Margalit Gur-Arie recently wrote about the concept of the Patient Centered Medical Homes (PCMH) and debunked some of the worries that this concept may bring to physicians. In my opinion, NCQA’s approach by setting out the standards as a roadmap is a better way to put forward the idea of the patient centered medical home rather than the Meaningful Use approach for EHRs where you’re having to “prove” that you are using the tools that they literally force you to use at a cost and promising some of that money back. If this patient centered medical home concept doesn’t get hijacked by other corporate interests, I think there is a good future for revitalizing primary care. However, I think that there is still a strong underlying culture of thinking there is an infinite amount money to be made in health care, and so the pressure will continue to morph this into something else that loses the essence of the idea.
None of these ideas presented in PCMH are necessarily groundbreaking if you’re already a primary care physician. There really shouldn’t be a kind of expectation that every practice has to be molded in the same way from coast to coast. I believe in my previous work as a micropractice family physician, I had all of these goals in mind when I developed my practice and actually acted upon those goals. The appearance of the practice was certainly unconventional and in the minority (in the midst of large multi-specialty practices), but it doesn’t mean it can’t be done.
Same here with my NOSH ChartingSystem project. I don’t aim for conventionality; I aim for what is the best way for doctors to be able to use technology to actually help (rather than hindering) do their jobs. Being a non-certified product certainly is not conventional either, but I’m banking on creating a powerful movement to counter the current conventions about health IT.