A Medical Home enabled by technology in Sonoma, California

While in the Bay Area, I had the opportunity to visit with Jason Cunningham, DO, at the Sebastopol Community Health Center in Sonoma, California. The Sebastopol Community Health Center is part of the Redwood Community Health Coalition, which is embarking on an ambitious electronic health record project, using the eClinicalWorks application.

Jason is a Board Certified Family Medicine specialist practicing a full spectrum of the specialty, including OB, pediatrics, and inpatient care. Unfortunately, I came to see the Center after he had finished seeing patients for the day, so I was unable to shadow. However, Jason embraced the idea of a walking meeting, so I could say I shadowed in the community as opposed to the medical office as we put steps on the pedometer.

Jason’s health center is designed to pilot an advanced medical home model, facilitated with a complete electronic health record. There are less patients receiving care at this brand new center while different approaches to care are tested in the practice. Specifically, there is more involvement of support staff in panel management, and a focus on excellent primary care provision, with a goal of creating a sustainable approach across the community. What I was really impressed by is the fact that this work is being done with the current reimbursement system as it is; in other words, the team is working to demonstrate better outcomes and affordable care through a focus on comprehensive primary care, within a safety-net, federally qualified health center system that emphasizes in-person visits. They are not waiting for a change in reimbursement approach to do this work.

In terms of the layout of the medical center itself, you can see from the images below that there is a focus on bringing the patient into the care experience. The patient sits across from the physician, and the computer, a tablet PC, is arranged so that both physician and patient have access to the information being used. Jason is also using after visit summaries with his patients, as shown in the image (test data shown), so that they leave with a written description of the visit and next steps. I of course think this is a key part of patient centered health information technology.

The surrounding community is both beautiful and also working diligently to provide access to regular, quality, primary care across the population.

Images, click on any to see full size

Jason is interested in changing that, and bringing more providers into the world of the EHR. He showed me the work he is doing to support management of his panel’s quality goals, with an interest to do this community wide. There is a plan to bring patient access to this system later this year, once the first three medical centers go live. We spoke a little bit about this – the medical home model, as described in presentations like this speaks about the MA-physician teamlet. In the care system I come from, the patient is part of the team, via access to their own health information online and print (e.g. the after visit summary). We have found that this is a critical part of the medical home – because a patient’s medical home is really where they live and work. This can be done with RCHC’s system, and I think RCHC’s efforts plus the efforts of MiVia (see tomorrow’s post), plus other local providers’ work could result in an entire community with access to their own clinical information.

I think it’s an important distinction that Jason is moving ahead to make an ideal care system work first compared to other places that look at structural issues first in deciding to innovate. I think think this is a great place for physicians to be leaders, as Jason is – to show how things should be for patients so that a system can then support it.

I remember a comment I heard at a meeting about primary care last year that, “medical students deciding to go into primary care are good at reading balance sheets.” I remember feeling uncomfortable with that idea in my own experience. I knew how to read a balance sheet in medical school, but I also knew how to read the face of a person (a patient) who is helped to achieve their life goals through good health. I think both of us shared this same experience in choosing family medicine. Jason and I both agree that in the work we do, every patient deserves to have the best of every system out there, not just the best of whatever system they receive care. My time in Sebastopol reminded me of something I have mentioned several times on this and other blogs: people who choose to go into health care are exceptional people, because they have to be. While we respond to incentives like most humans do, we also respond to the calling that got us here. Great things can happen even when they aren’t supposed to. After they happen, a system should be supportive of them still happening.

My only regret about coming to Sebastopol was that I did not observe the process of care with real patients, as I have done with other sites I have visited. My sense is that a lot of innovation is happening here and the work of Redwood Community Health Coalition has the potential to be the model for other safety net systems, or systems in general, to excel in primary care. Thanks again, Jason, and the entire team a Sebastopol Community Health Center for being gracious hosts!

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Ted Eytan, MD