Abstract--The mission of the Multiple Sclerosis Centers of Excellence (MSCoEs) is to optimize the services veterans with multiple sclerosis (MS) receive across the U.S. Veterans Health Administration. To accomplish this mission, the MSCoE West has adopted a collaborative chronic-disease management strategy along the lines of the model described by Wagner and colleagues. This model describes an organized, integrated, proactive, and population-based approach to patient care that includes healthcare delivery system change and patient-based self-management. While Wagner's model is described independent of information technology, the majority of actions called for in that model benefit tremendously from the application of a powerful and well-integrated informatics infrastructure designed to serve and support populations with chronic disease. Key elements such as goals and actions encourage high-quality care for those with chronic illnesses.
Key words: chronic disease, computerized order entry, computerized physician order entry, delivery of healthcare, health services, medical informatics, multiple sclerosis, physician's practice patterns, practice guidelines, veterans.
The mission of the Multiple Sclerosis Centers of Excellence (MSCoEs) is to optimize the services that veterans with multiple sclerosis (MS) receive across the U.S. Veterans Health Administration (VHA). To accomplish this mission, the MSCoE West is implementing a model of care adapted from other chronic-care models that have been successful in managing large populations with chronic diseases such as diabetes and asthma [1-2]. Wagner and colleagues have described a system approach to the care of populations with chronic disease that is built around two essential elements: (1) "prepared, proactive, practice teams" that use tools such as evidence-based guidelines, data repositories, and an electronic medical record (EMR) to manage high-risk groups with specific conditions and (2) "an educated and empowered patient" who receives education and training and is an active participant in his or her healthcare [3-4]. This organizational approach is built to support planned, productive interactions with the goal of optimizing desired outcomes for a particular population. Key elements such as goals and actions encourage high-quality care for those with chronic illnesses (Figure 1). In addition, an Institute of Medicine (IOM) report published in 2002 presents concepts for improving the quality of healthcare and suggests an approach to chronic care that has many of the same basic elements described by Wagner . Given the chronic-care model's effectiveness in chronic illnesses such as diabetes and asthma and its general acceptance in the medical community, we chose to adapt features and apply them to the delivery of services to veterans with MS in the VHA.
Many chronic-care models have been developed without computerization; however, when one reviews the components of a well-integrated health information system, it becomes apparent that such an infrastructure is at least highly desired for most of these actions and nearly essential for many. For a nationwide comprehensive system like the VHA, promoting effective improvement strategies aimed at comprehensive system change and identifying relevant subpopulations for proactive care may be impossible without a sophisticated clinical data repository (CDR) of all interactions within a healthcare system. Similarly, organizing internal and community resources to provide ongoing self-management support to patients and sharing evidence-based guidelines and information with patients to encourage their participation may be also impossible without taking advantage of the VHA's widely used Web site to integrate existing resources and guidance and effectively link veterans to that information. Even for systems with a relatively small number of patients, research has shown that the use of informatics infrastructure can improve outcomes . …