For the doctor:

• One might spend part of the work day caring for a few, very complicated patients, each requiring 45-60 minutes of concentrated time in the office.
• The other part of the day would be spent ‘surfing’ various dash boards offering quality measures on one’s patient populations, identifying outliers who need attention.
• Access to trended information about one’s patients (blood pressures, activity levels, medication adherence, etc.) in context, fed from their private PHR and viewable at that moment in time when a complex medical decision is required
• Patients and other health care professionals guided by decision support would make other medical decisions. The decision support would be constantly refined, backed by self-learning software taking data from the physiologic information, the online support groups, and other data such as laboratory tests.
• One would spend some of this online time communicating with patients who have questions that need a doctor’s attention.

In short, web-comfortable consumers want a ‘participatory medicine’ experience with their healthcare professionals that involves modern forms of communication and coaching. They want to be ‘connected’ online with their doctors and nurses, and they prefer having their health information searches guided, if not filtered, by their personal doctors and medical homes.

Yet, most discussion on the medical home focuses on the care team and coordinated care, and refers only in passing to the idea of monitoring. This model may sound appealing but this is clearly not feasible in today’s cost containment climate.

For the medical home concept to truly be effective, we believe that the emphasis should be in the other direction. Specifically, for the right patients, instituting the use of monitoring and messaging technologies with proper integration to providers, will result in improved population management, take some of the burden off of primary care physicians and keep costs in check.

The medical home model, as proposed to date, does not demonstrate that we ‘get it’ and are willing and able to embrace the paradigm of Health 2.0. Until we do, there will exist a divide between health care providers and their online patients. Lets start implementing the connected medical home.