This presentation is anchored in a study that Deloitte conducted in late 2009 to further investigate emerging trends in health care and consumer dynamics. Seeing an emerging trend in the US towards new attitudes around what constitutes health services and what patients want to see as part of their experience Deloitte replicated the US survey in Canada. A key finding was that as patients want to see the traditional model of healthcare evolve, how they capture, share and manage their health information is a key desire of theirs.
Markle foundation defines a PHR as : an internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it . This is different from the many of the recent models where the communications hub is controlled by governments, payers, hospitals, etc. In the PHR world, the patient is the keeper of the information and it resides on a non-owned technology platform. Based on other research we know that: over 40% of adults keep a personal or family health record in some form. And of those individuals that do, over 80% of them keep a paper record in a file or drawer at home. Although survey results in Canada and the US point to high interest in PHRs, there is a caveat. We also know that there is a significant gap among patients in understanding how IT contributes to improving care so PHRs provide a better platform than traditional EHRs to allow for patient participation and uptake.
Early days for PHRs but already we can see a maturity pathway starting to form. Points to very specific initiatives being critical to accelerating uptake of PHRs
A key challenge with EHRs has been to build a robust and understandable business case for participation. Often data sharing and participation has been driven by voluntary adoption, unclear business models, which has led to uneven implementation and success across Canada. – Why am I doing this? PHRs actually are premised on having patients be the advocates for connectivity – Why are you (hospital, MD, Lab, etc). Not doing this?
EHR challenges: All or nothing infrastructure Care providers first, patient access after Generic information views versus patient-specific (e.g. diabetes specific view). Build times (PHRs are ready now) and competency to “get it right” (government versus software company) Patient trust – Privacy debate Lack of reason for community MDs to use IT.
Do you have transparency built into your corporate values? Do you capture the information and are you ready to make it visible outside of your organization? Do your patients and community care providers use technology (stakeholder approach) or is their another lever (e.g. a specific disease group) that may make it more compelling to implement? Do you have the competency in house (integration, support, data quality)? Will you be able to sustain and enhance your PHR support?
Personal health records: Helping consumers take the driver’s seat Michael Matthews National e-Health Leader National Health Services Practice
A Canadian health consumer survey was conducted in 2009 highlighting the behaviours, attitudes, and unmet needs in areas of health consumerism <ul><ul><li>A survey was conducted to better understand the perspectives of public and patients as healthcare consumers. </li></ul></ul><ul><ul><li>Research focused on the behaviours and motivations of health consumers in making choices as they interact with the healthcare system. </li></ul></ul><ul><ul><li>A conceptual framework was used, reflecting the six major domains of healthcare consumer activity providing input into the consumer’s perspective for personal health records </li></ul></ul>Health Consumer Survey Framework <ul><ul><li>The survey was conducted online between October 29 – November 12, 2008. </li></ul></ul><ul><ul><li>74 questions and 46 potential follow-up probes: behaviours were asked before attitudes and unmet needs to reduce respondent bias </li></ul></ul><ul><ul><li>All 10 provinces were surveyed, but the territories were not included </li></ul></ul><ul><ul><li>The total sample size included 2,304 adults: </li></ul></ul><ul><ul><ul><ul><ul><li>The sample is nationally representative matched to age, gender and race/ethnicity </li></ul></ul></ul></ul></ul>Health Care Consumerism
Survey results revealed that consumers are spurring the demand for personal health records across Canada <ul><ul><li>Centres around the consumer </li></ul></ul><ul><ul><li>Offers self-care, self-management and learning capabilities </li></ul></ul><ul><ul><li>Is offered through a trusted source and secured from privacy breaches </li></ul></ul><ul><ul><li>Provides a flexible platform for a consolidated view of a patient’s health </li></ul></ul>This calls for a personal decision-support model that… <ul><ul><li>Over 65% of respondents feel it would be beneficial to have access to the PHR of a family member whose care they are helping to manage </li></ul></ul><ul><ul><li>Over 60% of respondents are interested in a PHR or online medical record provided by their doctor’s office, hospital and government </li></ul></ul>
Over the years, PHRs have evolved information management functionality to meet the needs of consumers <ul><ul><li>A personal health record can be initiated, maintained and/or supplemented by health care consumers. It reaches beyond the traditional paper charts and EMRs to include prescriptions, test results, wellness and other demographics deemed necessary by the consumer. </li></ul></ul>Level of functionality Examples Information collection: Aggregates data from multiple and external data sources Patient diaries; Family history; Supplemental health information Information sharing: Allows patients and others to view health information Laboratory/radiology/test result viewing; Viewing notes taken by the provider during a visit; Sharing of health information summary sheets Information self-management: Allows patients to learn about, monitor and/or manage own health and health of others Reminders for health care events and maintenance; Disease management plans; Health care education; Tracking of health care expenses/billing Information exchange: Allows patients to engage in automated data exchange transactions with others regarding their health / health care Health care support groups; Appointment scheduling; Pre-visit and post-visit care management questionnaires; Medication management; Secure messaging with health care professionals (e-visits)
