Affecting the latter are the aims of the USA’s healthcare reforms to drive towards more coordinated healthcare with a specific focus on electronic patient record (EPR) development and use. Thus, in late 2011 Siemens acquired MobileMD, Inc., the health information exchange (HIE) solutions provider, for reasons explained by Dr Sorensen in a talk with Daniela Zimmermann.
Siemens’ acquisition of MobileMD relates to a “medical home” concept. Currently most people begin their treatment journey with a primary care doctor, Dr Gregory Sorensen explained. ‘That physician is expected to be a medical diseases specialist as well as coordinating specialist. So, say the patient sees a cardiologist and
is prescribed blood thinners, and next sees an orthopaedic surgeon, the primary care physician has to warn the surgeon about the blood thinner. Then the orthopaedic surgeon puts the patient on an anabolism – the primary care physician should pick up on a conflict between that prescription and the blood thinner, and change to a different anabolic.’
Just one person is coordinating the patient’s care but… ‘It’s too much for a care physician to monitor everything – so instead you have an organisation with many sections to take responsibility and be accountable for all the care a patient might need.’ For this fully accountable organisation (the medical home) to succeed a dependable EPR is thus ‘critical’.
Thus, in 2011, the US Government’s new healthcare legislation began to provide large financial incentives for its development. To this end, government auditors check whether firms are producing meaningful software, and if so, ‘they write a big cheque’, said Dr Sorensen, adding: ‘Some of our customers [hospitals] have received $2-6 million cheques for implementing EPRs and demonstrating their medical use. Therefore, we’re building some software to facilitate this, and sometimes it’s less expensive for us to buy an existing software company than spend years and money to build it. So, we bought MobileMD.’
Does medical home refer to a physical or virtual place? ‘The accountable organisation could be a single hospital that has clinics in it, or is a distributed network, where there are small community clinics, big community hospitals, independent physicians buildings, imaging centres, blood test centres, all woven together and this organisation is the patient’s “medical home”.
So, when she needs an imaging test she goes to one part but, for a flu shot, she goes someplace else, but it is still the medical home – the organisation that provides the care, and is accountable for all of a patient’s care. It might be paid for by an insurer, or an insurance company might be owned by the accountable care organisation. That’s not relevant. The relevant question is: Who is the accountable care organisation.
Some we already see are hybrids between providers and insurance companies, as is already happening with Kaiser Permanente, a healthcare system in California that is both an insurance company and a provider for millions of citizens in that state. You pay Kaiser your insurance premium, and then they also take care of you. They don’t send you somewhere else.’ Such a dual provider is regulated, not controlled, he pointed out. ‘They’ve got rules, they must follow and the insurance companies have rules they must follow and Kaiser must follow both sides of the rules, acting like a good hospital and like a good insurance company.
Both aspects are regulated, but they happen to be combined. They see more efficiency in this, and many people think it is the future to combine them. Maybe that will be safe, maybe not.’ Inevitably, for all this to work
so must the EPR.