How can providers use health IT to help create a medical home?
The medical home establishes the primary care provider as the first point of care and as the leader of the care team responsible for the quality of the patient's overall care. Health IT can help facilitate this coordination and also increase efficiency and improve quality. By implementing health IT functionality for scheduling, evaluating patients, and communicating with providers and patients, providers can improve access to care. In addition, health IT can improve the ability to report on metrics related to the principles of a medical home.
While the medical home concept can be implemented without health IT, a "connected" medical home would take advantage of at least some of the health IT infrastructure components defined below.
Tools already showing promise for medical homes include EHRs, PHRs, patient portals, and telehealth applications. Particular functionalities of these tools such as secure messaging, access to test results, and capabilities for scheduling have fostered the vision of the medical home model that provides accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective care.
Electronic health records (EHRs) can be powerful tools in the creation of medical homes. EHRs can add value to the medical home model as a means to maintain and share a comprehensive record of health between providers. The New York Children's Health Project (NYCHP) serves as an example of the use of EHRs to create a medical home, particularly for medically underserved children experiencing homelessness and street-involved youth. NYCHP, a program of Montefiore Medical Center and the Children’s Health Fund, delivers critically needed health care services at 13 shelter sites across New York City via mobile medical or shelter-based, on-site clinics and at its clinical hub site located in the South Bronx. A recipient of the 2008 HIMSS Davies Award for achieving excellence in the implementation of EHRs, the NYCHP utilizes a wireless system to access a child’s medical records onboard its fleet of mobile clinics and at on-site clinics. NYCHP has tailored the EHR to meet the specific needs of the unique population served, which allows the program to provide comprehensive and compassionate medical, mental health, dental and enabling services to homeless children at all of its service delivery locations. NYCHP recently received the highest National Committee for Quality Assurance (NCQA) accreditation—Level 3—as a Physician Practice Connections - Patient Centered Medical Home. NCQA’s Level 3 accreditation requires the ability to communicate electronically to other entities, which NYCHP does using its cutting-edge health information technology.
The medical home and the personal health record (PHR) are two unique concepts that have similarities and are often confused. An important distinction is that a personal health record is a tool, while the medical home is an approach to care. An example of using a PHR to facilitate the medical home approach is the MiVIA personal health record that is helping patients and families to receive access to continuous and comprehensive care. MiVIA also was created to address a need for culturally-effective medical care for the migrant and seasonal workers and their families in the Sonoma Valley of California. This PHR is family-centered and allows users to create and manage PHRs for up to 8 people in Spanish or English, facilitates continuity of care for a transient population, and provides the ability to create a comprehensive health record that includes oral health information. The PHR system fosters a sense of community through the use of personal identification cards for members and its connection with mobile health units stationed within the community.
A patient portal is another health IT tool that can be used within a medical home. The patient portal allows patients to have increased access to care and information and is usually linked to a provider or payer health record. For example, this patient portal from a physician in Staten Island, NY uses a patient portal system to supply patients with links to facilitate routine tasks such as requesting a refill for a prescription or scheduling an appointment, quickly and electronically. Other portals may be similar to the previous example, but also allow patients and providers to directly communicate through the portal.
Telehealth is yet another means for achieving the goals of a medical home, particularly in rural settings. Researchers studying telemedicine as a method for providing pediatric subspecialty care for special needs children in a rural setting concluded in a study published in the journal Pediatrics (PDF - 301KB) that use of telemedicine in this setting can facilitate care that is more accessible, family-centered, and coordinated, thereby reinforcing efforts in providing a medical home.
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