Medical home adds value beyond electronic health record

Seattle, WA—Electronic health records (EHRs) are one element of the patient-centered medical home, an approach that has been spreading in the United States in attempts to improve health care’s quality and affordability—and patients’ experience. Many medical practices launch an EHR while becoming medical homes. So some people have attributed any improvement in health care quality to the EHR, not to other aspects of the medical home. But that’s not the case, wrote two Group Health physician-scientists in an invited editorial in the June 3 Annals of Internal Medicine.

Group Health Research Institute Senior Investigators Robert J. Reid, MD, PhD, and Michael Parchman, MD, MPH, commented on a large study led by Lisa M. Kern, MD, MPH, of Weill Cornell Medical College in New York and published in the same issue of the journal. In one year, in more than 300 practices with 140,000 patients, Dr. Kern found that practices with EHRs that became medical homes achieved somewhat better overall performance on quality measures than did practices with EHRs that did not become medical homes according National Committee for Quality Assurance criteria.

“This suggests that non-EHR aspects of becoming a medical home have an additive effect on improving health care quality, compared with only using an EHR,” said Dr. Reid, who is also the Group Health medical director for research translation and a Group Health physician. He has led evaluations of Group Health’s medical home transformation. “EHRs can make it easier to improve the quality of care, but on their own they may not be enough to do so.”

“Improving primary care requires attention to teams and workflow, not just information systems,” said Dr. Parchman, who is also the director of Group Health’s MacColl Center for Health Care Innovation. “Becoming a medical home focuses attention on the interactions between team members and work tasks required for outcomes to improve.”

The medical home reorganizes care in ways that improve primary care’s core attributes—access, continuity, comprehensiveness, and coordination—emphasizing a team-based orientation based in evidence and quality improvement, EHRs to enable improvement, and a payment system to reward these activities. Examples of quality measures are receiving lipid testing for diabetes and appropriately testing children with sore throats instead of giving them all antibiotics.

“Improving primary care requires continual attention to the complex interplay of clinicians, staff, patients, and information systems embedded in a busy practice setting with high levels of competing demands,” Drs. Reid and Parchman concluded.

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