Tuesday, February 17, 2009

Medical Home or Medical Office?

In many corners of the Health Care industry experts are busy developing the concept of the Medical Home. This appears to be one of the industry responses to the rising cost of health care and the challenges in effectively managing the treatment of chronic ailments. The concept of the Medical Home has been with us for years, since the late 1960's.

Following on from my blog post yesterday, when I looked at our role as consumers in the future of health care, I think it is time to look at the concept of the Medical Home and the continuing paternalistic role of the Medical Community. Don't get me wrong, I am all in favor of Primary Care Physicians being compensated for managing the care of the chronically ill. The complexities of the modern health care system make navigating it a daunting prospect. Assigning someone to help get the right care at the right time is a positive step forward.

My concern is whether it will really be patient-centered. Will the Medical Home perpetuate the paternalistic relationship between the patient and the medical community.

Isn't the concept of the "Medical Home" a misnomer. Isn't what is being created a "Medical Office" or "Medical Concierge" service?

As I mentioned yesterday. We, as patients, are the people that are dealing with our medical condition on a 24x7 basis. Even with the very best care, unless we are admitted to a hospital or hospice, our relationship with physicians and other medical specialists, while having more continuity than the current episodic nature of care, is still intermittent at best.

If we are truly trying to create the Medical Home then we should be re-thinking care from the ground up. The cost of care delivery drops significantly as we move from in-patient, to out-patient, to practice-based care and then to home-based treatment.

If we truly want to create a system of health care that puts the patient at the center then we need to promote the adoption of the Personal Health Record as the central coordination point. A Personal Health Record that is managed by the patient. A record that the patient can authorize others to manage on their behalf.

With a Personal Health Record at our side we can then adopt Tele Health Monitoring devices to help us manage conditions on a more continual basis. We can leverage the power of the Internet to enable remote monitoring. It could be like having an security company for your body, just like many people have alarm systems continually monitoring their home.

Experts might argue that remote tele Health monitoring might not be as reliable or accurate as measurements taken by an experienced physician or nursing assistant. But surely the trending of readings that might be taken daily, or even multiple times per day, would ultimately be more valuable that a reading taken once per month, or less frequently, in the artificial conditions of a hospital or doctors office.

If we progress down this route then I believe it is essential that the data collected is available to the patient in their Personal Health Record. We will fail in our education of patients if we collect the information centrally and make it difficult for patients to review and analyze this information. Self awareness is critical to changing habits and promoting healthier lifestyles. Making monitoring information available to the individual so they can correlate it with their schedule and habits is an important step in changing for the better.

If we are going to construct the Medical Home, let's really do that and work out how we can enable better care - Where patients actually live.

Let's continue to evolve the Advanced Medical Home - but call it for what it is - The Advanced Medical Practice and work out how to integrate Primary Care with patients in their home through, online care services, remote tele health monitoring and other services that will enable patients to maintain their independence for as long as possible.

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