Since I work at a large urban hospital, it’s no surprise that I often encounter children with complex medical histories. Just a few days ago I met a child who was born premature, had multiple surgeries, and asthma. He came in with fever and cough and I diagnosed him with pneumonia. As I dug through his records, I was relieved to find they were all in one place. The family has always brought their son to our facility for his medical care. At my institution, we are fortunate enough to have an electronic medical record which contains all records from all office visits and hospitalizations. Like many children with special health care needs, my patient has medical problems that span many organ systems. However, within 15 minutes, I was able to determine that this patient has had three pneumonias this year. I also had access to his previous work up. Therefore I was able to come up with an appropriate plan with minimal duplication.
I shudder when I think of the alternative. If this child had gone from clinic to clinic or institution to institution our visit would have been very different. I would not have been able to put his current illness into the context of his medical history or previous workup, in a timely fashion, if at all. In the absence of a unified portable medical record, visiting multiple different sites for care is like scattering pieces of a puzzle. After a while you risk losing big parts of the whole picture.
The Medical Home is a way to keep the big picture intact. In the age of subspecialists, hospitalists, and chronic health problems having one place to bring everything together has never been more important. As the country gets ready to embark on comprehensive health care reform for the first time in over a decade, I hope we come up with creative ways to promote the Medical Home model of care so we can avoid further fragmentation and waste.