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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 Geiger
Presentation to e-Health
2013
May 29th, 2013
Conflict of Interest Disclosure
Glen Geiger, BASc, MDCM, FRCPC, MASc, MBA
Has no real or apparent
conflicts of interest to report.
© 2013 HIMSS
Agenda
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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
Over Four Million Canadians
Don’t Have A Family Doctor†
“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.”*
†Statistics Canada. (2010). Canada Community Health Survey. Ottawa.
*Born and Laupacis, “Accessing Primary Care in Ontario”, Healthy Debate, Sept 28th, 2011
Its Not Just A Numbers Problem
“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.”*
*Canadian Health Services Research Foundation, “Myth: Canada Needs More Doctors”,
May 2012
The Personal
Health Record
A Simple Approach to Personal
Health Records: The Patient as Scribe
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
Health Information
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PHR
allergies
chronic diseases
family history
illnesses and hospitalizations
imaging reports (e.g. X-ray)
laboratory test results
medications and dosing
Surgeries
vaccinations
Control Sharing
So you expect me to type my health
information into a web page so I can
share it with you?
A More Sophisticated Approach:
The Patient as Participant
PHR
EMR
Results
Results
Appointment Changes
Appointments / Reminders
Prescription Renewals
Prescription Renewals
Texting / e-Mail
Texting / e-Mail
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 Mail
Published 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 patientcentered 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
Provider Power
MVA / Trauma
Patient
Diabetes
Wellness
Illness
Heart Failure
Customer
Laser eye surgery
Recipient Power
The Patient as Partner
PHR
Regional EMR
Results
Results
Appointment Changes
Appointments / Reminders
Prescription Renewals
Prescription Renewals
Texting / e-Mail
Texting / e-Mail
Health Reminders
Health Reminders
Service Requests
Service Requests
Implement wellness programs
through the PHR (eg. Mammograms)
Monthly
Screening
Reminder
Self
Screening
Self
Scheduling
Automated
eligibility
checking
Mammogram
Appointment
 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
24/7 Support Line
Implement Chronic Disease
Management Programs through PHR
(eg. Type 1 Diabetes)
Self-testing maintains
profile on PHR
Rule generates a
reminder for
specialized testing
Testing is
authorized
automatically
 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
Online access
to expert advice
My Prediction
Empowering Patients By Providing
Direct Access To Services Through
Their PHR Will Creatively Disrupt
The Health Care System
Glen Geiger
Chief Medical Information Officer
The Ottawa Hospital
(613) 737-8899 x79362
[email protected]