Skip to Content
SBMI Horizontal Logo

The Role of Consultancy in Enhancing Readiness for Implementation of the Medical Home Model Supported by Teleaccess Through a Quality Health Record: Barriers and Opportunities for Learning

Authors: Sharyn Smalls, BA

Primary Advisor: Kim Dunn, MD, PhD (co-author)

Committee Members: Jiajie Zhang, PhD (co-author)

Masters thesis, The University of Texas School of Biomedical Informatics at Houston.



In the current context, consultancy is being defined as the provision of advice and expertise to one’s clientele. This project addressed the task of preparing three types of clinics for implementation of the Medical Home model: an indigent clinic with no electronic medical record (EMR), a private clinic with a partial electronic record for appointments and billing of encounters, and a university/state funded clinic with a full EMR. The goals of the consultations were to: Improve communication, facilitate acceptance of, while identifying barriers to the process by both patient and provider, and assess and modify work flow in preparation of the medical home model implementation.


A five step consulting process defined by Bob Nelson, PhD and Peter Economy1 was used. During the consulting process for Your Doctor Program a survey instrument was developed for clinic needs assessment. The survey was applied to two clinics and workflows were developed from the responses.


At the indigent clinic, the clinical staff was trained to use the QHR and they in turn trained the enrolled patients. Communication between patient and staff was enhanced due to their ability to communicate by secure email. While the 3 clinics were each at different stages of readiness, a majority of the staff members were receptive to the needs assessment interviews and the upcoming implementation. They all exhibited the ability to use the system. Yet they all expressed the desire to receive additional training and the opportunity to walk through any new procedures with a test patient. In spite of the simplicity of the design of the QHR, part of the consultancy was to attenuate to clients actual and perceived needs, so additional training was conducted in each case. The staff then expressed confidence in the ability they had already exhibited.


Weekly communications in the form of visits, calls or email allowed the client to express their feelings and concerns about any aspect of the project. That allowed for reinforcement of training and other information previously shared. The problem to be addressed, other solutions attempted or in place, objectives and outcomes expected could all be answered by the interviews.  A plan for customer support should be presented to alleviate fears of abandonment once the implementation period is complete would also add to client acceptance.