Rehab Dialogue 2013 Issue 1

REHAB

Dialogue Personal Health Portals A Way for Alberta to Better Manage Chronic Conditions

PEYMAN AZAD, MSc OT

PhD Student, Rehabilitation Science MARTIN FERGUSON-PELL, PhD

Acting Provost, University of Alberta Dean of Rehabilitation Medicine D AV I D L U D W I C K , P h D , M B A

COO and GM, Sherwood Park-Strathcona County Primary Care Network

Can seniors manage their own chronic conditions using web-based personal health portals?

The answer is yes and researchers at the University of Alberta have been testing this hypothesis through the TELUS health space, a virtual data repository that allows patients to collect and record personal health data and transfer it to their health care provider.

WHAT IS A CHRONIC CONDITION? A chronic condition is a disease with one or more of the following characteristics: is permanent, leaves residual disability, is caused by nonreversible pathological alternation, requires special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation or care.

SOURCE:

http://www.deha.org/Glossary/GlossaryC.htm

The Rise of Chronic Conditions While medical advancements have increased the life expectancy of Canadians, it has also increased the number of patients with chronic conditions, adding a financial burden to the publically funded health care system.

Percentage diagnosed with a chronic condition Household population 15 years or older in Canada, 2011 25% 20%

Some researchers have estimated that more than half of all Northern American adults have a chronic disease and that two-thirds of medical admissions via emergency, 80 per cent of primary care physician visits, and more than two-thirds of all medical costs are related to chronic conditions.1

15%

Female

10%

Male

5% 0%

Diabetes

High blood pressure

Arthritis

Asthma

S O U R C E : http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11657-eng.htm

With increasing demand, the publicly funded health care system is facing an increasing shortage in health care staff and resources.

According to a 2011 Canadian health survey, 15.3% of Canadians aged 12 and older do not have a regular medical doctor. This percentage has remained steady since 2007. 2

Percentage of Canadians without a doctor Age 12 and older 25% 20% 15%

Rapaport, J., Jacobs, P., Bell, R.,N., & Klarenbach, S. (2004). Refining the measurement of the economic burden of chronic disease in canada Chronic Diseases in Canada, 25(1), 13-21.

1

Esmail, N. (2011). Canada’s physician supply. Fraser Forum, 20/06/2012.

10%

Males

Females

5% 0%

2003

2004

2005

2006

2007

2008

2009

2010

2011

2

S O U R C E : http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11656-eng.htm

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A TALE OF TWO CANADIANS WITH CHRONIC DISEASE Mr. Smith**, 55, has had Type 2 diabetes for many years, and like Mrs. Jones, tracks his blood sugar levels in a journal. He runs a successful business and

Mrs. Jones** is a 65-year-old woman living in rural Alberta who was in a serious car accident 20 years ago.

travels extensively out of the country. Due to his busy schedule, he finds it challenging to keep his journal up-to-date and make appointments with his health care providers to discuss his blood sugar management program. When he can, he faxes or emails copies of his journal but receives limited feedback on how well he is doing. He’d prefer to use the Internet to communicate with his health care providers while away but current health care security and confidentiality policies don’t allow for that.

The accident caused a traumatic brain injury, resulting in seizures, poor vision and the loss of her driver’s license. She was also diagnosed with Type 2 diabetes 10 years ago and constantly needs to monitor and report her weight, blood pressure and blood glucose levels to her health care providers. She tracks the data in a daily journal and shares it with her homecare nurse when the nurse visits. Despite her best efforts, she occasionally forgets to enter the readings or enters the information incorrectly. Another challenge sharing the data is poor weather preventing visits from the homecare workers.

**Names have been changed.

The Need for Canadian Chronic Disease Management Programs These stories and statistics highlight deficiencies in the current health care system. According to the Commonwealth Fund International Health Policy Survey of Primary Care Physicians, there is a deficit in the recommended chronic care and the received care in Canada known as the ‘quality chasm.’3 In order to address this deficit, Canadian health policy makers have started using population-based and patient-centric models of care that encompass health promotion, disease prevention and disease management.

Of those models, the chronic care model is most widely used.

According to the chronic care model, a community, a health system, a practice team and informed patients have a direct influence on the outcome of the chronic disease management program. Informed and empowered patients know and understand their conditions and are provided with the means to efficiently self-manage those conditions.

3

Schoen, C., Osborn, R., Trang Huynh, P., Doty, M., Peugh, J., & Zapert, K. (2006). On the front lines of care: Primary care doctor’s office systems, experiences, and views in seven countries. Health Affairs, 25(6).

