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The Virtual Health Home

The virtual health home is
the “other half” of the patient-centered medical home. Some might
say it’s the better half. Though related in purpose, the two “homes”
differ dramatically in perspective. While both place the patient at
the center of care:

  • In the medical
    home the perspective is that of health professionals who are looking
    and managing in toward the patient.
  • In the virtual
    health home the patient is looking and managing out from the center.

The difference is astounding.

Leslie Kelly Hall and I have
authored a white paper outlining the “comforts” of the virtual health
home. We hope you will read it and give us your thoughts.

A virtual health home is a
Web-place of integrated applications selected by the consumer to better
manage all aspects of his or her health and health care. The virtual
health home (VHH) brings together in one inter-related place the patient’s
view of the EMR and information prescriptions for decision support,
self-management, and wellness promotion tools. Also included are health-related
social network connections and a wide variety of other health-enhancing
and health care management applications created by a broad variety of
stakeholders across the health care and wellness spectrum. The consumer-owned,
consumer-designed and consumer assembled virtual health home provides
one-stop shopping for information, tools, and support for every aspect
of a person’s health.  A Call to Action

Most of the information prescription
content, technology, and programs already exist in leading organizations
and are well-positioned for mainstream application. In spite of that,
an increased commitment to take action in three specific areas could
greatly speed the needed coordination that a virtual health home would
bring:

    • Every hospital,
      hospital group, or RHIO coalition should plan to either deliver or interact
      with the virtual health home of each patient in their service area.
    • Major IT companies,
      such as Microsoft and Google, that provide secure management of individual
      health records should lead or align with the development of the virtual
      health home and ensure that the interoperability standards are met.
    • CMS and health plan
      policymakers should decree that every eligible person covered in their
      plans receives a virtual health home at no expense to them.

    The virtual health home, in
    combination with the patient-centered medical home, will significantly
    fill the debilitating gap that currently exists in care coordination
    and continuity.

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12 replies »

  1. I want a er-diagram for virtual medical home
    the users of the project are doctor,kioskmanager,admin,patient

  2. I want a er-diagram for virtual medical home
    the users of the project are doctor,kioskmanager,admin,patient

  3. It’s a lovely vision, and perfectly suited to all of us reading and posting on this site: the technological elite, who thrive on personal access to high speed internet at home and/or work and increasingly rely upon electronic sources of information.
    You may sniff self-righteously when faced with what appears to you to be an archaic, paternalistic attitude in the traditional medical home model, but the reality is that many among us – arguably most of those with inadequate access to health care, since relative poverty, lower wage jobs, relative lack of eduction, and lack of health insurance correlate with one another – are not so electronically blessed. This makes these discussions appear utopian and off the mark in light of more pressing problems.
    If, like most US trained physicians, you spent some time caring for the health care underclass, you’d experience first hand just how far most of the people who are struggling with health care access are from contemplating self-management via a web-based medical home. People struggle to get timely transport and time off between their several part-time jobs to make it to their medical appointments. They struggle to keep prescriptions filled and brand/generic/alternates straight throughout ups and downs in insurance coverage. Many do not have high speed internet access at home or work, much less via an iPhone or blackberry, and haven’t had occasion to become facile with navigating the web.
    A universal, consistent and reliable electronic record to keep all health records accessible and available across health settings, including for the patient at their leisure, would indeed be a valuable achievement and without doubt would save many lives, and improve many others. But do not think that by building this, even by making it free, that the masses will automatically be saved.

  4. Don — Great stuff you are doing here. I applaud the movement toward patient autonomy that integrated applications and information make possible and especially the use of simple, plain language. Its all about having the right information, expressed clearly, in the right place. What I would like to see more of is how the virtual health home can support wellness. The preventive steps to help “Barb” and her bad back avoid surgery are a great first step, for example. But how will virtual health home support weight loss in the 60% of Americans who need it? How about screenings, exercise, and smoking cessation?
    Looking forward to good things in the future!

  5. Since I started off with a dyspeptic comment, I probably should explain what I meant because based on some subsequent comments, I don’t know how my short post was understood:
    1) I have nothing against participatory medicine. Obviously, all medicine requires some degree of participation. (It is true that, when this topic was discussed elsewhere, I verbalized serious doubts about how many patients are truly able to pearticipate on a high level. That does not mean that I am “against” PM or that I think that “all patients are simpletons”.)
    2) So why the irritated tone of my firts post? As most readers of THCB know, we are living in a time where, what was it, 30 or 40 Million Americans are uninsured, countless more are underinsured or face personal bankruptcy related to med. expenses, medicare is facing a shortfall that will endanger the coverage of services on today’s limited eligibility criteria … and I am reading a “call to action” in order to divert attention and resources for something of debatable (at best) value. Could it be potentially helpful for some patients with complex health problems, and is there something desirable to the idea? Of course. But in these times, I find it difficult to come up with health care issues that require a less urgent call to action. If a virtual medical home is in great demand by patients/”consumers”, it will come quick, at least for the affluent and interested (admittedly, my perspective might be slightly tilted here because I currently work for a patient- and profit centered MSG that is quite proactive re. patient preferences and IT).

