A Proposal to Leverage Electronic Personal Health Records to Provide Direct Access to Health Services Thereby Empowering Patients and Triggering Disruptive.

A Proposal to Leverage Electronic Personal Health Records to Provide

Direct Access to Health Services Thereby Empowering Patients and

Triggering Disruptive Transformation of the Canadian Health Care System

Dr. Glen GeigerPresentation to e-Health

2013

May 29th, 2013

© 2013 HIMSS

Conflict of Interest Disclosure

Glen Geiger, BASc, MDCM, FRCPC, MASc, MBAHas no real or apparent

conflicts of interest to report.

Agenda

• Cost and Quality of Healthcare• Access to Healthcare• The Role of the Personal Health Record• The Patient as Partner in Care

Cost and Quality of Healthcare

How does healthcare control costs?

How does healthcare deliver quality?

Courtesy: Commonwealth Fund Report, “Mirror Mirror on the Wall, 2010 Update

Access to Healthcare

“Simply having a family doctor though is not enough…most people in Ontario are unable to get an appointment to see their doctor the same day

or the next day when they become sick.

Rick Glazier, a primary care doctor and researcher at the University of Toronto says that “it really undercuts the value of having primary care

providers if you cannot see them when you need them…these individuals then end up visiting walk-in clinics, urgent care centres or emergency

departments. In fact, it is estimated that about a quarter of Ontarians with a family doctor have been to a walk in clinic in the past year.”*

Over Four Million Canadians Don’t Have A Family Doctor†

*Born and Laupacis, “Accessing Primary Care in Ontario”, Healthy Debate, Sept 28th, 2011

†Statistics Canada. (2010). Canada Community Health Survey. Ottawa.

“There are promising ways of improving access to much needed primary care….the Health Council of Canada has advocated for Primary

Healthcare Teams in caring for people with chronic disease such as asthma, heart disease or diabetes and mental health conditions, including

depression.”

While the jury is still out on which model is best, the underlying message is clear: improving care (and access to it) is more about how

care is delivered, than how much.

And we shouldn’t forget that for the majority of problems for which Canadians visit family physicians, nurse practitioners provide care of

equal (and sometimes better) quality.”*

Its Not Just A Numbers Problem

*Canadian Health Services Research Foundation, “Myth: Canada Needs More Doctors”, May 2012

The Personal Health Record

PHR

A Simple Approach to Personal Health Records: The Patient as Scribe

Health Information

– allergies– chronic diseases– family history– illnesses and hospitalizations– imaging reports (e.g. X-ray)– laboratory test results– medications and dosing– Surgeries – vaccinations

Control Sharing

Personal Health Records were originally conceived as a tool for patients to input their health history in order to foster sharing with the many physicians that see them

So you expect me to type my health information into a web page so I can

share it with you?

Prescription Renewals

Appointment Changes

Texting / e-Mail

Results Results

A More Sophisticated Approach: The Patient as Participant

EMRPHR

Prescription Renewals

Texting / e-Mail

Appointments / Reminders

MyChart: One Toronto Hospital’s E-health Triumph*

“MyChart is the wave of the future. When patients have electronic access to their medical records they can take greater

control of their own health care.”

“Sunnybrook is a pioneer in the field – with the focus placed on the patients themselves. Indeed, a decade ago, most health-care

providers were primarily interested in developing electronic systems that would permit the easy transfer of patient records

between hospital departments or to other medical institutions.”

*PAUL TAYLOR, The Globe and MailPublished Thursday, Sep. 20 2012, 5:20 PM EDT

When Will PHR Platforms Gain Consumer Acceptance?*

"Consumer adoption of PHRs and the reasons for not using them have not changed significantly over the

past five years. Greater strides in patient engagement will be required if interoperable, personal medical device–connected PHRs are to play an important supporting role for accountable care and patient-

centered medical homes."

*IDC Health Insights - 2011

Making the Patient a Partner in ‘Sickness and in Health’ by

Leveraging Integrated Personal Health Records

The Power – Illness Relationship

Wellness Illness

Provider Power

Recipient PowerLaser eye surgery

MVA / Trauma

Customer

Patient

Hospital

EHR

Community

Care EMR

Self Care

(PHR)Heart Failure

Diabetes

Health Reminders

Service Requests

Results

Prescription Renewals

Appointment Changes

Texting / e-Mail

The Patient as Partner

PHR

Prescription Renewals

Texting / e-Mail

Appointments / Reminders

Regional EMR

Results

Health Reminders

Service Requests

Implement wellness programs through the PHR (eg. Mammograms)

24/7 Support Line

Empower patients by implementing access to services and results through their PHR

Reminders and gating functions are performed by the Regional EHR infrastructure

PHR Access to Results

Mammogram Appointment

Automated eligibility checking

Self Scheduling

Self Screening

Monthly ScreeningReminder

Implement Chronic Disease Management Programs through PHR

(eg. Type 1 Diabetes)

Self-testing maintains profile on PHR

Online access to expert advice

Automate the routine management of chronic disease by empowering the patients

Focus primary care and specialist resources on exception handling, (i.e. when the patient gets sick)

Automated Prescription renewal

Testing is authorized automatically

Rule generates a reminder for specialized testing

Empowering Patients By Providing Direct Access To Services Through Their PHR Will Creatively Disrupt

The Health Care System

My Prediction

Glen Geiger

Chief Medical Information Officer

The Ottawa Hospital

(613) 737-8899 x79362

[email protected]