Thursday, September 27, 2007

Medical Home, a case of the “Emperor’s New Clothes” ?

I’m still trying to understand the concept of the “Medical Home”. To me, all the talk, and there’s plenty, just read the current issue of AMA news, “New Orleans grows into testing ground for medical homes”, it all seems like talk about the “Emperor’s New Clothes”.
So far, what I heard, the medical home concept sounds awfully similar to the concept of the “HMO Health Center” of the 1990’s with the addition of EMRs.

“…continuous care, coordinated care across the health system, utilization of information technology and enhanced care through systems such as open scheduling.”

“…the concept of partnerships between primary care physicians and patients to coordinate access to all needed medical services and consultations (a 'medical home') for all patients."

In the “HMO Health Center” model, the PCP was the “gate-keeper” or care-coordinator. From my experience in managing an “HMO Health Center” during its final days in 1999, we had our own case managers and social workers who helped coordinate the care of our patients. We followed the care of our patient’s from the ambulatory setting, to the hospital, and then to the return to home. We worked closely with our “contracted VNA” (Visiting Nurse Association), hospital case managers, and nursing homes. We had our panel of preferred specialists who helped care for our patients.

What we did not have however, was an electronic medical record or a community health information exchange. I remember being frustrated with not always having right clinical data when I needed it. As a former engineer, I knew then that clinical data access was the one thing that was truly lacking and prevented us from achieving the promise of the HMO health center model of safe, efficient and patient friendly healthcare.

Well, with EMR and health information exchange technology (or RHIO), I hope the "Medical Home" does not turn out to be a case of the "Emperor’s new Clothes".

If you are trying to understand the Medical Home concept, check these :
Medical Home Concept Catching on in the US a Washington Post Article
Medical Home Concept Paper An in depth paper from the state of Louisiana

Waye and Means, Medical Home
eCareManagement Blog item on Medical Home

The Patient-Centered Primary Care Collaborative : coalition of major employers, consumer groups, and other stakeholders who have joined with organizations representing primary care physicians to develop and advance the patient centered medical home.

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