Consumer health informatics
Patient-Centered Medical Home Cyberinfrastructure: Current and Future Landscape

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Abstract

The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.

Introduction

The efforts to promote PCMH principles are especially important in the light of recent healthcare reform initiatives that call for greater emphasis on health promotion and disease prevention. The delivery of preventive services has been shown to improve in primary care practices enhanced by HIT. Based on the recent demonstration projects, this article provides an overview of major requirements for HIT infrastructure needed to support successful PCMH implementation and describes barriers that will be potentially addressed by the recent federal legislation on electronic health records (EHRs), health informatics, and standardization.

The patient-centered medical home (PCMH) is an approach to providing comprehensive primary care that facilitates partnerships between individual health consumers and their primary care clinicians. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality (AHRQ) at the Informatics for Consumer Health Summit.1 The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future Health IT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.

Section snippets

Gaps in Primary Care Delivery

Multiple studies have demonstrated that health care provided across the U.S. is highly variable with respect to both cost and quality.2, 3, 4 Where there is a higher ratio of primary care physicians to specialists, higher-quality care appears to be provided at the same or lower cost.5 Internationally, countries that have a more robust primary care foundation for their healthcare systems have lower per capita healthcare costs and deliver better-quality care than the U.S. healthcare system.6

Health Information Technology Applications to Support the Patient-Centered Medical Home

Recent demonstration projects illustrated need in a comprehensive HIT infrastructure to achieve the goals of PCHM and provided insight on major capabilities and functionalities of HIT that are needed to build the PCMH cyberinfrastructure in the future.31, 32, 33, 34 For example, implementation of the PCMH model in the Group Health Cooperative heavily relied on HIT including an EHR, electronic registries, health maintenance reminders, best-practice alerts, secure e-mail messages, patient access

Current Health Information Technology Landscape of Patient-Centered Medical Home: Challenges and Opportunities

As was shown above, HIT is a critical foundation to support a fully functioning PCMH that efficiently operates within a medical neighborhood context at the community level. However, to date, there have been only scattered examples of robust, fully integrated HIT within implemented medical homes. Currently, a limited number of physicians in the U.S. use outpatient EHR, although it appears that most would like to begin using them.60 In the recent national survey of ambulatory care,61 only 4% of

Future Health Information Technology Landscape of Patient-Centered Medical Home: Federal Initiatives on Health Informatics, Legislation, and Standardization

The U.S. federal government, which both purchases care and delivers care, has the ability to support the development of the cyberinfrastructure for the PCMH. In addition to direct efforts to support infrastructure development for its own delivery systems, the federal government can provide incentives for adopting systems and processes in line with this model of care, facilitate standards harmonization, remove technical and legal barriers, and establish demonstrations and other initiatives to

Conclusion

Health information technology has enormous potential in improving primary care delivery, and it will play a pivotal role in implementing the PCMH model. Further development of HIT infrastructure is required to fully uncover the potential of HIT in facilitating quality, efficiency, and safety of clinical care. A successful implementation of optimal HIT infrastructure will have to address multiple barriers on several levels. First, on the healthcare system level, a national health information

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