What is it?
The Comprehensive Disease Management Program (CDMP) is a complete customizable web-based clinical application for management of patients with chronic disease. Based on the Chronic Care Model, it was originally designed for military healthcare to better manage patients with diabetes, but has evolved into a generalized chronic disease and population health management system supporting the Patient Centered Medical Home model. With clinical decision support for managing patients with Diabetes, Chronic Kidney Disease, Liver Disease and Hepatitis B and C, it is currently in use at multiple leading government, academic, private, and community health clinics around the nation.

CDMP allows the entire care team to access a unique combination of clinical and patient behavioral data. The result dramatically improves patient outcomes and significantly reduces healthcare costs.

CDMP employs a continuum-of-care model (in distinction to the episodic care available through the traditional acute care provision model) that fosters productive interactions between patients who take an active part in their care and a variety of providers backed up by resources and expertise. Thus, the patient is an informed, proactive self-manager using CDMP support to keep their chronic disease in control and provide them with ongoing training to minimize their complications, symptoms and disability. The core of the effectiveness of the CDMP is its ability to empower the patient.

Major CDMP Components

The Care Manager is the centerpiece of the overall platform. It empowers a diverse group of healthcare professional to provide better patient care through the use of a unique set of tools specifically designed to meet their needs in the collection, interpretation and documentation of patient care.

DM Everywhere is the patient portal application allowing patients to be an active and engaged participant in the care management process. DMEverywhere’s many features include secure HIPAA compliant messaging, appointment reminders, the ability to take surveys, the ability to view lab results and medications with appropriate educational material and securely upload self-management data including blood glucose, blood pressure, and weight from home.

Survey Tool is a robust platform allowing patients and providers to take an array of industry standard instruments and new innovative surveys designed to capture patient behavioral information and drive a patient encounter. Capable of administering surveys in multiple languages additional surveys can be easily added and scored according to guidelines.

The integrated Study Manager enables the efficient administration and management of clinical studies from recruitment to data collection - from analysis to publication. The Study Manager Protocol Engine insures the study protocol is strictly adhered to and creates administrative reminders for study coordinators to function more efficiently.

CDMP Reporting has implemented the open source business intelligence tool BIRT. Extensive pre-configured reports enable administrative, management, population and patient level reporting. Researchers can access de-identified study data customized to their specific research data reporting needs with output in multiple formats for additional analysis.

Integration Engine: CDMP is designed to be interoperable with electronic medical records along with lab, pharmacy, billing and scheduling systems. It has been integrated with the Department of Defense AHLTA, VA VistA, and the Indian Health Service RPMS medical record systems as well as numerous commercial EHRs. Through standard HL7 messaging or a customized interface CDMP handles patient demographics, allergies, appointments, vitals, labs, medications, procedures, diagnoses, and admissions.

CDMP has been in development since 2001 and represents the cumulative results of many thousands of hours of effort from technical as well as clinical resources.

Mission - Why this wiki?
To provide one common repository for information about the Comprehensive Diabetes Management Program (CDMP).