The Value of a Patient-Centered Medical Home

This month HIMSS Digital Office newsletter provides our readers with several resources on the Patient Centered Medical Home. The PCMH is an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a healthcare setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.

The American Academy of Pediatrics introduced the medical home concept in 1967, initially referring to a central location for archiving a child’s medical record. In its 2002 policy statement, the AAP expanded the medical home concept to include these operational characteristics: accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective care.

Several medical societies and organizations, such as the AAP, AAFP, ACP, and AOA that together represent about 333,000 physicians, have developed joint principles to describe the characteristics of the PC-MH.

These principles encourage the adoption and use of information technology for practices that want to achieve true PCMH certification. The principles of the PCMH can truly be fulfilled with the adoption and use of health information technologies in a PCMH such as:

Personal physician - Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. Patient portals, e-mail and personal health records can assist with and enhance the physician-patient relationship.

Physician-directed medical practice – The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

Whole-person orientation – The personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life: acute care, chronic care, preventive services and end-of-life care.

Coordinated and/or integrated care – The coordination and integration of care goes across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies and nursing homes) and the patient’s community (e.g., family, public and private community-based services).

The electronic health record, E-prescribing and health information exchanges would assist with practice documentation, registries and care coordination to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Quality and safety are hallmarks of the medical home:

• Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication.
• Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.
• Evidence-based medicine and clinical decision-support tools guide decision-making.
• Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
• Patients actively participate in decision-making, and feedback is sought to ensure patients’ expectations are being met.
• Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.
• Patients and families participate in quality improvement activities at the practice level.

 Enhanced access to care is available through systems, such as open scheduling, expanded hours and new options for communication between patients, their personal physician and practice staff. Telephony, patient portal scheduling systems, PHRs and e-mail are great enablers to assist with enhanced patient access to care.  

Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home. Patient accounting and medical coding, and transcription and billing information systems, are integral to assist with these functions.

Many of the medical associations have developed their own models for improving patient care called the “medical home” (AAFP, 2004) or “advanced medical home” (ACP, 2006). No matter which model a practice uses, a true PCMH will require the adoption and use of health information technology.

One of our 2009 HIMSS Community Health Organization Davies award winners, Urban Health Plan, with Alison Connelly-Flores and Dan Figueras, and others, have shared their stories on how they used health information technology to achieve PCMH status.

I would like to hear about your practice’s journey in using health information technology to support your goal become a PCMH. Please share it with me here on the HIMSS Blog.

 Sources for this blog post: National Center for Medical  Home Implementation and American College of Physicians.