Innovative Ways To Deliver Care

July 07, 2010
By Dr. Dale Glenn

Dr. Dale Glenn
Family Medicine

Where did you receive your schooling and training?

I’m board certified in family medicine. I completed medical school here at John Burns and then residency at the Medical College of Pennsylvania in Philadelphia.

How long have you been practicing?

Ten years.

Can you provide your job description and what your role is as a family physician?

In addition to seeing patients as a family physician, my role is to help physicians adapt to new technology. I do a lot of work on electronic medical records and health care reform, helping to change our delivery system to both improve quality and lower costs.

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How has your field evolved since you started practicing?

I think one of the biggest changes we’ve had in medicine is the ability to share information electronically. For the last 1,000 or so years, whenever a patient spoke with a doctor, they wrote that information down on paper and that was stored in a closet somewhere. It wasn’t shared or easy to access. There has been such an explosion in knowledge in medicine that it’s become increasingly difficult for any one physician to know everything, and that’s why we have increasing specialization where doctors are becoming better experts at smaller areas of the body. The plus side to that is we get really good care focused on specific areas. The downside is that the care tends to get broken up and not every physician on the team knows what’s going on with a given person. The computer has allowed us to change that because it allows doctors to share information from anywhere. So within our system all physicians can see the exact same information whether it’s lab data, notes or questions from a patient. With the Internet, patients can see that information as well, and also communicate with their doctor.

Can you explain the Patient-Centered Medical Home approach to health care?

Because of this explosion of knowledge and science we now have many more tests and specialties. So medical care has become infinitely more complicated than it used to be. In America we’ve gotten really good at treating serious acute problems. What we haven’t done a really good job at is prevention. In other countries where health care costs are lower, they have focused a lot more effort on preventing disease and making primary care accessible and affordable.

Will this be an element of the Health Care Reform Act?

Not as much as we’d like it to be. The Health Care Reform Act focuses on insurance and changing the way insurance pays. But unfortunately it doesn’t deal with the core issues that need to change, because many of the changes need to occur in the way that people interact with the health care system. So the Patient-Centered Medical Home is the idea that a patient can get all their health care from one location, but still have access to a full team of health care professionals. It lowers cost by providing one-stop convenience, more education, a shared care plan, and generally fewer visits to the doctor’s office. The team works together to prevent problems rather than treating them after they happen.

How long until you think everyone will be operating on this Patient-Centered Medical Home concept?

We’re already delivering it. Ultimately it’s what Washington hopes to achieve, but we can’t afford to wait until someone legislates this in Congress. In fact, the way things are going it’s not really happening that way. So what we’ve done at Hawaii Pacific Health is establish the largest health care network in the state. We have four hospitals, more than 44 clinics and more than 1,000 physicians using this system. This system also allows patients to view their own health information from anywhere, including their home, as well as stay in touch with their health care team. For me, I think it’s great as a physician to maintain that working relationship with patients outside of office hours. For instance, using e-mail: It allows us to deliver care in a whole new way. The issue we’re facing, though, is that at present most insurance companies don’t reimburse for this kind of care. They only pay for formal office visits even though there are easier, more innovative and functional ways of delivering care.

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You mentioned the team approach in treating patients. What professionals are on such a team?

Currently I work with Straub Hospital and we have a multi-specialty group, so I have access to a multitude of specialists anytime I need it. But the core team in the office, in addition to myself, also includes a licensed nurse, a diabetes nurse educator and health advantage navigators. Our health advantage navigators do outreach over the phone, which means we don’t wait until someone becomes sick and feels they need to come in to see the doctor. What we do is review their health history on a regular basis and call patients in advance to arrange preventative tests and visits that will keep them healthy and out of the hospital.