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Home Is Where the EHR Is

July 5, 2011
by Mark Hagland
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When EHRs are used correctly, they support the medical home model, a new study finds

The Washington, D.C.-based eHealth Initiative recently completed a projected in collaboration with a pharmaceutical company and a small consulting firm that demonstrated the value of intelligent EHR deployment to the patient-centered medical home.

The project, with the complicated title “Care Coordination & Medical Homes: Bringing Primary care Physicians, Patients, Families, and Specialists Together,” encompassed the development of a full demonstration involving two medical groups with different populations (including one whose population is Medicaid and uninsured patients) and different organizational structures and management styles.
Here’s the interesting part: given thoughtful EHR support, eHealth Initiative’s leaders reported, “EHRs make care coordination possible, within the medical home, and produce more systematic information,” though they add that “Additional EHR functionalities are needed to further support medical homes’ care coordination tasks.” Getting down into the weeds a bit, the investigators found that developing a mature medical home model is an extremely complex undertaking, with many lessons learned around who should be doing what (particularly with reference to parsing the duties of physicians, nurses, and others), what pieces of information are most important to communicate and when, how best to facilitate and support patient-clinician and clinician-communications, and other issues, only some of which are touched by automation.

When it came to automation, though, the investigators found that successfully leveraging IT to support the creation of robust care delivery and care management summaries, communications between providers, and communications between clinicians and their patients, remained an incomplete journey at the end of the study (while of course the medical home projects continue forward).

To me, all this says both that intelligent automation will be essential to the development and maturing of patient-centered medical homes nationwide; and that at the same time, there will never be anything akin to “plug-and-play” when it comes to inserting EHRs, eMARs, physician and nursing documentation systems, and other clinical information systems, into medical home organizations.

Instead, as with everything else in healthcare, moving forward on the medical home journey will require tremendous strategic thinking, planning, execution, and patience. “Essential but not complete in itself” here seems a phrase equally applicable both specifically to the medical home journey and to the broader forward evolution of clinical IT in patient care. In short, there seem to be no shortcuts—only smart starts and perseverance.