Building a Medical Neighborhood for the Medical Home

“Recent efforts to improve primary care in the United States have focused largely on the development and implementation of practice models and payment reforms intended to create a “medical home” for patients. The notion of a medical home makes intuitive sense and indeed has great promise. But unrealistic expectations about this approach abound, and insufficient attention is being paid to several important barriers to the clinical and financial success of the medical-home model.”
Article
Elliott S. Fisher, NEJM, Volume 359:1202-1205, September 18, 2008, Number 12

No Place Like Home — Testing a New Model of Care Delivery

“Seeking ways to slow the growth of Medicare spending and to better coordinate the health care it finances, the federal government is preparing to test the concept of the “medical home” in the Medicare program. In response to a mandate in the Tax Relief and Health Care Act of 2006, the staff at the Centers for Medicare and Medicaid Services (CMS) is developing a demonstration program that will operate for 3 years in rural, urban, and underserved areas in up to eight states. Congress has directed the agency to use the program to “redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations.” Reluctant to constrain the freedom of beneficiaries currently covered under the traditional fee-for-service model, however, Congress placed no limits on patients’ freedom to seek treatment, without a referral, from physicians not affiliated with their medical home and made virtually all practices eligible to participate in the demonstration program.”
Article
J. K. Iglehart, NEJM, Volume 359:1200-1202, September 18, 2008, Number 12

House calls

“In the future, our homes will not only be the place we lay our heads, but our pillows could even know if we need medical attention.”
Article
Donna Laporte, Toronto Star, 2 August 2008

Sharing and Caring, PHSCG Conference, 1 July 2008, Chesford Grange, UK

More details on the conference.

View the speech.

Ladies and Gentlemen,

First of all I would like to thank the organisation and Dr. Amir Hannan for inviting me to address this conference.
Secondly I apologize for not being here myself.

This conference deals with sharing and caring and I was specifically asked to highlight the international aspects.

ICMCC introduced 4 years ago the word Compunetics and we were the first to link it to healthcare. Compunetics defines the social, societal and ethical aspects of the use of computing and networking. So we already realised the importance of these issues before Web2.0 and Health2.0 appeared on the horizon. The use of the word compunetics directly and urgently implicates the patient as one of the main focussing points of our foundation. More specifically we concentrate on awareness and information supply. To serve the patient in the best way, we also have to concentrate on the health professional.
Read the rest of this entry »

Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control

“Abstract
Context: Treating hypertension decreases mortality and disability from cardiovascular disease, but most hypertension remains inadequately controlled.
Objective: To determine if a new model of care that uses patient Web services, home blood pressure (BP) monitoring, and pharmacist-assisted care improves BP control.
Design, Setting, and Participants: A 3-group randomized controlled trial, the Electronic Communications and Home Blood Pressure Monitoring study was based on the Chronic Care Model. The trial was conducted at an integrated group practice in Washington state, enrolling 778 participants aged 25 to 75 years with uncontrolled essential hypertension and Internet access. Care was delivered over a secure patient Web site from June 2005 to December 2007.
Interventions: Participants were randomly assigned to usual care, home BP monitoring and secure patient Web site training only, or home BP monitoring and secure patient Web site training plus pharmacist care management delivered through Web communications.
Conclusion: Pharmacist care management delivered through secure patient Web communications improved BP control in patients with hypertension.
Abstract
Beverly B. Green; Andrea J. Cook; James D. Ralston; Paul A. Fishman; Sheryl L. Catz; James Carlson; David Carrell; Lynda Tyll; Eric B. Larson; Robert S. Thompson, JAMA 2008;299(24):2857-2867

New e-service development in the homecare sector: Beyond implementing a radical technology

“Purpose
This paper explores the constituents of and challenges related to the innovation of technology-based services in the long-term homecare sector.
Methods
This research used purposeful extreme case sampling, a mixed methods approach to research that included focus groups and interviews, to learn from the experiences of an innovative telehomecare project. The paper uses a framework that integrates service management; information systems innovation and medical informatics theory.
Results
The findings indicate that the claimed and the rather abstract benefits of the technology espoused by information technology vendors were difficult to transform into a service concept. The organization studied is still struggling with conflicts between technological possibilities on the one hand, and the prevailing service delivery systems and user preferences on the other. Decisions about the extent to which the service needs to be reengineered, what non-technology resources are required, what should be the role of the consumer in the new care process and identifying who is actually the primary beneficiary and user of the new service remain.
Conclusions
A comprehensive development model and ‘mindfulness’ is necessary for radical service innovation in the long-term homecare sector. Creating new services that exploit the capability of radical technical innovations requires organizational development and the use of many non-technology innovations and resources. To understand what combinations of technological and non-technological resources can provide sustainable benefit, all key internal and external stakeholders must be involved from the beginning of the project.”
Abstract
Anna Essén, Moya Conrick, International Journal of Medical Informatics, Article in Press, Corrected Proof, Available online 29 May 2008, doi:10.1016/j.ijmedinf.2008.02.001

Digital Homecare book. Deadline call for chapters extended.

Due to many requests, the deadline for the chapter submission for the ICMCC book on Digital Homecare has been extended till June 15

ICMCC Newsletter 10

The latest ICMCC Newsletter is available.

Covered issues:

• ICMCC Event (including PHR panel discussion on Tuesday June 10)
• Call for chapters: ICMCC Digital Homecare Book
• ICMCC Community
• ICMCC Newspage
• ICMCC supported Events

Call for Chapters: ICMCC Digital Homecare Book

ICMCC has launched a “call for chapters” for its book on Digital Homecare.

This book, to be published by Springer Verlag early 2009, will cover all aspects of Digital Homecare, e. g. technologies; clinical applications; social, ethical and legal aspects; and future trends. It is certainly one of the important and fast growing areas in the fields of medicine. Springer Verlag, one of the leading publishers in the world has agreed to publish the book.

Digital homecare can be defined as the use of information and communication technologies to enable delivery and management of health care services at home.
Due to various needs digital home care is becoming part of main stream health care delivery in most of the countries:

• Patients are being discharged from hospitals early and often require additional Health care services and monitoring of their health status.
• Preference for Point of care
• Increase of chronic disease such diabetics
• Increased aged population

Philips acquires cardiac home care company

“Royal Philips Electronics announced Oct. 4 that it is extending its cardiac care services into the home. The Dutch firm announced that it would acquire Raytel Cardiac Services, a U.S.-based supplier of home cardiac monitoring services, and other ancillary operations from Israeli-based SHL Telemedicine, Ltd. for approximately $110 million in cash.”
Article
Eric Wicklund, Healtcare IT News EU, 4 October 2007

Philips And RTX Are Bringing Wireless Healthcare Home

“Philips is offering a comprehensive telehealth program to CAHSAH members: wireless telemonitoring measurement devices, robust clinical content—including patient education, validated health surveys and risk assessment tools—as well as innovative pricing models and wide-ranging service delivery and implementation support.”
Article
Wireless Healthcare, 24 August 2007