Integrating Systems for Patient Centered Medical Homes

Overview

Achieving quality excellence in care coordination with controlled costs is one of the top most needs today and demands enhancing the relationship between patients and physicians. It is also an acceptable fact that increased use of primary care physicians has reduced inpatient visits as well as other expenses in specialist services. Patient Centered Medical Homes (PCMH) is an innovative care model that links the primary care physicians (PCP) and the patients with the objectives of coordinated primary care with improved quality and increased patient/physician satisfaction while reducing cost of care. With the aim of achieving the desired objectives, PCMH model demands integration of care information across various healthcare systems. For efficient and continuity of care, readily accessible and accurate care information needs to be shared since it influences the business as well as patient safety. The services provided through system integration should be in compliance with the principles and the standards laid down for the PCMH model as well as meet the regulatory requirements

This document addresses the System Integration approach for PCMH along with key requirements.

1.    PCMH - Systems Requirements based on model principles

The American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics and the American Osteopathic Society have set up a national coalition -the Patient-Centered Primary Care Collaborative (PCPCC)-to advance the PCMH model.  The Collaborative has formalized a set of principles which focuses on the trust relationship between a patient and the PCP. IT systems integration as needed for PCMH implementation should be designed in consideration with these principles so as to achieve the desired objectives.

2.    PCMH - Regulatory requirements

A recent 2010 study , conducted by researchers of Harvard University for seven most successful PCMH organizations, shows that data-driven analytics and expanded access to care managers are the most important features of a successful PCMH model. Hence, it is evident that integrated healthcare system is one of the most important success factors for PCMH.

The National Committee for Quality Assurance (NCQA) has defined guidelines for designing PCMH. According to these guidelines, a practice is assessed for following considerations in order to be certified as PCMH. Some of the guidelines mentioned below help in deriving functional imperatives of systems integration:

•    Patient Tracking and Registry Functions

• Integrating with Practice Management Systems (PMS) for Patient  Demographics
• Integrating with EMRs and PHRs (e.g. HealthVault/ Google Health etc) for patient clinical data access
• Patient data reconciliation with all systems through EMPI integration

•    Care Management

• Integration with Clinical decision support system for checking various interactions while prescribing drugs
• Integrating with medical devices from home through device integration drivers to plug-in patient data

•    Electronic Prescribing

• Interoperability with pharmacy systems for Electronic prescribing along with payer specific formulary integration

•    Test Tracking

• Integration with diagnostic systems for getting labs and radiology data
• Labs and imaging order entry using HL7 (if not available in practice) and tracking

PCMH – Systems Integration approach

Once the system integration needs/requirements are identified, the implementation model should focus on integrating the systems, complying with the following requirements:

• Real-time access to the care data
• Standards compliance
• Leveraging existing investments and infrastructure
• Configurability and adaptability for all types of patients and their conditions, including high risk patients
• Integrating with payer systems, involving payers for tracking physician performance (through reporting) and related payment model

Unique Patient Identification: An important implementation factor is unique  identification of patient and physicians. Hence registry and Enterprise Master Patient Index would play vital role in ensuring data integrity.

Integration with Medical Devices: The implementation model should also have integration with Home Health monitoring systems or medical devices which patients or care coordinators use to provide self-monitored health data such as vitals, blood glucose etc comfortably at home without visiting the facilities.

Integration with Mobile Devices or other communication media: Having the services available on mobile or other handheld devices is needed for increased accessibility. This can be achieved using thin client mobile applications which can synchronize with PCMH platform database. Apart from application rendering on mobile, even SMS advisory services can be implemented using gateways thus enabling personalized care. With communication providers investing in healthcare, their services can be utilized for chronically ill or disabled patients who can avail the consulting services from home using television media. Such e-consultation services can be availed in synchronous communication mode (such as audio or video or text based chat) or asynchronous workflow based mode with secure messaging.

Integration with Payer Systems: Integration with payer systems is important for PCMH business model. Primary physicians based on their performance will get rewards/incentives from payers under pay for performance initiatives. Payers would provide the patient clinical data as obtained in claims along with demographics data, if needed by PCMH. Payers would in turn need data around patient satisfaction and physician performance using reports. This integration can be achieved with standardized EDI transactions through messaging standards such as X12. The infrastructure for the same usually resides with payer and can be leveraged. This can be implemented with two models – Centralized and Federated. In Centralized mode, the data gathered will be stored in PCMH interoperability platform whereas in Federated it will not be stored. In Federated approach the data will be sourced in real-time through interfaces developed using integration engines.

Integration with Health Information Exchange (HIE): Integration with HIE can be done to leverage the HIE infrastructure for data sharing. With recent health reform laws there are drivers for implementing HIE and Health Benefit Exchange. This opportunity can be leveraged by PCMH organizations to reduce infrastructure costs by establishing symbiotic partnerships with HIEs.

PCMH is an important and innovative initiative since it helps not only build relationship between patients and physicians, but also has potential to reduce costs and improve- quality of care. At the same time, it is also important that physicians get paid appropriately for the PCMH related services they provide. Patient-centric, collaborative platform with buy-in on data sharing from all the stakeholders is the most important critical success factor in implementing PCMH through systems integration.

About The Author:

Triveni Harsh Mohta:  Senior Project Manager, Insurance Healthcare and Life Sciences Practice, Infosys Technologies

Triveni has more than 10 years of experience in Insurance and Healthcare industry. She has managed solutions development and customer projects around Electronic Health Records, Disease registry and Management, Hospital Performance Management, Teleradiology and healthcare systems integration. She also has worked as Business and research Analyst in healthcare solutions program at Infosys.

She is certified in one of the biggest Health Information Systems product, HL7 standards, AHIP and LOMA

Triveni can be reached at:  triveniv_t@infosys.com