Reorganization of Primary Care as Disruptive Innovation: From Molecules to Practice - HIT and the Medical Home

4.26.2011

PRESENTER:

David Bates, MD, MSC, Chief of the Division of General Internal Medicine, BWH; Professor of Medicine, HMS; Professor of Health Policy and Management, Harvard School of Public Health; Medical Director, Clinical and Quality Analysis, Partner's HealthCare System

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PANELISTS:

Asaf Bitton, MD, MPH, Associate Physician and Instructor in Medicine, Division of General Medicine, Brigham and Women’s Hospital

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Jonathan Harding, MD, Senior Medical Director, Senior Products, Tufts Health Plan, Inc.

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Dr. Jeremy Lim, Executive Director, Lien Centre for Palliative Care (Duke-NUS); on secondment from Singapore Health Services (SingHealth); Senior Consultant, Agency for Integrated Care; Chair, SingHealth Centre for Health Services Research; Co-Director, Singapore Management University-SingHealth Graduate Diploma in Healthcare Leadership and Management Program

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MODERATOR:
Frederick Schoen, MD, PHD, Professor of Pathology and Health Sciences and Technology, Harvard Medical School (HMS); Executive Vice-Chairman, Department of Pathology, Brigham and Women's Hospital (BWH); Director, BWH Biomedical Research Institute Technology Innovation Program; CIMIT Site Miner, BWH

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Forum Summary

The federal government has created large incentives for adopting healthcare information technology (HIT), but it remains to be seen if the introduction of this technology will have the desired impact on healthcare.  The usefulness of an electronic medical record (EMR) is dependent on the system of care delivery in which it is embedded.  Studies have suggested that the quality of care provided by an institution is usually not related to whether or not it uses EMR’s.  Currently, it also appears that EMR’s do not promote quality improvement.  These findings do not necessarily mean that EMR’s are not helpful, but they do reflect poorly on the way in which EMR’s are used.  The Institute of Medicine has stated, “Current care systems cannot do the job.  Trying harder will not work.”  New models of care delivery are needed to harness HIT effectively.

The most important new model is the patient-centered medical home (PCMH).  At a PCMH, patients are cared for by physician-led teams, and patient engagement is a priority, as is providing good access to care.  In this setting, HIT is used to enhance communication among patients and care providers and to provide decision support.  Electronic patient portals are showing promise as a means of promoting patient engagement.  Poor communication, especially amongst providers during care transitions, can lead to errors.  In PCMH’s, HIT has been shown to improve intermediate outcomes, such as the frequency of adverse drug-related events.  Improving long-term outcomes is more difficult.  Computerized decision support could potentially be used effectively in the PCMH, but the technology needs to improve.  Many providers currently turn off decision support because most systems add problems to patients’ problem lists without providing clear benefits.  HIT is a necessary component of the PCMH, but it is not sufficient.  It must be incorporated into an effective system of care delivery.        

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