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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
