Building integrated information systems for chronic care: the California experience

For over three decades, chronic-care services have been described as fragmented, complex, difficult to access, overlapping, and duplicative in function. Although a number of remedies have been implemented to improve service delivery, little has been written about the potential of integrated information systems (IIS) to serve as a remedy to fragmentation. We begin to address this gap by comparing and contrasting three unique models of chronic-care IIS developed in California to improve service delivery. To analyze the current status of each IIS, we apply six design criteria: (1) the information on programs and services is comprehensive, (2) the system has the capacity to serve the needs of diverse users, (3) the system integrates multiple layers and levels of information, (4) information from multiple sources is standardized and uniform, (5) information can be accessed in a timely manner, and (6) provisions are adequate to meet all requirements for privacy and confidentiality. Although much work remains to be done, there is reason to be optimistic that innovative IIS can contribute to the development of more effective chronic-care delivery systems.