A consistently available record would allow PCPs to provide patients with a top quality medical home.
Editor’s note: This article is the 10th in an ongoing series by James McGauley, M.D., on the idea of a Coordinated Medical Record system, which literally produces a single comprehensive medical record for every patient. The record contains all of the patient’s clinical and financial healthcare information over space and time. The credit card industry is the model. This type of information system will do more to increase the quality and decrease the cost of healthcare simultaneously than any other single initiative.
The term “medical home” was introduced by the American Academy of Pediatrics (AAP) in 1967 to describe a central source of a child’s pediatric records. It particularly emphasized the importance of centralized medical records for children with special healthcare needs. The concept was introduced to address the duplication and gaps in services that resulted from a lack of communication and coordination among the different practitioners who cared for special needs children.
To address these problems, the AAP advocated for three steps to spread the word about the importance of the medical home: “The first requirement is the teaching of all medical students that a medical home and a complete central record of a child’s medical care are the sine qua non of proper pediatric supervision. Second, the concept must spread from physicians to all agencies and people caring for children—schools, child guidance clinics, well-infant stations, surgical specialists, emergency departments and so forth. The third step is the indoctrination of parents.”
In 1977, the concept of a medical home as a central repository for medical records actually became a formal policy of the AAP. Its statement read: “Quality medical care is best provided when all of the child’s medical data are together in one place (a medical home) readily accessible to the responsible physician or physicians.”
Since 1977, the concept of a medical home has evolved and expanded, but in the process, the original idea that a medical home is essentially a Coordinated Medical Record system has been abandoned.
In 2006, the Patient-Centered Primary Care Collaborative, a multi-stakeholder advocacy organization, described a medical home as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety.
In 2007, a consensus statement on medical home principles was jointly endorsed by the American College of Physicians, the American Academy of Family Physicians, the American Osteopathic Association and AAP. It defined a medical home as a healthcare setting led by a personal primary care physician that facilitates partnerships between individual patients, their personal physicians, and when appropriate, the patient’s family members.
The 2010 Patient Protection and Affordable Care Act mentions medical homes in the context of new payment policies, Medicaid demonstrations and the creation of Accountable Care Organizations.
Recent articles describe a medical home as a partnership between patient, family, primary provider, specialist and community support groups whose goals are to provide comprehensive care and minimize gaps in healthcare delivery. Other articles describe it in terms of a personal physician, a physician-directed medical practice, whole person orientation, integrated care across the lifespan, enhanced access to care and payment structures that reflect the value of care management.
The initial AAP definition of a medical home was focused and specific — a primary care physician plus a Coordinated Medical Record for every patient. It was remarkably prescient of the AAP to define a medical home in this way because 1967 was a time when all medical records were still on paper, making it virtually impossible to generate a single, comprehensive, coordinated lifetime record for any patient.
All of the subsequent descriptions of a medical home are laudable but vague. They essentially define what primary care physicians already do — coordinate care for their patients and communicate with other care providers and family members.
What’s missing in the recent descriptions is the specific requirement for the coordinated and comprehensive information that automatically ties all of these functions together. It’s unfortunate that this requirement is still missing at a time when it is actually technically and logistically possible to provide this information to the caring physicians.
The simplicity of what AAP recognized long ago was that the formula for providing the highest quality of medical care was simply to have all of a patient’s healthcare information readily available to the providing physician at the time of every healthcare encounter. They recognized that a Coordinated Medical Record was the necessary foundation of a true medical home.
None of us get all of our lifetime healthcare from a single physician. As we all move through space and time, a consistently available Coordinated Medical Record would allow all of our primary care givers to provide us with a top quality medical home without them needing to build the foundation of that home from scratch every time.
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