Leveraging Mobile Health Technology in a Model for Home-based Primary Care: a Demonstration Project

House calls by physicians and physician extenders are time-consuming and have historically been poorly reimbursed.  Nevertheless a number of factors are driving a resurgence in this form of patient-provider encounter.  The burgeoning fields of mobile health technology, mobile communications and electronic medical records are converging to create new opportunities to leverage advances in a robust model for home-based primary care that may be an integral component of a patient-centered medical home.  Health care systems are emphasizing initiatives to enable elderly patients to continue independent living at home, to reduce hospital admissions and readmissions and to reduce the numbers of patients entering nursing homes.   Our model for Home-Based Primary Care (HBPC) is an operational component of a Patient-Centered Medical Home (PCMH) for geriatrics.  We identify the patient’s residence as a site for point-of-care service which is enabled by employing cutting-edge, highly mobile, wireless, health technology to accomplish routine and specialized monitoring, to execute diagnostic laboratory testing, imaging and physiological testing such as electrocardiography.  We use electronic medical records (EMR) and employ new data-transfer technology that enables patients to bring their files from other providers and sytems into our EMRs.  Our process is supported by a secure medical email system and a telemedicine activity that help to sustain patients’ compliance with regimens.  As demand surges and competition increases, costs for wireless communications and mobile health technologies are falling.  By  leveraging these technologies in a new PCMH model for HBPC, we seek to demonstrate cost effectiveness and high quality care with greater satisfaction among geriatric patients continuing to live at home.

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