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The Electronic Medical Home

In previous blog posts, I’ve mentioned an idea deserves its own dedicated post.

Over the weekend, I keynoted the eClinicalWorks National User’s Conference in Florida. One of the attendees emailed me the following question:

“I have a number of questions regarding certain types of patient-level data that might cause us problems in the future of HIE. No one, to date, has been able to answer these and I thought I might ask you.

The first, and easiest, is how we we going to handle the following situation:

1) I am seen in Boston as a child and my mother says that I am allergic to Penicillin (or pick your drug of choice). The nurse-practitioner asks a few questions of my mother, who isn’t terribly forthcoming with information but insists that I am allergic. While he/she has reservations, they record it as an allergy in their eclinicalworks EMR. It goes to the Massachusetts HIE.

2) I move to Washington DC to go to college and the family practitioner hears my allergy story. ┬áHe asks more detailed questions and decides that I DON’T have an allergy. He records it in his Epic system and it goes to the DC HIE.

3) I get my first job in Dallas. Unfortunately, I wind up unconscious in the Dallas Ed and the doctor queries my records – in our future super-connected world, he/she sees that I am both allergic and not allergic to Penicillin.

How do I, as a patient, protect myself from this happening?”

The best way to accomplish this is for each patient in the country to choose an Electronic Medical Home (EMH) which stores a copy of their electronic data as gathered by clinicians, pharmacies, labs, payers, and other data generators.

The concept is simple. An Electronic Medical Home vendor would create a URL or secure email address for each participating patient.

The patient would provide this URL or secure email address to every caregiver.

At the end of each visit, test or hospitalization the data would be sent securely to the Electronic Medical Home of the patient’s choice.

These Electronic Medical Homes could be offered by primary care givers, EHR vendors (such as eClinicalWorks’ 100millionpatients.com), or non-tethered EHR vendors such as Google Heath, Microsoft Healthvault, or Dossia.

Over the next few weeks, I predict that even telecoms like AT&T and Verizon will announce eHealth offerings.

All we need to get started is for one of these groups to create simple software capable of receiving clinical data via a RESTful URL or via SMTP/TLS Secure email/XDR as suggested by NHIN Direct.

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Electronic Medical Homes nicely solve the problem of consolidating multiple disparate records in one place. They solve the Meaningful Use requirement to deliver summaries and educational materials to patients. The make the patient the steward of their own lifetime records, simplifying consent issues for data sharing.

But what if a patient does not want to be the steward of their Electronic Medical Home? That’s ok. It will give rise to a new professional service, the healthcare knowledge navigator, an expert who manages your Electronic Medical Home on your behalf. This could be a primary care clinician, a midlevel (Nurse Practitioner/Physician Assistant) or a trusted vendor.

Here’s my challenge to the industry.

Create an Electronic Medical Home using a RESTful URL or the NHIN Direct specification.

As long as you protect privacy, ensure technical security, and obtain patient consent, I will send data to you on behalf of the patient.

John Halamka, MD, is the CIO at Beth Israel Deconess Medical Center and the author of the popular “Life as a Healthcare CIO” blog, where he writes about technology, the business of healthcare and the issues he faces as the leader of the IT department of a major hospital system. He is a frequent contributor to THCB.

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4 replies »

  1. Shared Care Plan site referenced by @cascadia above is quite neat. I like it as a patient-led HIE/PHR kind of deal. I think it would be more robust if it had a means of HL7 link to the full EHR, especially actual clinical notes (H&P, D/C summaries, progress notes).

  2. That idea makes a lot of intuitive sense empirically, but as a practicing family physician, I conclude the custodian of the PHR/EHR data for a given patient needs more context – the ability to query the patient and make clarifications; by definition, that kind of agent meets the definition of a ‘provider’ for that patient – and we’re back to the provider needing to manage the records. To my best knowledge and conjecture, the best bang for the overall buck is the medical home model, but highly-integrated PHR / EHR components – on a foundation of a standardized HIE protocol (hopefully, a nationwide interoperability standards set soon as usership increases). I think my point is that – ultimately – the patient (not being a competent healthcare expert her/himself) must trust some provider agent to manage and consolidate the records, and define what the true, unified set is for the patient. Absent this ideal (which may be years away from ubiquity), another way to do it is merely label the source of the info in the consolidated record; eg., you label the CCR or clinical notes from the Massachusetts physician as such, and the ones from the DC doctor as such. Then, the current physician / ER can review and decide which to believe in context.

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