Comments on: Empowering Health IT for the Medical Home http://e-CareManagement.com/empowering-health-it-for-the-medical-home/ Chronic Disease Management • Technology • Strategy • Issues and Trends Mon, 15 Mar 2010 19:40:15 -0600 http://wordpress.org/?v=2.8.2 hourly 1 By: Colleen http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11667 Colleen Wed, 05 Nov 2008 13:49:39 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11667 I am hearing and seeing much about what a EMR should be able to do/provide and agree. What I am not seeing is how the lack of technology and basic computer & keyboard skills will be addressed as related to individual patients. Many pts today lack computers and cannot afford online access. Where are the plans to address the basic issues of connectivity in the home necessary if we are to successfully include the pts in the EMR, self-managment process? I am hearing and seeing much about what a EMR should be able to do/provide and agree. What I am not seeing is how the lack of technology and basic computer & keyboard skills will be addressed as related to individual patients. Many pts today lack computers and cannot afford online access. Where are the plans to address the basic issues of connectivity in the home necessary if we are to successfully include the pts in the EMR, self-managment process?

]]> By: Melinda Huffman http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11666 Melinda Huffman Wed, 05 Nov 2008 13:03:07 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11666 Coordination and communication, from the patient's perspective, is still in my opinion the most important point of all that must be addressed, no matter what the setting or technology. This week, my son, had an evaluation for back surgery. Great facility, great reputation, highly recommended surgeon's group, etc. However, he has been asked to provide the same personal information at least 3 times already, and we've been in the surgeon's office only one time this week. On the day prior to surgery, he was asked AGAIN to bring his Driver's license and insurance card to the center!! They photocopied it only two days prior.. Amusing, yet tiring to say the least. Think of the $ spent to ask for this same information repeatedly and do something with it... (who knows what) Health IT... Hmmm.. Even if it's in the system,whether an EMR or not, it has to be used!. This info was entered into their system, but for some reason, maybe out of habit, they continue to ask for it again and again! Comfort level? Maybe for them, but it has worn us OUT! Coordination and communication, from the patient’s perspective, is still in my opinion the most important point of all that must be addressed, no matter what the setting or technology.
This week, my son, had an evaluation for back surgery. Great facility, great reputation, highly recommended surgeon’s group, etc. However, he has been asked to provide the same personal information at least 3 times already, and we’ve been in the surgeon’s office only one time this week. On the day prior to surgery, he was asked AGAIN to bring his Driver’s license and insurance card to the center!! They photocopied it only two days prior..
Amusing, yet tiring to say the least.
Think of the $ spent to ask for this same information repeatedly and do something with it… (who knows what)
Health IT… Hmmm.. Even if it’s in the system,whether an EMR or not, it has to be used!. This info was entered into their system, but for some reason, maybe out of habit, they continue to ask for it again and again!
Comfort level? Maybe for them, but it has worn us OUT!

]]> By: Christopher Langston http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11652 Christopher Langston Sat, 25 Oct 2008 18:31:56 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11652 If I were a provider getting started using the PCMH, I would avoid the capital cost and complexity of monitoring hardware in patients' homes. I would consider first either a robo-call system or even human dialed call system for key data collection. In most cases there really only a few things you need to know on a daily basis -- and only a few pieces of info your disease managment staff can manage. For example, daily weights for CHF, weekly PHQ9s for depression, maybe daily physical activity for coaching. It is probably as important to be offering reminders and encouragement to patients as it is to collect lots of data that no one can ever possibly use. Would you really want daily blood sugar or just quarterly A1C? Daily BP? For an interesting alternative view see - http://www.iom.edu/Object.File/Master/59/180/Tang.pdf If I were a provider getting started using the PCMH, I would avoid the capital cost and complexity of monitoring hardware in patients’ homes. I would consider first either a robo-call system or even human dialed call system for key data collection. In most cases there really only a few things you need to know on a daily basis — and only a few pieces of info your disease managment staff can manage. For example, daily weights for CHF, weekly PHQ9s for depression, maybe daily physical activity for coaching.

It is probably as important to be offering reminders and encouragement to patients as it is to collect lots of data that no one can ever possibly use.

Would you really want daily blood sugar or just quarterly A1C? Daily BP? For an interesting alternative view see – http://www.iom.edu/Object.File/Master/59/180/Tang.pdf

]]> By: colaK http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11642 colaK Tue, 21 Oct 2008 18:28:14 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11642 I really hope we get this over in the UK sometime soon. My mother is 73, diabetic with arthritis and glaucoma... it is really difficult for her to get to all the medical appointments she needs, most of which are testing that could be done remotely. Cola K. I really hope we get this over in the UK sometime soon.

My mother is 73, diabetic with arthritis and glaucoma… it is really difficult for her to get to all the medical appointments she needs, most of which are testing that could be done remotely.

Cola K.

]]> By: Linh C. Nguyen, MD, MS, MM http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11639 Linh C. Nguyen, MD, MS, MM Sun, 19 Oct 2008 23:34:26 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11639 Vince and David: This is an important topic. I agree with David that "these home base tools" should not be a requirement. Web-base PHR and EMR are available now aday, if not free for the basic functionalities. Having home base tools is certainly nice, but providers will calculate the overhead cost in their financial cash flow. Again, these should not hinder the great concept of medical home. LCN Vince and David: This is an important topic. I agree with David that “these home base tools” should not be a requirement. Web-base PHR and EMR are available now aday, if not free for the basic functionalities. Having home base tools is certainly nice, but providers will calculate the overhead cost in their financial cash flow. Again, these should not hinder the great concept of medical home. LCN