  6. I agree that the medical home must be augmented by the virtual health home…one way to help make that happen is for organized medicine to provide patients with the day-to-day support they need to prevent disease and to self-manage their conditions if they are ill.
    In the connected era that means just in time delivery of the personalized and up-to-date data and information a person needs to have the knowledge and skills to make wise choices.
    It means supporting patients to easily and accurately keep track of their performance and use that knowledge to plan and implement new approaches to reaching their goals.
    It means providing tailored messages and experience that speak to each person based on their unique characteristics, their performance on key behaviors and their needs at that moment in time.
    It means helping patients link directly to family and friends for critical support, and link to their many providers to help integrate medical care with everyday life.

  7. The medical home looks like it does what a good primary care physician does (or used to do). What is the big deal? Isn’t that what you went to Med school to learn? Even so, the patient is only peripheral, most of the interaction takes place among medical people.
    The “virtual health home” envisions a specialised ‘home page’ with instant access to a wide range of information, decision tools and more. The premise is to enable coordination of care by the patient. I’m not sure if I agree entirely with the underlying premises, but they are certainly worth discussing:
    1. The self-care rule: Help people do as much for themselves as they can.
    2. The guidelines rule: Help people ask for the care they need.
    3. The veto rule: Help people say no to care that will not improve their lives.
    (The Virtual Health Home: The Dashboard for Health and Health Care by Donald W. Kemper, MPH, and Leslie Kelly Hall)
    I’ve been searching for ways to enable people living with a condition/disease (a/k/a “patients”) to take control of their health AND have better interactions with health professionals; I called this “a third network.” http://photoluminations.com/drupal/node/43
    We need a “third network” to provide consumer-oriented services that are solidly informed by valid medical science and supported by trained healthcare persons, yet open to new discoveries by patients and that can provide medical-patient interaction as well as the e-patients and their networks.
    Kemper and Hall present a potentially valuable model for enabling patients to manage their care. As a writer and publisher, I appreciate their focus on useful information to enable patients to better carry out what is medically appropriate.
    To read the white paper by Kemper and Hall, try this link:
    http://hwinfo.healthwise.org/docs/DOCUMENT/8287.pdf
    If that doesn’t work, go to healthwise.org, search for white papers, click on white papers, and sign up.

  8. Polarities aside, thanks for a very interesting article. It is closer to a patient’s understanding of participatory medicine than anything I’ve seen on this site, plus it would seem to answer David Kibbe’s call to patients: What Do Patients Want in IT?
    I believe that given where the profits are, IT is devoted to billing and coding, doctor/payor nexus. Therefore VHH is more respectful, and more promising. As a taxpayer, I’m not enthusiastic about handouts for physicians who show little respect for patients. (Duke was practically deaf, dumb and blind to patient issues until the ER expense came up. Unbelievable.)
    Sorry. I can’t get your link to work, either.

  9. The polarities in attitude: For the “medical home,” which sees itself as looking in and “managing” the health of a not-quite-bright patient, patient access to records is a low if not ridiculous priority.
    “Patient. If you are too shiftless o lose weight, exercise, and build a nice psycho-social environment for yourself — i.e., do the simple stuff — how could you possibly make intelligent use of your health records?”
    For the VHH inclined: “Physician. Access to my records and test results is both a legal right and a personal priority. Given the fragmented state of the hc system, I am checking and double checking YOUR work so you don’t accidentally kill me while you are ‘managing’ my health and that of my loved ones.”
    This is polarity indeed. If it were a Hollywood script, it would be Medical Business meets Activated Patient.
    Check out the recent Duke University study on reasons patients give for over-use of the ER. Patients have long been screaming at the medical community about modernization of IT and attitude, but Duke only just now connected patient desire for efficiency of communication, respect for time and e-mail communication to their bottom line.
    As an rbar-type VHH-oriented person might say, If you can’t do the simple stuff (make a phone call or send an e-mail), why should I trust you to do the hard stuff?

  10. As illustrated by the above comment, what the two communities have in common is a desire for greater patient education and proactivity.
    I am dismayed by the persistent hostility toward patients, explicit and inexplicit, expressed by assumed physicians on this site. This attitude feeds patient distrust of physicians and strengthens determination to exert some measure of control over obtaining best practices. It exactly expresses the1950s Doctor as God, Patient as Unworthy Supplicant culture that started the e-medicine phenom on the first place. In a broke down health care system such as ours, this is the attitude that gets patients killed in complex cases. Truth be told, the bitterness by now is probably both widespread and mutual. Physicians, by their own reckoning, particularly specialists, are not paid enough to put up with all this patient stupidity. For the patient, there is nothing quite as stellar as the memory of arrogance — and sheer unavailability– of physicians after they have committed an error that nearly got your loved one killed.
    “I want a second opinion.”
    “You want a WHAT!!???”

  11. Leslie Kelly Hall and I have authored a white paper outlining the “comforts” of the virtual health home. We hope you will read it and give us your thoughts.
    I’d love to, but am having trouble with the link you’ve provided. Does it work for anyone else?

  12. You know what, Don, even though that may sound acidic:
    Work out. Eat a varied low fat diet (and loose weight if needed). Focus on medical treatments that pay off (e.g. treatment of hypertension, hyperglycemia). Try to create a healty psychosocial environment, and engage in meaningful social interaction. That should do it for most people.

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