The notion of healthcare providers, patients and care managers electronically accessing patient health information is creating an increasingly compelling vision that promises better patient care, reduced medical costs and an improved work environment for physicians and other providers of care. None of these principals engaged in the delivery, receipt and coordination of care truly benefits from today’s fractured and contentious healthcare model, with patients and their families often bearing the brunt of the expensive, confusing and error-ridden experience. The emergence of more collaborative models, particularly in the area of the management of chronic diseases, will give hope to a beleaguered industry.

The roots of collaborative disease management lie in the challenges encountered in the first generation process experimentation. Like the early stages in development of virtually any “big idea,” progressive thinkers conceived of new models for managing chronic conditions that took advantage of what was known as “best practice” (defined as the best sequence of procedures, therapies and medications, typically for single conditions). The problem, however, was that they also needed to invent a “best process” (defined as the best interactions with the various providers of care and the patient to help ensure compliance with best practice) for managing care and for motivating behavior changes in a relatively ill patient population.

Limited by the financial realities of an unproven model and a skeptical healthcare ecosystem, they faced issues and challenges that continue to affect their relationships and reputations today. To be fair, though, the early innovators created a body of knowledge–in many cases through trial and error–that informs the much more successful choices being made today in the growing field of disease management.

Physician-based disease management efforts often stumbled when trying to coordinate complex, multispecialty care plans that required significant patient contact outside the office setting. Disease management companies, structured to deal almost exclusively with the patient, found physicians resistant to their perceived interference in the doctor-patient relationship, regardless of the appropriateness of the interventions proposed. Patients, caught between an insurer-sponsored disease manager they liked and their doctors, struggled to understand whose message to metabolize.