Remember your family doctor? The person who knew your whole history? Who would see you outside of office hours and on weekends? IBM and healthcare advocates want to bring the family doctor back... in the form of a new model for primary care: the Medical Home. And in this new world, he or she will even make house calls—albeit virtually.

"It started about three years ago," remembers Dr. Paul Grundy, IBM's director of healthcare transformation. "We were talking about all the things that large employers in the U.S. like IBM had done to reduce costs and improve quality and we realized we were failing to address a fundamental issue: primary care."

Shortly afterwards, he helped found the Patient-Centered Primary Care Collaborative (PCPCC), a coalition of large employers, consumer organizations and medical providers. They developed a healthcare model based on the premise that more holistic primary care could save money by reducing the incidence of major health problems later in life.

From episodic care to holistic care

In the Medical Home model, the primary care physician acts as healthcare "coach", leading the team that manages a patient's wellness, preventative and chronic care needs. He or she spends more time with each patient in person, is available via email and phone for consultation; offers expanded hours and coordinates care across the individual's entire care team.

For example, a diabetic in the Medical Home model could give daily blood test readings by phone, email or even a state-of-the-art remote monitoring device and get medical instructions the moment he needs them, rather than wait for an appointment. The care team would have a holistic health plan in place focusing on diet and exercise as well as monitoring glucose levels.

Countries outside of the U.S. are also taking new approaches to primary care. In the U.K., they have adopted a similar "family doctor" model that provides better accessibility to one's general practitioner and continuity of care for patients, which leads to better patient satisfaction.

Going digital creates a smarter doctor's office

Health information systems are central to the Medical Home model. An electronic health record (EHR) serves as the single source of information that can be shared across a network of providers and specialists. In a 2008 Commonwealth Fund survey of 7,500 chronically ill participants, Americans fared worse than their counterparts in seven other countries. They were most likely to report wasting time because their care was so poorly organized. About a third reported that medical records and test results were not available when needed or that tests were duplicated unnecessarily. A third experienced a medical error, such as being given the wrong medication or test results.¹ An EHR can help to reduce such errors, eliminate duplicate tests, highlight drug interactions, improve overall quality of care and reduce costs.

Other IT tools can reduce errors and enhance collaboration. These include:

• a Web portal for patients to make appointments and look up lab results
• computerized physician order entry
• e-prescribing
• patient registries.

Work flow tools can help automate tasks such as sending patient reminders and ease coordination across a variety of providers.

Health analytics and decision support tools offer the ability to look across a patient registry for trends that can provide clinical insight into the treatment of disease.

Moving to an EHR system may also prompt a change in support roles. Since less time is required to maintain paper records, staff can take on more strategic tasks. A practice may need to add roles such as a case manager or benefits specialist to manage the ongoing care of a roster of patients.

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¹ Health Affairs Journal, The Commonwealth Fund, NY, Fall 2008