1. Connecting with Patients to Prepare for Care: The Partners HealthCare Patient Gateway Blackford Middleton, MD, MPH, MSc Chairman, Center for IT Leadership Corporate Director, Clinical Informatics R&D Partners HealthCare System, Inc. Harvard Medical School The Many Faces of Person-Centric Electronic Health Systems

4. Per “Average” Provider Annual Cost Saving Projections ACPOE $28K $16.6K $12.3K $2.5K $2.2K

8. The “CPR Adoption Gap”: The United States vs Others Primary Care Physician Office CPR Use by Country, 2002 Source: "European Physicians Especially in Sweden, Netherlands, and Denmark, Lead U.S. in Use of Electronic Medical Records." Harris Interactive Health Care News 2(16).

9. National Cost Savings to Providers and Other Healthcare Stakeholders In US Millions

11. Health Care Costs Concentrated in Sick Few Source: A.C. Monheit, “Persistence in Health Expenditures in the Short Run: Prevalence and Consequences,” Medical Care 41, supplement 7 (2003): III53–III64. Distribution of Health Expenditures for the U.S. Population, By Magnitude of Expenditure, 1997 1% 5% 10% 55% 69% 27% 50% 97% $27,914 $7,995 $4,115 $351 Expenditure Threshold (1997 Dollars) www.cmwf.org

12. U.S. Patient Cost-Sharing is Highest c b a a a 1999, b 1998, c 1996 Source: Anderson et al., Multinational Comparisons of Health Systems Data, 2002. The Commonwealth Fund, October 2002. Dollars Per Capita Out-of-Pocket Health Care Spending in Selected Countries, 2000 www.cmwf.org

13. Cost Sharing Reduces Both Appropriate and Inappropriate Hospital Admissions Percent reduction in number of hospital admissions per 1000 person-years Source: A.L. Siu et al., “Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance Plans,” New England Journal of Medicine 315, no. 20 (1986): 1259–1266. *Based on Appropriateness Evaluation Protocol (AEP) instrument developed by Boston University researchers in consultation with Massachusetts physicians www.cmwf.org

15. Dilbert Wisdom…

21. "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care." President George W. Bush State of the Union Address January 20, 2004

26. A possible schematic PHR EMR Clinic EMR 2d Clinic EMR Hospital EHR

27. Sept. 9, 2005 NCVHS Letter Report to Secy Michael Leavitt

28. e-Health?

34. Who Creates the Electronic Health Record at Partners HealthCare? Physician Longitudinal Medical Record (LMR) Patient LMR/PHR

35. Intuitive Chart Summary Automatic Reminders Summary Flowsheets Coded Clinical Data Customizable Desktop LMR Secure Clinical Communication And Notification of Results

39. Account Growth

40. Sessions/week by Practice

41. Patient-to-Practice Requests 2524 2383 2353 2580 2409 2840

43. Research portal “Home” Tasks

44. Tele-care option LMR Details List More Info Shared Online Health Records for Patient Safety and Care AHRQ R01 HS13326, PI: B. Middleton, J. Wald co-PI

45. LMR DSS logic General info

47. FHx Checklist Enter Relatives

48. Discrepancy Details

49. Patient Clinical Decision Support Personalized information

51. LMR: to “view” the Journal information Narrative view in the LMR

52. Journal Health Mtce visible in LMR LMR

53. LMR Anticipated LMR entry

54. May be changed by provider LMR

55. LMR item has been updated Next item LMR

60. Where Are We?

61. “ I conclude that though the individual physician is not perfectible, the system of care is, and that the computer will play a major part in the perfection of future care systems.” Clem McDonald, MD NEJM 295:1355, 1976 Thank you! Blackford Middleton, MD [email_address]