5 Key Features to Look for in a Chronic Care EHR Management System

May 21, 2024
A doctor is talking to an elderly woman while looking at a tablet.

Chronic diseases remain the leading causes of death and disability in the United States. In fact, according to the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), 6 out of 10 adults in the U.S. have a chronic disease, and 4 out of 10 have at least 2.

As a healthcare provider who sees these alarming statistics come to life in your clinic every day, you understand the urgent need for an effective chronic care management program and technology's critical role in delivering that.


You recognize that high-quality chronic care demands more than just clinical expertise—it also requires the right tools. Thus, the quest for the ideal chronic care EHR management system begins.

How a Chronic Care Management Platform Can Transform Your Practice

A doctor is using a tablet computer while sitting at a desk with a laptop and a stethoscope.

At its core, a chronic care management (CCM) platform is a comprehensive digital solution designed to streamline and enhance the management of patients with chronic health conditions. Seamlessly integrated into your electronic health record (EHR) system allows you to access a unified ecosystem that leverages core EHR functions to boost your CCM program.

Here are the top benefits you can expect from a tried-and-tested chronic illness medical EHR system:

Improved Patient Outcomes

When your practice management system features a robust CCM module, you can expect improved patient outcomes through enhanced care coordination and visibility. By centralizing patient data and facilitating seamless communication among care team members, you can more effectively monitor patient health, track progress, and intervene promptly to prevent complications. This proactive approach to chronic care management ultimately results in better disease management, reduced hospitalizations, and enhanced quality of life for patients.

Enhanced Practice Efficiency

A practice management platform equipped with CCM features can help streamline CCM workflows, automate administrative tasks, and improve practice efficiency. By digitizing patient records, automating documentation processes, and providing tools for task delegation and scheduling, your practice can minimize paperwork, reduce manual data entry errors, and optimize staff productivity. This allows your practice to support more patients with better quality care without hiring more staff members.

Increased Reimbursements

A comprehensive CCM module plays a crucial role in accurately documenting and billing for the services you render. With built-in billing functionalities and automated coding assistance, a CCM-equipped EHR software like IMS can help your practice capture billable activities, streamline insurance claims, and optimize revenue cycle management, leading to higher reimbursement rates and improved financial viability.

5 Must-Have Features for Your Chronic Disease Management Software

A doctor is using a tablet computer with a handshake icon on the screen.

There aren’t many EHRs approved to participate in Medicare’s Chronic Care Management program, so if you’re considering equipping your practice with a CCM system, you must ensure you get the best one. Here are five indispensable features you should prioritize:

Data Security and HIPAA Compliance

Ensuring the security and privacy of patient data is paramount in any healthcare setting, especially in chronic care management. Healthcare practices like yours must abide by HIPAA regulations to secure clinic and patient data. Unfortunately, not all EHR solutions are HIPAA compliant.

When looking for a CCM platform, you must ask vendors if their technology has security measures in place and if it is certified by the Office of the National Coordinator for Health Information Technology (ONC). Meditab’s flagship software, IMS, for example, is ONC-certified and has security measures (e.g., audit trails, data encryption, password protection, etc.) that cover its robust chronic care management module.

Healthcare Interoperability

Interoperability among healthcare systems is crucial to informed decision-making and care coordination. Suppose you want to build an effective and efficient chronic care management program in your practice. In that case, you need a CCM module or CCM EHR system that can support interoperability standards such as Health Level Seven International (HL7) and Fast Healthcare Interoperability Resources (FHIR). This allows you to access comprehensive patient profiles that aggregate data from various sources, including EHRs, laboratory systems, pharmacies, and remote monitoring systems.



When your practice is equipped to handle healthcare interoperability, your team can access a holistic view of each patient's medical history, diagnoses, medications, allergies, and chronic disease management plan.

Read More: What is Interoperability in Healthcare & How Will It Help My Practice?

Care Plan Customization

Every patient with chronic conditions has unique needs, preferences, and goals that require personalized care plans tailored to their circumstances. If you want to provide your patients with the best care possible, you need to be able to create, modify, and track personalized care plans using evidence-based guidelines, clinical best practices, and patient input—and the ideal chronic disease management software should empower you to do all these.


When choosing the right CCM system for your practice, you must ensure it allows you to define goals, interventions, milestones, and follow-up tasks. It should also allow you to assign responsibilities to different care team members and engage patients in shared decision-making.


Meditab’s IMS, for example, offers practices two chronic care management tools to choose from:


  • A comprehensive CCM module fully integrated into IMS that equips your practice with the tools you need to provide end-to-end CCM service and support.
  • A Clinii CCM Dashboard that allows you to access the Clinii Web platform seamlessly via single sign-on technology. If your practice uses Clinii remote patient monitoring, this option allows you to streamline chronic and remote care management.

Analytical Reporting

If you want your practice’s CCM program to grow and become more profitable, you need to be able to monitor and optimize its performance in real time. Actionable analytics from a comprehensive CCM system can help.


When choosing a CCM module or CCM EHR system, ensure that it offers comprehensive reporting tools that allow you to analyze the following areas:


  • Clinical Outcomes
  • Resource Utilization
  • Patient Engagement Metrics
  • Reimbursement Trends



The tools must allow you to automatically generate revenue key performance indicator (KPI) reports that track your billable activities, claim submissions, reimbursement rates, and revenue cycle metrics to ensure you stay compliant with regulatory requirements and maximize the financial return on investment.

Automated Billing

When your practice has a CCM program, the Centers for Medicare & Medicaid Services (CMS) reimburses you for your time with your chronically ill patients. If you want to get paid for all your work, you need to leverage the technology that top CCM solutions offer. 


IMS’s CCM tools help facilitate accurate and efficient billing for every CCM service you render. This includes automatically generating billing codes, claims, and invoices based on documented patient interactions, care plan activities, and billable time. 


The system you choose should also support the electronic submission of claims to payers, real-time eligibility verification, and payment reconciliation to streamline revenue cycle management and minimize your team's administrative burden.

Elevate Your Chronic Care Management Program with IMS

A doctor is talking to a patient in a hospital.

As modern healthcare providers navigate the complexities of chronic care management, the need for a robust and user-friendly CCM tool becomes increasingly apparent. With the right technology in hand, your practice has the power to streamline workflows, enhance patient engagement, optimize resource allocation, and, ultimately, improve the quality of care patients with chronic conditions receive.


As one of the select few EHRs certified in the CMS Chronic Care Management program, IMS empowers you to provide better care for chronically ill patients and maximize your reimbursements. 


Build personalized care plans, automatically generate detailed patient and revenue reports, optimize insurance claims processing, stratify your patients based on their health status, maintain HIPAA and regulatory compliance, facilitate seamless communication among care teams, and get paid for the hard work you do—all with the intuitive, comprehensive, and CCM-equipped IMS.

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