Question

1. Explain the concept of patient-centered medical home

2. Discover how information technology will foster patient center medical home

3. How will IT foster patient center medical home from a patient perspective?

4. How will IT foster patient center medical home from a provider perspective?

Answer 1

Ans) 1) The Patient-Centered Medical Home (PCMH) is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.

2) Despite the significant advantages of incorporating HITs into primary care practices, a minority of practices actually utilize EHRs because of the multiple barriers that exist.

- Findings from the 2011 Physician Workflow Study suggest 54% of physicians have adopted an EHR, although one-quarter report their system does not meet meaningful use guidelines.

- Barriers to adoption of HITs include issues with information exchange and interoperability between information systems, challenges with technical implementation, low acceptance rates by physicians and patients, and patient access issues due to the digital divide.

- Unfortunately, a paradox exists for HIT within the PCMH model. Although the overall aim of PCMH is to improve the coordination and comprehensiveness of care that is achievable through information technologies, such technologies are expensive.

- As the PCMH model also aims to reduce costs associated with health care, the upfront expense of HITs represent a financial risk that may not be recoverable.

- For example, implementing a completed EHR system requires a significant up-front investment of time and money.Even with an EHR in place, implementation of further HIT (e.g., registries, e-prescribing, patient portals) has been found to be more difficult and time consuming than envisioned in the National Demonstration Project on practice transformation to a PCMH. For example, absence or awkward activation of a patient registry within the EHR often requires complicated workarounds and redefinition of work processes.

- Given the significant investment of time, energy, and money required by HIT adoption, the National Demonstration Project recommends that “practices should develop their own plan that projects which technology components they will implement and in what sequence to achieve the care capabilities they desire.”In addition, payment models will have to take this into account when determining payment reform to better support what is in the patient’s and public’s best interests.

- Interestingly, the case for HIT adoption can be made through the use of both clinical and economic advantages. For example, this technology can provide decision support for physicians, thereby lowering the risk of costly adverse effects; reduce fling, transcription, and staffing costs through the use of an EHR; decrease duplication of tests; and improve billing—all cost-saving or revenue-generating opportunities. Successful HIT implementation requires a series of steps, including appropriate system selection, a collaborative vendor relationship, and proper physician preparation. Understanding how to successfully integrate HIT is critical to a practice’s transformation into a PCMH.

3)Patient perspective: higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care.

4) The patient-centered medical home (PCMH) is four things:

• the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership;

• new ways of organizing practice;

• development of practices’ internal capabilities,

• related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare.