One of the concepts we hear about in the effort to improve our health care system is the idea of a patient-centered medical home.
Traditionally, a patient's health might be managed based on whatever ailment prompted an office visit. A medical home, by contrast, takes the person's major health issues into account as a more holistic idea. It requires the entire office staff to be involved in anticipating what care and information that patient will need. It's that anticipation that's one of the key differences that makes a medical home work.
http://www.vpr.net/audio/news/regional_news/2013/04/vpr-vermont-edition-medical home.mp3
White River Family Practice in the Upper Valley is a patient-centered medical home, and it was recently awarded the highest level of certification by the National Committee for Quality Assurance. Dr. Mark Nunlist is a physician there, and he explains what this approach looks like in action.
Also
Performance Results See how White River Family Practice charts its progress in providing patient-centered care as a medical home.
We also spoke at length about the role of electronic medical records in helping 'patient-centered medical home' work as well as possible:
http://www.vpr.net/audio/news/regional_news/2013/04/vpr-vermont-edition-medical home1.mp3