The patient-centered medical home (PCMH) model embraces five core principles, including, a patient-centered orientation, comprehensive team-based care, care coordinated, continuous access to care, and a systems-based approach to quality and safety, to augment primary care. Health IT can also play a significant role in realizing the benefits of primary care practices. Accordingly, the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed by the Congress, with a view to foster health IT adoption, has potential to further the goals of medical home approach through its various programs (Moreno, Peikes & Krilla, 2010). The Health Informatics/Health Information Technology (HIT) leader has a special role in fostering the five cornerstones in primary care. As an HIT leader, I can achieve these five objectives in primary care services by leveraging health information technologies.
Healthcare Informatics to accomplish Five Principles
The PCMH is an established model of high-quality care to address the limitations and delivery gaps within the existing primary care system in the United States. Medical homes are highly sophisticated, collaborative systems that promote patient centered care of improved clinical quality and efficiency (Bates & Bitton, 2010). These are increasingly using electronic health record technologies in improved patient reforms and payment structures.
Healthcare informatics can be used to develop primary care services: it can provide easily accessible services via email, phone, text messaging, web-based connections; coordinate care through technological means like electronic prescribing, clinical decision support, patient-tracking and registry functions, and secure e-mail/web-based information sharing with patients and families; and engage patients (and families) "in developing care/treatment plans with trained healthcare professionals while also providing interactive support through personal health records (PHRs) and other technology such as remote monitoring, education, and counseling" (Finkelstein, Barr, Kothari, Nace & Quinn, 2011, p. 226-227 ).
HIT in accomplishing patient-centered Orientation
HIT positively impacts patient-centered care on healthcare outcomes and healthcare processes. It also affects intermediate outcomes such as patient or provider satisfaction, health knowledge and behavior; it increases responsiveness to patients' needs, augments shared decision-making and patient-healthcare provider interaction, and intensifies access to medical information (Finkelstein et al., 2012).
As an HIT leader, I would initiate quality improvement in primary care to facilitate patient-centered approach. I would implement quality improvement efforts and coordinated care by applying information technologies. I would involve my quality improvement teams of primary care department to handle quality improvement efforts. I would expect managers and clinicians work in close collaboration in identifying the hurdles to foster quality improvement and finding solutions to overcome them.
HIT, especially patient registries, are the main ingredients of the PCMH model. Patient registries that consist of patient lists, automated notifications, and decision support tools play a crucial role in quality improvement in patient care by capturing and tracking important patient information and assisting providers in checking patient’s health status (Cantiello, Kitsantas, Moncada & Abdul, 2016). I would make use of patient registries in improving data evaluation processes. Further, I would use them as reminder system alerts for appointments with patients. Registries would greatly help in achieving patient-centered approach in primary care services.
HIT to achieve Comprehensive team-based care. The delivery of safe, high-quality patient care depends on a multidisciplinary team of professionals, each possessing a unique set of competencies and committed to assigned duties. Effective communication is the basis of intercollaborative and interprofessional approach of primary care that prioritizes patient safety. The To Err is Human asserts that lack of team-based communication compromises with patient safety issues (Institute of Medicine, 2000). Subsequently, the Institute of Medicine (IOM) in its Fostering Rapid Advances in HealthCare: Learning from System Demonstrations urged for using information technology to deal with patient safety issues (Erickson, Greiner & Corrigan, 2002). Moreover, the IOM, in its Crossing the Quality Chasm report, referred to the saliency of cooperation and coordination among healthcare professionals (Corrigan, 2005). The report findings strongly encourage me to use information technology expertise to facilitate teamwork, workflow, and patient safety.
I would definitely use electronic health records (EHR) in primary care practice. However, to maximize EHR functionality, I would employ behavioral health clinicians (BHCs) on my clinical teams for utilizing patient information. The BHCs are expected to provide a problem-based therapy or help in terms of teaching and linking patients with support groups or other services. Woodson et al. (2018) developed Behavioral Health (BH) e-Suite by working with BHCs, informatics experts and developers that had quick buttons, drop-down menus and point-and-click fields to record information about care in addition to behavioural health screening tabs to address the unmet EHR needs. I hope to install the BH e-suite to operationalize team work by properly harnessing EHR systems in primary care.
HIT to achieve care coordinated. To enable coordinated care in primary care practices, I would explore Information and Communication Technology (ICT) resources, especially patient portals. Placing patient at the center of care and focusing on coordinated care are the indications of patient-centered care coordinated approach. We can achieve this goal by the new interactive patient portal tool to allow peer communication between stakeholders, including patients and their families, and healthcare professionals. Comprehensive patient portals promote enhanced clinical outcomes, patient-provider interaction, patient compliance with health processes, patient knowledge, patient satisfaction, and effective health service delivery (Goldzweig et al., 2013). It would require coordination between portal vendors and organizational members for delivering portal. I plan to introduce relational coordination in patient portal networks, which is influenced by Gittell et al.'s theory (2011) that proposes mutually reinforcing process of interaction between communication and relationships for task integration. The Relational model I believe, would strengthen the goals of primary care practices, embolden shared knowledge, mutual respect and communication channels with patients.
