The “Medical Home Model” for health information exchanges

This morning, I had a conference call with patient rights advocate, Dr. Deborah Peel.  Dr. Peel and I are scheduled to appear together on at panel at the World of Health IT Summit in Berlin, Germany, on October 12th.  Dr. Peel wanted to bounce around a few ideas on our topic, “Information Technology:  New Horizons in Healthcare”.  In particular, Dr. Peel and I wanted to synch our messages around the privacy and security of health information.  Dr. Peel believes, as do I, that the best model for exchanging personal health information is when the patient is at the center and has control over when and to whom information is shared.

Over the summer months of 2008, and again in 2009, I shared my thoughts on the topic of health information exchanges.  In 2008 I wrote a piece titled “A Possible Sea Change in How to Share Health Data”  In 2009, I updated my thinking with a piece titled “Governments begin to take note of a new model for health information data sharing and exchange”.  The later piece imagewas stimulated by a debate going on at the time in the British press regarding cost overruns and social and technological challenges of the so-called “Connecting for Health” initiative in the UK—a project to more or less “hard wire” the ecosystem of healthcare and enable the sharing of health information across participating entities on a national basis.  Frankly, in my travels around the world, I’ve never really come across any nation, large or small, that has actually pulled this off no matter how much money has been spent trying to do so. 

Whether or not they eventually get it right in the UK, it is clear to me that a better model has emerged since the engineers and architects of that project began their planning.  The model I’m speaking of is the same model I was advocating back in 2008 and even earlier.  It involves aggregating health data around the patient and giving the patient control over when and with whom that data is shared,   This is, in fact, the model we use for HealthVault.  It is also a model that seems to appease most patient rights advocates.  Finally, it is a model that is likely to be much less expensive and technologically more feasible than some of the other ideas floating around about national health information exchanges.

imageI was heartened to read a post today by health IT luminary, Dr. John Halamka, which seems to suggest a similar position.  On his popular blog, Life as a Healthcare CIO, Dr. Halamka approaches the topic from the perspective of caring for an unconscious and naked patient who arrives in the emergency room.  He suggests how establishing a “medical home” for personal health data in the cloud could fulfill many of the requirements of more traditional, and far more costly, health information exchange architectures.  He writes, “What if payers, providers, and private vendors offered something called "the electronic medical home"?  The patient needs to pick some hosting option they trust.  Just as Stage 1 of meaningful use supports push transactions from provider to provider, the same transactions could be pushed to the electronic medical home designated by the patient”…….”If every producer of data (lab, pharmacy, hospital, eligible professional etc.) pushed a copy of the data they generated to the electronic medical home chosen by the patient, then the patient could become steward of their lifetime medical record hosted by the trusted agent of their choice.  Medical home data would be complete and constantly updated by data producers”.   Dr. Halamka goes on to say, “In Meaningful Use Phase 1, we implement push transactions by 2011.   Google Health, Microsoft HealthVault, Hospitals, and Payers should create electronic medical home repositories capable of receiving push transactions so that copies of inpatient, outpatient and lifetime summaries can be sent there.   The transport mechanism used to push data to the medical home could be REST, SOAP, or SMTP, just as the NHIN Direct project has suggested.   Ideally electronic medical home providers will issue each patient a Health URL, making it easy for EHRs and  health information exchanges to route data to the correct location”.

Yes!  Thank you, Dr. Halamka.  I too believe this is the answer.  That is not to say there isn’t a role for local or regional exchanges of health information.  But putting patients at the center and in control of their data is the model that I believe will get us closest to the vision of the “always available, truly transportable electronic health record for most Americans” advocated by President George W. Bush in his 2004 State of the Union address.  We aren’t there yet, but the path seems more clear than ever before to me.  And some really smart folks seem to agree.

Bill Crounse, MD    Senior Director, Worldwide Health          Microsoft

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