Information Technology Reference
In-Depth Information
Chapter 5
Patient-Centered Care
In this chapter we'll look at some new health informatics tools designed to over
come the challenges of chronic disease management and supporting prevention and
wellness in community-based healthcare. Traditionally a provider is focused on
each patient, as they physically see them. That is how they were trained. In most
circumstances that is what is required to get paid. Is should be no surprise that most
electronic medical records reflect this “one patient at a time” view of care.
As we've seen, success in managing chronic disease requires a new model
emphasizing “patient-centered care” with continued patient interaction and obser-
vation between office visits. While it goes under several names, such as the Chronic
Care Model, the Patient-Centered Medical Home and others, they all recognize that,
to achieve success, the patient and their providers as a team must manage their
health and their chronic medical problems on a continuous basis. Adoption of any
of these models requires informatics tools designed to support this new approach.
Medicare's Accountable Care Organizations and similar “outcome-based” reim-
bursement systems now being offered by the major private insurers provide the
economic incentives for this approach to care. In this chapter we will look at the
contemporary informatics tools available to implement them.
In Chapter 3 we discussed the long time issue of interoperability among diverse
health informatics systems. Historically the focus was on hospitals and health sys-
tems who sought to bring together data from many - often more than 100 - diverse
and specialized systems so that they could have an integrated view of their adminis-
trative and financial status and, more recently, so that clinicians working in their
facilities could have an integrated clinical view of their patients.
A proactive, patient-centered view of wellness and prevention and the management
of chronic disease places new emphasis on solving this long time problem so that:
A group of geographically dispersed providers can work together to better manage the
complex chronic disease patients who, according to the Anderson and Horvath study we
cited earlier [ 1 ], may typically receive that care from around 14 offices per year.
That same group of providers can proactively manage a contract with an employer or
insurance company based on their success as a group in achieving certain defined quality
metrics (a financial arrangement often termed “pay-for-performance”).
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