]]> By: Steve Adams http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11628 Steve Adams Tue, 14 Oct 2008 18:17:30 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11628 This is a key discussion. I heartily agree that home monitoring needs to be a key component of a "connected" PCMH to better achieve an activated, engaged patent. Home monitoring information should be available to all the appropriate members of a coordinated care team and minimize any burden for providers in getting this data through an integrated communication platform. I believe this capability is important for all five of capability categories points David has outlined above. To change tracks a bit, thought should be given to the role of home care providers in the PCMH. As our aging population needs more home care (Hospital at Home thinking) there is an important role for home care providers as part of the coordinated PCMH care team. Home care providers can have a role in properly training patients in the use of home monitoring devices and support the connected PCMH by helping to facilitate the flow of that information to other providers. This is a key discussion. I heartily agree that home monitoring needs to be a key component of a “connected” PCMH to better achieve an activated, engaged patent. Home monitoring information should be available to all the appropriate members of a coordinated care team and minimize any burden for providers in getting this data through an integrated communication platform. I believe this capability is important for all five of capability categories points David has outlined above.

To change tracks a bit, thought should be given to the role of home care providers in the PCMH. As our aging population needs more home care (Hospital at Home thinking) there is an important role for home care providers as part of the coordinated PCMH care team. Home care providers can have a role in properly training patients in the use of home monitoring devices and support the connected PCMH by helping to facilitate the flow of that information to other providers.

]]> By: David C. Kibbe, MD MBA http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11626 David C. Kibbe, MD MBA Tue, 14 Oct 2008 08:52:40 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11626 Dear Vince and Joe and Amy: I will add home monitoring as one of the examples under the "communications" capability, as well as under the capability for patients and consumers to be informed and increasingly literate about their medical conditions. The medical home ought to be "connected" and should create the environment for participatory medicine to thrive. Thanks for your comments. DCK Dear Vince and Joe and Amy: I will add home monitoring as one of the examples under the “communications” capability, as well as under the capability for patients and consumers to be informed and increasingly literate about their medical conditions. The medical home ought to be “connected” and should create the environment for participatory medicine to thrive. Thanks for your comments. DCK

]]> By: Vince Kuraitis http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11622 Vince Kuraitis Tue, 14 Oct 2008 00:57:58 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11622 Joe, As always, you provide words of wisdom. I was particularly struck by the following excerpt you wrote: "Most writings on the medical home emphasize the care team and refer in passing to the idea of monitoring. Our work at the Center for Connected Health suggests that the emphasis should be in the other direction; for the right patients, instituting the use of monitoring and messaging technologies with proper integration to providers will result in improved population management, take some of the burden off of primary care physicians and keep costs in check. So perhaps the right concept is the connected medical home." My take here is that beyond a few conceptual white papers, there's been little thought given or even early experimentation with to how to implement information and communication technologies in the medical home. This isn't a criticism, but rather an observation about the early stage of medical home development. Joe,

As always, you provide words of wisdom. I was particularly struck by the following excerpt you wrote:

“Most writings on the medical home emphasize the care team and refer in passing to the idea of monitoring. Our work at the Center for Connected Health suggests that the emphasis should be in the other direction; for the right patients, instituting the use of monitoring and messaging technologies with proper integration to providers will result in improved population management, take some of the burden off of primary care physicians and keep costs in check. So perhaps the right concept is the connected medical home.”

My take here is that beyond a few conceptual white papers, there’s been little thought given or even early experimentation with to how to implement information and communication technologies in the medical home.

This isn’t a criticism, but rather an observation about the early stage of medical home development.

]]> By: Joseph Kvedar http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11621 Joseph Kvedar Tue, 14 Oct 2008 00:01:21 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11621 This is an important post. I have heard much about the patient centered medical home of late and I think it is fair to say that if it is implemented without the IT components mentioned above (including the remote monitoring component mentioned in the follow on), it is likely to be much less efficient and less likely to achieve the goals of increased performance at lower cost. Earlier this year, on the Connected Health discussion site, I posted on this topic and suggested the phrase connected medical home might be the most fitting for a holistic view of success. See http://www.connected-health.org/about-us/get-connected-discussion/discussion/connected-health-and-the-medical-home-savior-or-distraction.aspx This is an important post. I have heard much about the patient centered medical home of late and I think it is fair to say that if it is implemented without the IT components mentioned above (including the remote monitoring component mentioned in the follow on), it is likely to be much less efficient and less likely to achieve the goals of increased performance at lower cost. Earlier this year, on the Connected Health discussion site, I posted on this topic and suggested the phrase connected medical home might be the most fitting for a holistic view of success. See http://www.connected-health.org/about-us/get-connected-discussion/discussion/connected-health-and-the-medical-home-savior-or-distraction.aspx

]]> By: David C. Kibbe, MD MBA http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11619 David C. Kibbe, MD MBA Mon, 13 Oct 2008 18:08:13 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11619 Yes, I believe this can be an important aspect and feature of a medical home. I would not require it of all medical homes, however. DCK Yes, I believe this can be an important aspect and feature of a medical home. I would not require it of all medical homes, however. DCK

]]> By: Amy http://e-CareManagement.com/empowering-health-it-for-the-medical-home/comment-page-1/#comment-11618 Amy Mon, 13 Oct 2008 17:45:53 +0000 http://e-CareManagement.com/empowering-health-it-for-the-medical-home/#comment-11618 Do you believe that home monitoring of vital signs with transmission to a database monitored by a healthcare practitioner should be included in the medical home? There are many existing systems for this: the Health Hero Health Buddy, HomMed's telehealth systems, the Intel Healthguide, the RTX Telehealth Monitor, and others. Do you believe that home monitoring of vital signs with transmission to a database monitored by a healthcare practitioner should be included in the medical home? There are many existing systems for this: the Health Hero Health Buddy, HomMed’s telehealth systems, the Intel Healthguide, the RTX Telehealth Monitor, and others.

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