The patient-centered medical home holds a lot of promise for curing what ails the nation's health care system. So does information technology. Combined, the two could form an extremely powerful tool for achieving the Triple Aim, but is one ready for the other?
Patient-centered medical homes have been around since the 1960s. As David Keller, M.D., clinical professor of pediatrics at UMass Medical School, pointed out in a recent Health Affairs blog, the term initially was coined by the American Academy of Pediatrics as a way to "describe a repository of records that would offset the dispersal of records between pediatric offices, health departments and hospitals."
The concept has clearly evolved and is now being viewed as an underpinning for the new delivery model. As Agency for Healthcare Research and Quality officials, including Director Carolyn Clancy, M.D., noted in a 2010 commentary, the evolution of PCMH is a promising development, made even greater when combined with health IT and its power to promote quality improvement. "The development of health IT, such as electronic health records, was unforeseen when the PCMH was proposed. While a PCMH could be established without health IT, health IT will facilitate their development and implementation," Clancy et al. wrote.
The AHRQ commentary lists several ways in which health IT can help promote medical homes:
- Collect, store, manage and exchange relevant personal health information.
- Enhance or facilitate communication among providers, patients and their care teams.
- Collect, store, measure and report on the processes and outcomes of individual and population performance and quality of care.
- Support providers' decision-making on tests and treatments.
- Inform patients about their health and medical conditions and facilitate their self-management with input from providers.
Yet for all of that potential, today's EHRs may not be fully capable of supporting the medical home, David Bates, M.D., and Asaf Bitton, M.D., of Brigham and Women's Hospital, wrote in an April 2010 Health Affairs article. Bates and Bitton highlight seven areas where advances are needed:
- Clinical decision support
- Team care
- Care transitions
- Personal health records
They urge policymakers to include medical homes in future health IT regulations, but also say that more research is needed to know exactly how technology can promote team care.
Even if health IT capabilities improve, Keller offers this observation in his blog: "I worry that the medical profession has once again focused so much on technology that we have lost track of our relationship with the patient. Any primary care provider will tell you that it is our long-term relationship with the patient that enables us to manage care without the heavy hand of rationing or gatekeeping. Health information technology is a really useful tool, but it will not bring us to the promised land unless we use it to enhance our relationships with patient and families. I would urge all involved in medical home transformation work to take practical steps to keep the patient at the center of the patient-centered medical home."