While consumers stand to gain significant benefits from PHRs, so do health care providers and governments <ul><li>Success of PHRs will depend on the participation of stakeholders across the health system </li></ul>Key players Motivation Benefits Consumer <ul><li>Empowered to provide physicians with a complete picture of their personal health history </li></ul><ul><li>Promote improved quality of care through information sharing </li></ul><ul><li>Share PHR information with a family member, friend, or provider via the delegation option </li></ul><ul><li>Engage and self-manage health and health care </li></ul><ul><li>Focus on prevention and continuous monitoring </li></ul><ul><li>Consolidated source of health care information </li></ul>Government <ul><li>Improve resident health, thereby increasing productivity and lowering absenteeism </li></ul><ul><li>Use PHRs to reinforce health and wellness </li></ul><ul><li>Eliminate duplicate tests and unnecessary hospital admissions </li></ul><ul><li>Reduce errors </li></ul><ul><li>Engage consumers </li></ul><ul><li>Provide a single view of consumer health </li></ul><ul><li>Reduce overall costs through a more health conscious consumer and appropriate use of hospital/clinic visits </li></ul>Health providers <ul><li>Provide critical documentation in emergency situations </li></ul><ul><li>Reduce clinical errors through access to accurate, relevant data </li></ul><ul><li>Serve as a back-up data source to assist with disaster recovery operations </li></ul><ul><li>Enhance provider productivity and improve use of resources </li></ul>
The success of these entrants is dependent on strategic enablers to address the key issues faced today Change management Clinical process redesign Education Technology enablement Today “Pre-PHR era” Enablers Future “PHR era” Consumer <ul><li>Limited confidence in health record security </li></ul><ul><li>Limited access to electronic or paper health data </li></ul><ul><li>Challenges in care and information management for chronic disease </li></ul><ul><li>Challenges for family caregivers to manage health information and connect with care team </li></ul><ul><li>Trust in health data security </li></ul><ul><li>Varying levels of need for and acceptance of PHR functionality and complexity </li></ul><ul><li>Individual family caregiver access and increased involvement with care team </li></ul><ul><li>Lower barriers to switching care providers </li></ul>Organization and people <ul><li>Provider-centric </li></ul><ul><li>Individual provider or organization-based </li></ul><ul><li>Face-to-face provider-patient interactions </li></ul><ul><li>Consumer-centric </li></ul><ul><li>Interdisciplinary team and multi-organization-based </li></ul><ul><li>Increased frequency of PHR-based e-communications and e-consults </li></ul>
The success of these entrants is dependent on strategic enablers to address the key issues faced today (cont’d) Electronic data standards Legislation EHR/EMR implementation e-Reimbursement models Today “Pre-PHR era” Enablers Future “PHR era” Information technology and infrastructure <ul><li>Mixed paper/electronic health records </li></ul><ul><li>Organization/provider-controlled IT and health data </li></ul><ul><li>Fragmented hospital, lab, diagnostics, drug, physician and other data </li></ul><ul><li>Mixed federal/provincial health information and privacy legislative requirements </li></ul><ul><li>Increased numbers of organizations/providers with EHRs/EMRs </li></ul><ul><li>Integrated or interoperable electronic health data that feed a PHR </li></ul><ul><li>Provider-based PHRs, Government-based PHRs, Vendor-based PHRs </li></ul><ul><li>Need for consistent privacy/security legislation across Canada </li></ul>Health care reimbursement <ul><li>Reimbursement schedule that supports traditional face-to-face patient care </li></ul><ul><li>Individual professional payment model </li></ul><ul><li>Shift to e-visit/consult reimbursement </li></ul><ul><li>Support for team consult reimbursement models </li></ul>
In the midst of evolving times, its imperative for your organization to consider its readiness to meet the needs of its consumers <ul><li>As organizations prepare for the PHR and consider related investments, they will need to consider their overall readiness across several dimensions including their organization, stakeholders, broader environment, and approach to implementation as seen in the checklist below: </li></ul>How ready is your organization in terms of culture and infrastructure? How willing are your stakeholders, consumers and healthcare providers, in participating in this innovation? What is the state of personal health record (PHR) readiness for your external stakeholders? Have you defined your method for implementing PHRs? (e.g. technology platform of choice, funding source, change management philosophy, and consumer engagement process?) What is the appropriate funding model you plan to use for your organization’s PHR? Personal health records readiness checklist
For more information, please contact: <ul><li>Michael Matthews National e-Health Leader [email_address] </li></ul><ul><li>Mark Fam Deloitte Center for Health Solutions [email_address] </li></ul>Lisa Purdy National Health Consulting Leader [email_address] Ian Tait Public Sector Technology Leader [email_address]