Engaging the Patient

Another challenge with regard to the PCMH model is the nuts and bolts of health information exchange (HIE), according to John Bender, M.D., the medical director of the NCQA-recognized tier-three medical home Miramont Family Medicine in Ft. Collins, Colo. Bender observes that the free market wasn't able to fully support EHR adoption and HIE in the past, and that's why he believes the federal government stepped in with the Health Information Technology for Economic and Clinical Health (HITECH) Act. He likens the expansion of HIEs to building out driveways to main roads. “In my clinic I feel we've built our driveway out, and we're just waiting for the road,” he says. “But in other clinics, the road can be built and they're going to have to build their driveway out to it. It depends how well-funded an individual clinic is.”

MGMA's Gans adds that information exchange will most likely be on a push basis at first with organizations and offices connecting via virtual private networks (VPNs), which will then grow to a more advanced push-pull model of information exchange. But he notes that this advancement will need standardized directories and communication requirements, which contributes to overhead. “A freestanding physician's office has much more difficulty sustaining a patient-centered medical home unless it's a part of a demonstration,” says Gans. “It takes a foresightful health system with sufficient capital to understand how they're going to provide these services and at what cost.”

PORTALS ON THE RISE

On the horizon this year for the PCMH will be patient portals, according to those interviewed for this story. Both Bender and Holly are excited to unveil their portals later this year, which will allow patients to schedule appointments, refill medications, and send secure messages to physicians. “It [will] really cut down on the phone traffic, which frees up the staff to do other things that are revenue-generating,” Bender says. “It gives the consumer more power in the healthcare marketplace and makes them feel like they have more of a say in what's going on, and that's a good thing.”

Healthcare Informatics 2011 March;28(3):16-18