The deployment and implementation of health IT systems, such as EMRs and Web-based patient portals, is achievable by both small and rural practics, according to a report on the two-year results of the American Academy of Family Physicians' TransforMED project.

A team of independent evaluators released a second round of preliminary findings on May 28 from the TransforMED medical home national demonstration project (NDP). The report found that practices of all types and sizes can successfully implement health IT, including EHRs, Web portals and chronic disease registries.

Other report findings include:

• Small, private practices in the NDP were "enormously successful" in the implementation of EHRs, due largely to their decision making autonomy and not having to rely on the development process and priorities of a larger health system.
• Fourteen of the 31 practices successfully implemented patient Web portals, which enable patients to receive services via the internet, such as secure e-visits and online lab results. Twelve of the 14 practices that implemented portals were small, private practices.
• Fifteen practices successfully implemented disease registries, 10 of which were small, private practices. Larger practices, again, seemed hindered by their dependence on their larger health systems and IT departments.
• While money and financing were important, small practices were mostly needed assistance in selecting an EHR and related technologies. Financial assistance alone does not appear to offer a complete solution.
• Some practices needed assistance in the ongoing implementation of an EHR. Nearly all of the NDP practices reported that implementing the EHR was tougher and more complicated and time consuming than they anticipated.
• Some practices needed assistance in developing communication and leadership skills to better adapt to the new challenges presented by new technology, including patient flow, documentation, communication in the exam room, follow-up care, which all change as a result of EHR implementation.
• Rural practices were able to successfully implement a range of health IT, including EHRs, patient portals and disease registries.

Based on the concept of a relationship-centered personal medical home, the TransforMED Model of Care is family medicine’s answer to the Institute of Medicine’s call to cross the quality chasm. The model, proposed in 2006 as part of the Future of Family Medicine Project report, has both a patient focus and a systems focus, and features eight core elements:

1. Patient-centered care;
2. Whole-person orientation;
3. Team approach to care;
4. Elimination of barriers to access; open access by patients;
5. Advanced information systems, including EHRs;
6. Redesigned, more functional offices;
7. Focus on quality and safety; and
   
8. Sustainable reimbursement.