Paul makes some excellent points, especially regarding how we protect the patient who is determined to be an "outlier" with frequent ER visits for a cold or runny nose etc.
And Leslie I take no offense whatsoever at your criticism of my "Outcome Oriented Medical Record". I appreciate the time you are taking to give me the feedback as I work to define this concept.
But let me separate this into three parts.
1- The "Medical Home" model of practice as pioneered by pediatrics for the past 20 years is a valuable concept that all primary care physicians need to embrace and expand. It has nothing to do with the money, it is just a comprehensive approach to medical care and management of the records. (And it was never any invention of mine, the AOA adopted it several years after the AAFP and I didn't catch on for two MORE years!)
2- My idea of the concept of an "Outcome Oriented Medical Record" is an approach to the management of the patient and the application of this powerful tool that the EMR provides. The concept of practicing medicine on your practice, the database, that is what I am most excited about. If you were to embrace this concept, returning to your database to practice medicine on it, (the database) think of the power it gives you. You return from a conference with knowledge of a new treatment for condition common in your practice. Turn to the database to find the appropriate patients. Contact them and notify them of the change in therapy without waiting for them to show up in the office on the next appointment, if they keep the appointment. Paul you are upset at the adult who does not take responsibility for following up with the orders for a mammogram or lab work. But it still needs to be done. And what if all the call backs for failed follow thru on mammograms or labwork were only one keystroke of your EMR. Then why not help them? Would you refuse just because they are adults? Of course not. NOW WHAT IF the EMR could keep track and anyone who failed two tasks could be identified and the EMR cues them up to come in for a MMSE. Do you see what I mean. You have the same relationship with the patients but you also have a relationship with the database, and you return to it time and time again to build it into a healthier PRACTICE.
3- In a managed care environment I think that I see a way to get paid for the extra work if we negotiate our rates based on our outcomes, but that is not really relevant if you don't have to deal with a lot of managed care.