HIT to achieve continuous access to care. Clinical informatics ensure uninterrupted access to care. With the help of telehealth technology I could provide distant diagnosis and consultation through video conference. The electronic equipment in telehealth medicine can monitor patients diagnosed with chronic diseases. It can transfer important reports about patients' conditions to the nurse who can take actions in response to the conditions. The EMRs combined with other technologic innovations promote not only data storage and provider efficiency but also allow shared access to patient information, thus enabling unceasing and smooth delivery of care (Buttaro, 2013). I would engage all the concerned stakeholders in primary care to increase their knowledge of medical informatics and upgrade their wireless hand-held persona devices to increase access to medical database so that they can determine correct medical dosages and drug-drug interaction. I would employ medical informatics to guarantee instant access and easy transmission of pharmacologic information, diagnostic test results, and prescriptions to professionalize primary care.
HIT to achieve systems-based approach to quality and safety. Effective healthcare delivery systems involve the application of HIT. EHR is an essential component of HIT that registers patient's medical information. The Institute for Healthcare Improvement (IHI) introduced the Triple Aim initiative that focuses on HIT designs in three areas: improving patient experience of care and his satisfaction; improving the health populations; and reducing the per capita of healthcare (Heller, 2016). I would implement the Triple Aim initiative in primary care to build a systems-based orientation to quality and safety. HIT would help me to empower and educate patients and their families and diversify the impact and responsibilities of the primary care providers in compliance with IHI vision.
A twenty-first century healthcare model should be integrated and linked by information technology. It should be patient-centered and based on new technologies. I prefer to integrate all these features to craft a cost-effective, qualitatively improved care by involving stakeholders, all of whom being committed to efficient quality of care and better patient safety. HIT has been recognized as a sophisticated healthcare model that has transformed the U.S healthcare system in terms of patient safety, efficiency, and quality. Abdelhak, Grostick and Hanken (2014) indicated that HIT applications such as EHR logistics, electronic prescribing, bedside bar coding, computerized physician order entry, and decision support systems can significantly reduce and improve quality. I intend to install these applications to realize a systems-based approach in primary care setup. Moreover, I would also apply mobile health technologies, including telehealth and telemedicine infrastructures to continuously promote excellence in healthcare.
Plan engaging Staff, Stakeholders, and Disciplines with HIT and Expected Outcomes
I would first determine the learning outcomes that my staff and healthcare providers should gain at the end of the training program. The main objective of the primary healthcare project would be to ensure that the healthcare employees and stakeholders remained familiar with, and were ready to adopt technology in the workplace. The plan would provide a set of health informatics education materials so that the staff would be ready to use the new technologies as they became available. I would make sure that my staff were technology-ready and computer literate.
I would include professionals from varied disciplines, namely, clinicians, ICT experts, software developers and engineers to learn the knowledge and necessary skills required for enhancing the expertise of of healthcare informatics. I would enrol nurses, general practitioners, allied health professionals, and health administrators to learn and use ICT in delivering primary health services. They are professionals working in different healthcare environments. The clinicians will be able to understand how to use ICT to support their practice; ICT professionals will get to know health information system and the way healthcare is delivered; and software developers will be able to configure new heath informatics applications.
The plan would have a technological focus as well as a socio-technical focus. The stakeholders would inquire into the cultural, social, economic, political, and legal implications of the implementation of the health information systems. The expected outcome would be generating health informatics practitioners, leaders, and researchers. I would enforce essential support services and strategies to facilitate the speed and extent of the application of HIT data. I would initiate steps like translating rules and regulations into individual practice settings, advocating interdisciplinary communication, offering the platform equipped with processes and tools for practice improvement; maintaining accountability and momentum; and providing local electronic health record (EHR) technical expertise to use HIT effectively in primary care. The plan would require continuing support for community-based practitioners to translate their learning into practice for quality care to patients.
Health Information Technology is a necessary ingredient of PCMH. Emulating the PCMH model, the primary care services can successfully achieve quality improvement, patient empowerment, and improved communication by exploiting the HIT resources and capabilities. A qualified HIT leader can accomplish the five major goals of PCMH model in primary care setting by resorting to various medical informatics facilities. A well-planned program to educate primary care personnel regarding HIT applicability would give a blueprint to accomplish these five objectives justifiably.
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