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We have been establishing a PCMH in our practice since January, 2009.  I posted on NCQA in the reporting section of this site as well, I just thought it would be good to open a separate PCMH topic within the implementation section here.  Establishing a PCMH requires a considerable amount of time and effort, workflow redesign, policies and procedures for patient tracking, coordination of care, etc.  Although all providers may attempt to do all that is necessary for patients, fee-for-service/point of care service lacks the oversight and coordination that is necessary to achieve higher levels of quality for your patients.  We see that quality endpoints are achieved more successfully in the new model.  Patients take more ownership of their care when the Nurse Case Manager sits down with them and creates their Care Plan.  It is a new approach that is refreshing and exciting.  Although one might consider "implementation" to be the startup of the EMR use, I introduce the PCMH topic here because there are many ways in which the EMR customization/implementation is different when you are establishing a PCMH.  It is somewhat like a secondary level implementation that takes into consideration the team approach, integration of different care providers and coordination of care utilizing the EMR to its fullest.