Posted on | June 2, 2009 | No Comments
Two years ago, the major national primary care organizations went public with their patient-centered "Medical Home" concept.1 Since then, the AMA and 17 other specialty societies, as well as many Fortune 500 companies have endorsed the movement. This includes a vote of confidence for primary care, patient centrality, coordinated team care and payment reform to acknowledge the management of data and logistical complexity. Today there are 22 pilot projects under way in 14 states with Medicare and Medicaid planning to test out the concept in 400 practices in 2009. Ten states currently have supportive legislation in the works.2
I contributed to some of the original trend analysis – namely in aging, the internet, and health consumer empowerment – that pointed to the home. In a recent Institute of Medicine presentation I summed up my concerns about this currently under-powered vision in six words, "Too Much Medical, Not Enough Home."3
At the core of the problem is an insufficiently powered vision of the transformative power of modern information technologies, and their capabilities to reposition health care around a virtual primary loop. This virtual loop should be able to go from home to care team and back to home. Information technologies should also have the ability to coordinate and rationalize highly productive health care, community and family resources, and the ability to redefine health as a forward-facing strategic planning exercise with a 100-year preventive horizon.4
Instead, what we have is the old standard medical office, now called "home." It is a place where patients still need to physically travel to for many activities that could be done more conveniently in their own homes. We also have an electronic medical record which is little more than a passive repository for disparate past information, rather then a ‘Lifespan Planning Record’ that provides the proper scaffolding to support anticipatory planning and improved adherence with better long-term health outcomes.5,6
On the other side, many traditionalists feel that my vision goes too far, not philosophically so much as technologically. They feel that such a revolutionary re-centering of the system nationwide and overnight is unrealistic. I think they are wrong. So do some of this nation’s digital leaders who contributed to D7, the Wall Street Journal‘s seventh ‘All Things Digital’ Conference last week. What the information experts see is a shift from Web 2.0 to Web 3.0. This software is embodied by the Apple iPhone which is described as a "thin client, running clean, simple software, against cloud based data and services."
What do they mean by this? They mean, "the complete integration of computing into every part of our lives in a way that is seamless, ubiquitous and ideally, dead simple." They go on to say, "…no one knows where it will lead. More importantly, few can predict the impact it will have on all kinds of businesses."2
Arun Ravi, a Health Digital consultant for Frost & Sullivan thinks he knows. "With over-crowded hospitals and millions of uninsured patients in the U.S., the next wave of health care innovation will involve technologies that make it easier to treat or monitor patients from their homes."2
So,I may be crazy, but I’m certainly not alone.
For Health Commentary, I’m Mike Magee.
1. American Academy of Family Physicians (AAFP), et al. Joint Principles of the Patient-Centered Medical Home. March 2007.
2. Swisher K., Mossberg W. All Things Digital. Wall Street Journal. 2 June 2009. R1.
3. IOM Summit on Integrative Health Care. 25 Feb. 2009.
4. Magee M. Connecting Healthy Homes To A Preventive Healthcare System: Leveraging Technology For All It Is Worth. Harvard Health Policy Review. Fall 2007. Vol. 8:2, 44-52.
5. Magee M. Health Records of the Future. Health Politics. 6 Nov. 2006.
6. Yoediono Z, Snyderman R. Proposal for a new health record to support personalized, predictive, preventative and participatory medicine. Personalized Medicine. 2008. 5(1), 47-54