The concept of medical homes as a model for delivering coordinate, patient-centered health care has been widely promoted and implemented in health care organizations across the U.S. In truth, there is no one model but diversity of approaches and a recent survey of medical home demonstration projects performed by The Commonwealth Foundation calls for more comparative data and evaluation of these models that can assist in determining success and best practice. A critical component to the medical home concept and a key to providing comparative and evaluative data is the implementation and support of health technology systems. Electronic health records (EHRs) within care settings, particularly in physician offices, and the exchange of health information through Health Information Exchanges (HIE) are crucial to the success of medical homes and a key aspect of recent health care reform initiatives.
Primary care physicians are the cornerstone of the medical home. Through a team approach, the primary care providers bring together resources in the community to assure coordination and integration of personalized health care for patients. Achieving efficiency, quality and safety in the provision of this care begins with data management within the medical home setting through an EHR which will link with data of other health care providers and community resources within an HIE. These technological tools create a virtual environment which supports interdisciplinary care, access better and more timely clinical and patient information, improved quality and lower costs. In addition, administrative processes can be streamlined to improve physician productivity.
Adoption and implementation of EHRs, however, has been slow, particularly in small practices that provide primary care – the foundation of the medical home. The American Recovery and Reinvestment Act (ARRA) of 2009 seeks to increase the use of EHRs and provides support through Regional Health Extension Centers (RECs) which offer technical assistance, guidance, and information on best practices. The ARRA also recognized that adoption and implementation of EHR technology was not sufficient to achieve the goals of improving quality care and outlined financial incentives for providers to adopt “meaningful use” of EHRs. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides financial incentive payments for eligible Medicare and Medicaid providers for adoption of certified EHRS and achievement of ”meaningful use”. On July 13, 2010 the Centers for Medicare and Medicaid Services (CMS) announced final rules on Meaningful Use and Standards and Certification of EHRs for professionals and hospitals.
The South Florida community was among the first in the country to receive funding for a REC to assist primary care practices with the adoption EHRs. The Health Choice Network (HCN) received funding to establish the South Florida Regional Extension Center (SFREC) which now assists physicians in selecting prequalified EHR vendors, guidance on meaningful use data criteria, data collection and reporting, implementation support, and a forum for exchange of health information. Through the SFREC, small physician practices as well as settings which serve uninsured, underinsured and medically underserved populations can find the resources needed to implement the health information technology critical to the medical home concept and in alignment with federal requirements for “meaningful use.”
Lisa Rawlins, Executive Director of the SFREC, says the organization seeks to support at least 1,500 primary care professionals in South Florida. In conjunction with the Health Foundation of South Florida (HFSF), a co-applicant on the federal cooperative agreement, the South Florida Health Information Exchange seeks to improve the healthcare delivery of our community. The SFREC has currently enrolled more than 180 health care professionals and is working to connect and assist practices in the move to EHRs and meaningful use.
The SFREC is one of 60 Regional Extension Centers around the country, designated to offer health care providers a local resource for technical assistance, guidance, and information on best practices to support and accelerate health care provider efforts to become meaningful users of EHR. “The services offered through the community collaborative, the SFREC, is a once in life time opportunity for the private physician practices to offset the cost of EHR selection, implementation and training by the federal stimulus dollar, “ Rawlins said.
Health care technology is moving ahead and as additional federal and mandates for EHR and HIE “meaningful use” are on the horizon, South Florida has the resources to assist. The community has the opportunity to improve healthcare delivery through implementing EHRs, adopting HIE, and promoting the medical home concept.
One resource which has not yet been addressed is the need for more individuals who have knowledge and skills in fields of informatics and management systems. The College of Business at Florida International University (FIU) will soon offer a Graduate Certificate in Health Informatics & Management Systems to provide information systems professionals, physicians, nurses, other clinical personnel and healthcare managers a foundation in health information technology and management of the complex social and organizational issues surrounding the increased emphasis on managing healthcare quality, efficiency and outcomes through information systems.
