1. 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 29 th, 2013

2. © 2013 HIMSS Conflict of Interest Disclosure Glen Geiger, BASc, MDCM, FRCPC, MASc, MBA Has no real or apparent conflicts of interest to report.

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

4. Cost and Quality of Healthcare

5. How does healthcare control costs?

6. How does healthcare deliver quality? Courtesy: Commonwealth Fund Report, “Mirror Mirror on the Wall, 2010 Update

7. Access to Healthcare

8. “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 28 th, 2011 † Statistics Canada. (2010). Canada Community Health Survey. Ottawa.

9. “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

10. The Personal Health Record

11. 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

12. So you expect me to type my health information into a web page so I can share it with you?

13. Prescription Renewals Appointment Changes Texting / e-Mail Results A More Sophisticated Approach: The Patient as Participant EMRPHR Prescription Renewals Texting / e-Mail Appointments / Reminders

14. 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

15. 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

16. Making the Patient a Partner in ‘Sickness and in Health’ by Leveraging Integrated Personal Health Records

17. The Power – Illness Relationship Wellness Illness Provider Power Recipient Power Laser eye surgery MVA / Trauma Customer Patient Hospital EHR Community Care EMR Self Care (PHR) Heart Failure Diabetes

18. 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

19. 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 Screening Reminder

20. 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

21. Empowering Patients By Providing Direct Access To Services Through Their PHR Will Creatively Disrupt The Health Care System My Prediction

22. Glen Geiger Chief Medical Information Officer The Ottawa Hospital (613) 737-8899 x79362 ggeiger@toh.on.ca