Fall 2007 Edition

November 7, 2007

Healthcare in the United States at the beginning of the 21st century is undergoing dramatic changes due to increasing costs, the increase in the burden of chronic disease due to the aging of the population, health disparities due to lack of access and insurance coverage, a quality chasm with 50% of recommended evidence-based therapies not being implemented and the lack of health information infrastructure- an unwired, fragmented health information infrastructure. Addressing the quality concerns from a national perspective, the IOM report for patient care for the 21st century identified the critical role of information technology in designing a new health care system that produces care that is “safe, effective, patient centered, timely, efficient and equitable.” Recently several primary care organizations have conceptualized this model of care as the “Patient-Centered Medical Home”.

The Patient-Centered Medical Home (PC-MH) as envisioned by a 2007 joint statement of the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association involves each patient having: a personal physician who directs a health care team, providing whole person as opposed to disease specific care, which is coordinated/integrated care throughout all aspects of the health care system including outpatient, subspecialty, nursing home and hospital care. The Care Model shown has all the features of the PC-MH model. To bring the PC-MH model to fruition enhanced practice re-design and physician/patient/family partnership for the highest level patient-centered quality and safety outcomes need to incorporate Health Information Technology. This practice redesign includes incorporation of clinical decision support tools, patient participation in decision-making, patient feedback, and use of cutting-edge information technology to promote optimal patient care, patient education and communication.

Most practice redesign using health information technology have focused on utilization of an electronic medical record and the integration of medical information between hospital, office practice, specialty practice. Recently it has become apparent that more completely involving the patient and family members by use of an integrated personal health record is potentially a much more effective solution. Using an integrated personal health record or patient portal allows with appropriate privacy and security authorization, electronic copies of patient’s diagnoses, medications, allergies, laboratory reports, pathology reports, x-rays, progress notes, to auto-populate a patient’s personal health record from a practice’s electronic medical record. Patient’s can review these records and message back to the provider team corrections or add additional information such as family history, medication adherence, side-effects, questions about their care. Patient self-management behavioral modules have been incorporated into some personal health records/patient portals. Behavioral specific goal setting, monitoring and support for improved disease and whole person management are incorporated into these tools allowing for improved two-way communication and are being tested in several pilot studies to see if they improve patient outcomes.

Charles B. Eaton, MD, MS
Memorial Hospital of Rhode Island

The views expressed in this article are those of the author and do not imply endorsement by The Robert Wood Johnson Foundation or the Health e-Technologies Initiative.