managing their conditions, chronic disease self-management programs and information systems that support them are recognized for their potential to improve the quality of healthcare delivery. These programs often rely on recording longitudinal patient data and analyzing it. Therefore, maintaining appropriate data quality is important for self-management programs to be efficient and safe. We designed and implemented a prototype of a health self-management service for chronically ill people. It is a distributed application that supports patients with diabetes at tracking their blood glucose levels. The main design goals were usability, extensibility, security, and interoperability. The system integrates with the Microsoft HealthVault and Google Health personal health record platforms. It utilizes industry-strength storage and security mechanisms, is scalable, and as a result, can be used to gather, securely store, and analyze patient data over long periods of time. In this article we examine how software information technology can support chronic disease self-management and its impact on the quality of patient data. Furthermore, we describe the requirements that drove the system's development, its architecture, and design decisions.