The patient centered medical home (PCMH) has been defined as ‘an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.’ Its principles (a personal physician, a physician-directed medical practice, whole person orientation, and coordinated or integrated care) define a care program centered on the primary care physician (PCP) as the coordinator for medical services. The stated hallmarks of the PCMH are safety and quality. These principles were laid out in a joint statement by the American Academies of Family Practice, Pediatrics, Physicians, and the American Osteopathic Assn in 2007.
Mobile health technologies support the aims of the PCMH. Patients may need to see specialists less to adjust their medications for chronic diseases if appropriately tested algorithms in wireless programs are effective. The data may be sent to the PCP’s EHR as a central data bank instead of to multiple specialists’ EHRs (providing HIEs aren’t perfected). Ideally the programs are operating on an actionable alert basis, thereby decreasing the need for routine specialist follow-up. Certainly there are remote monitoring tools that will require the specialist to be the follow-up physician (those involving implantable cardiac devices, for example). mHealth goes, I believe a step further and focuses on the patient as the home. It shifts the focus further away from the PCP and has the patient take more responsibility for healthcare, specifically regarding medication adherence, lifestyle modification, and coordination of care with a caregivers and providers. So in a way, proponents of mHealth embrace the same goals and principles of the PCMH, but take them further, involving the patient more and removing the provider as the focus. Some advocates of the PCMH might see mHealth as inconsistent with their vision, but I see it as the most useful ally and the only way the goals of PCMH can succeed, given the present and increasing shortage of PCPs. Is mHealth a shorter road towards the PCMH?Let us all, as providers, embrace the tools that improve our delivery of healthcare.
For more information on the PCMH see:http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home