The Future of Family Medicine: Clinical Practice
How will the family practice of the future need to be structured and function to be successful? An EMR will serve as the practice’s central nervous system, handling many of the complex information management tasks inherent in primary care medical practice. Registries of patients with chronic diseases linked to physician prompt and patient reminder systems will enhance evidence-based disease state management in the practice. Process and outcomes of care evaluations will be carried out through electronic audit of EMR-linked clinical data repositories. Patient care will be rendered by an integrated multidisciplinary health care team that optimizes the use of each team member’s skills. The family physician will coordinate and direct the team’s work, leveraging her time and expertise through a collaborative model of practice. An open-access appointment system will allow patients to receive care when they want and need it. Group visits will provide more efficient care and a means of mutual support between patients. Patients will be able to communicate asynchronously with the practice through the use of a secure Internet portal and E-mail to make appointments, receive laboratory and imaging study results, request prescription refills, report self-monitoring data such as blood pressures and blood sugars, access their own medical records, ask questions about their health and health care, use decision support systems to allow them to share in important decisions about their care, and pay their bills. Family practice offices will have highly standardized and efficient processes and work flows that minimize waste, eliminate backlog, and allow the health care team to do today’s work today.7 Family physicians will have ready access to just-in-time information systems that will provide evidence-based answers to the majority of their clinical questions within 60 seconds, essentially eliminating the need to refer patients because of insufficient knowledge or experience.
Overcoming barriers
Much of the needed information technology and most of the know-how regarding the clinical process redesign needed to make this vision a reality exist today. However, it is practically impossible for small or even large group family practices to aspire to such a model of care in today’s economic environment. A new business model is needed that can bring together software and hardware vendors, application service providers, and clinical management and redesign expertise and package a series of turnkey products and services that are accessible and affordable even to small group family practices. The model could take the form of a franchise or perhaps a cooperative, funded through private investment, or the federal government could subsidize the development of this package, insuring its availability at a low cost to physician users. The new model should allow family physicians to maintain ownership of their practices, while redesigning the way they provide care to their patients. The development and implementation of such a model is critical to the survival of our specialty.
All correspondence should be addressed to Stephen J. Spann, MD, Professor and Chairman, Department of Family and Community Medicine, Baylor College of Medicine, 5510 Greenbriar, Houston, TX 77005. E-mail: sspann@bcm.tmc.edu.
