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Medical home model improves patient care

By Dr. Nathan Fujimoto

LAST UPDATED: 1:54 a.m. HST, Jun 11, 2011

We should all take a moment to applaud recent developments at the state Department of Human Services and the Legislature. Kaiser Permanente's experience in coordinating care is a good indicator that moving to a "medical home" model for Medicaid patients and managing their health records electronically will increase the efficiency and effectiveness of their care.

The medical home model, also known as the Patient-Centered Medical Home, or PCMH, represents a team approach in which a patient's personal-care physician leads a team of health care professionals, addressing every aspect of a person's care in a coordinated manner.

We can vouch for the model's ability to expand access, and improve treatment and satisfaction at a lower cost. Kaiser Permanente is one of several integrated systems that have been delivering care in this way for many years. Research shows PCMH is capable of improving clinical outcomes, expanding access to care outside of the usual office setting, improving patient and staff satisfaction, and reducing health care costs. It has bipartisan support as a key element of any meaningful federal health care reform and is supported by all major medical organizations as an accountable model of care.

Kaiser Permanente's care model was created as an alternative to the way traditional medical care is delivered in the United States. Public health and health care financing experts tell us the conventional fee-for-service model tends to encourage more care versus better care. The PCMH model addresses this issue by encouraging measurable quality and prevention, and by focusing on outcomes rather than volume.

The delivery of medical care is complex, with patients often seeing multiple physicians in a variety of health care settings and disciplines. Without a means for providers to communicate with each other and have real-time access to patients' medical information, care can become fragmented.

Electronic management of medical information enables PCMH to function optimally. Electronic health records make it possible to share medical information in a secure and confidential way, enhancing coordination of care between providers, reducing the likelihood of duplicate testing and expanding preventive care outside of the doctor's office. It allows your doctor to proactively search and identify patients who are missing important preventive interventions and notify them.

Comprehensive electronic records that contain a complete history of outpatient (clinic), emergency room and inpatient (hospital) information are also fundamental for medical advice to be provided over the telephone or electronically. We have had complete integration of electronic medical records for several years and have been able to accountably offer phone appointments and secure email messaging. Electronic records enable physicians to give patients access to care around the clock, every day. Patients can speak to an advice nurse who has access to their medical information or an on-call physician, even when the clinics are closed.

Only in a vertically and horizontally integrated system of care is it possible to coordinate care across time, setting, specialties and disciplines, and truly do what's in the best interest of the patient. Doctors, physician assistants, midwives, Advance Practice RNs, nurses, pharmacists, therapists, dietitians, social workers and medical professionals in the emergency room, hospital, home care, operating rooms, ICUs, lab and X-ray all need to be aligned and supported by an integrated electronic health record. We've been using what is now called the medical home model for more than 50 years, and it will get better as competition drives the will to innovate and improve.


Dr. Nathan Fujimoto specializes in internal medicine at Kaiser Permanente Hawaii.

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