Faculty/Presenter Disclosure

1. Faculty/Presenter Disclosure CFPC CoI Templates: Slide 1 • Faculty: Ian Fish • Relationships with commercial interests: • Other: Employee of Accenture

2. eHealth Conference 2013:Accelerating ChangeCreating True Continuity of Care: An Innovative application of ICT to engage patients and improve care coordination

3. Healthcare today Provider world Two diametrically opposed worlds… Predominantly fee-for-service / global funding Sick care focus, primarily single channel (in-person @ clinical site) Fragmented, episodic care & data One size fits all Outcome/value focused Wellness/prevention/care plan focused Multi-channel engagement Personalized experience User-friendly apps; Highly-mobile; Abundant data collected Consumer

4. Healthcare today Reforms have tended to be provider-centric Health Reform Trends Canadian Health Marketplace Examples “Ontario Integrated Client Care Project” - The goal is to move toward a value based model of care organized around clinical conditions that will improve health outcomes for clients. A key component will be the development of bundled reimbursement methodology that will pay physicians based on outcomes of wound care patients “Manitoba PIN Project” - Participating clinics have access to Quality Based Incentive Funding (QBIF). This funding can be used by the clinics to make changes within their practice that will contribute to the PIN objectives. The amount of funding available to each clinic is determined by how it performs on a range of Primary Care Quality Indicators. ““Pay For Performance Programs in Ontario, BC” In Ontario and BC, separate envelopes of funding have been allocated to incent increased utilization in parts of the system such as EDs and surgeries “Alberta Family Care Clinics” - Clinics are staffed by a multidisciplinary team of health care providers. As part of the team, family physicians will provide care beyond the scope of the other health care providers as well as provide advice as required.

5. Accenture Connected Health Global Research Three levels of IT value-creation were identified – Most of the IT investment in Canada has been on Stages 1 & 2

6. Accenture Doctor Survey 2012 Canada had the lowest HIE & EMR adoption although Canada did experience an increase in adoption 2012 over 2011

7. Consumer access to electronic medical record data Many doctors in Canada state that patients should be able to update information in their EMR Patient Allowed Access to Electronic Medical Record Patient Updateable Information in Electronic Medical Record Canada Total 8-Country Total Canada Total

8. Healthcare tomorrow Provider Consumer-centric • Leverages new care delivery channels outside of clinical establishments • Care coordination evolves to include nonclinical professional care givers, patients and their family members • Creates new opportunities for provider & consumer incentives to focus more on the quality of care, cost and overall patient experience “Increased accountability for outcomes” Consumer “Increased accountability for wellness, behaviour changes & prevention”

9. Healthcare tomorrow A framework for consumer-centric collaborative care

10. Continuity of Care Demo – ED, PCP and Patient’s home Use-Case Demonstration (Conceptual and Hypothetical) Clinical Workflow Overview A 38 year-old male patient comes into the Emergency Department (ED) with fever, chills, and localized pain on left side The ED clinician uses the Electronic Health Record (EHR) to obtain previous history, medications and investigations The ED clinician creates a ED Physician Note (EDPN) to record the care delivered to the patient in the ED The patient is discharged from ED and asked to visit his Primary Care Provider (PCP) next day for follow-up The Patient visits his PCP’s office, where his PCP retrieves patient’s medical history and ED note PCP encourages patient to follow a healthy lifestyle and instructs him to proactively start monitoring his physical activity and weight using Fitbit pedometer and A&D weight scale PCP monitors activity / weight based on defined exceptions Patient at Home Post discharge, Visits Primary Care (PC) Visits Hospital Track activity & weight at home PCP office ED Patient

11. ED doctor uses Orion EHR system to check patient’s medical history…

12. …and procedure, lab and medication history

13. After tests are done in ED, ED doctor uses ED Note portal to update and submit ED Note for patient

14. In ED Note, Discharge Instructions tell patient to visit PCP next day. This emphasizes the focus on continuity of care.

15. The ED Note after submission in ED portal, becomes part of the patient’s Orion EHR patient record. So any doctor/nurse with the required access controls can see it. Again this emphasizes Continuity of Care.

16. PCP looks at patient’s medical record, PCP is using cloud-based EMR system from HealthyCircles. PCP also clicks on Documents tab to see patient’s ED Note, sent earlier from ED portal to HealthyCircles.

17. PCP looks at Patient’s ED Note to get complete context of the patient. Next PCP makes his recommendation to the patient.

18. PCP asks patient to use Fitbit pedometer and A&D Weight scale at home. Data from both gets uploaded automatically through Qualcomm Life’s 2Net device cloud service to HealthyCircles’ provider and patient portals.

19. Patient portal (from HealthyCircles)  showing patient’s pedometer tracker

20. Patient portal (from HealthyCircles)  showing patient’s weight tracker

21. PCP’s provider portal (from HealthyCircles)  showing patient’s pedometer tracker

22. PCP’s provider portal (from HealthyCircles)  showing patient’s weight tracker

23. In conclusion Pushing the needle forward requires technology innovation & industry experience and input

24. eHealth Conference 2013:Accelerating Change

25. Supplementary Continuity of Care Demo Architecture