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CHRONIC CARE MODEL COMMUNITY

HEALTH SYSTEM Delivery System Design

Resources & Policies

Decision Support

Self-Management Support

INFORMED, EMPOWERED PATIENT

PRODUCTIVE INTERACTIONS

Health Care Organizations

Clinical Information System

PREPARED, PROACTIVE PRACTICE TEAM

IMPROVED OUTCOMES S O U R C E : http://www.hc-sc.gc.ca/hcs-sss/pubs/prim/2006-synth-chronic-chroniques/index-eng.php. (Original source: Figure 1 from Wagner E.H., Chronic Disease Management: What Will It Take to Improve Care for Chronic Illness? Effective Clinical Practice 1998; 1:2-4. Reproduced by permission.)

80% of community care in Canada is provided by informal caregivers (e.g. friends, family members) Canadian Institute for Health Information.

Supporting Informal Caregivers - The Heart of Home Care.

Ottawa: Canadian Institute for Health Information, 2010.

Costs and Benefits of Chronic Disease Management Programs Data from a 2007 study looking at the social and economic impacts of implementing a nationwide chronic disease management program based on the chronic care model shows an annual reduction of 1.5 million in-patient nights, a cost avoidance of $1.6 billion and 22,360 fewer deaths.4 According to these projections, the cumulative benefits of a chronic disease management program would surpass the start-up costs in six or seven years. By year 10, the return on investment to the Canadian health system would be more than $9 billion.

4

Morgan, W.,M., Zamora, E., N., & Hindmarch, F., M. (2007). An inconvenient truth: A sustainable health care system requires chronic disease prevention and management transformation. Health Care Papers, 7(4), 6-23.

The Chronic Care Model and Personal Health Portals As shown in the illustration of the chronic care model above, improved outcomes are achieved if two major challenges are addressed: facilitating the interaction between health care providers and their clients; and empowering and enabling patients, their families and other caregivers through reliable, up-to-date information. For many years health professionals have tried to bridge the communication and information gap by using traditional methods such as group meetings with patients, special events and exhibitions, and educational booklets and brochures on chronic conditions.

Although these methods are well-intentioned, they don’t facilitate the interactive communication needed with patients or enable patients to share the responsibility of managing their condition.

Personal health portals such as TELUS Health Space are a great solution as they provide the following benefits: • Real time communication between patients and health care providers • Ability for health care providers to review results immediately and communicate with patients in a safe, secure environment • Overall system cost savings due to fewer office visits resulting from regular monitoring of chronic health conditions • Less burden on informal caregivers

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Personal health portals such as TELUS Health Space are a convenient, secure way to transfer data to health care providers.

Personal Health Portals at Work in Alberta A pilot study was conducted in 2011 involving the Sherwood Park Primary Care Network, Alberta Health Services Home Care – Strathcona County, the University of Alberta’s Faculty of Rehabilitation Medicine, TELUS and TRLabs. The purpose of the project was to determine the viability and perceived effectiveness of using a personal health portal for patients to electronically submit health information to their health care provider. The participants were seniors with Type 2 diabetes, one of the most common chronic conditions among Canadian seniors. They were deemed ideal candidates to test the system because of the system’s potential to improve the rate of early detection of complications. Participants were given user names and passwords to a personal health portal account on the TELUS Health Space website and used the portal to enter personal data, which was monitored by health care staff over the course of the study.

The majority of the participants found it easier and more convenient to submit information via a personal health portal rather than providing daily journals. Participants experienced an increase in communication with their health care providers and improved confidence with the ability to self-manage their diabetes. Results of this study suggest that seniors with basic computer skills can easily use personal health portals as a convenient, secure method to transfer data to health care providers.

This is an important collaboration between the University of Alberta and TELUS that will significantly advance the development of new technologies in the community so people—particularly seniors—can remain independent and healthy.

MARTIN FERGUSON-PELL ACTING PROVOST, UNIVERSITY OF ALBERTA

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Next Steps for Alberta Understanding the important role of personal health portals in successfully implementing chronic care models, the University of Alberta recently partnered with TELUS to advance consumer health care technologies in this area. TELUS, the Faculty of Rehabilitation Medicine and the Health Sciences Council at the U of A launched the Consumer Health Technology Living Laboratory Community in May 2012, a research platform geared toward developing and commercializing innovative health technologies. TELUS has committed $1.3 million over three years to the initiative, along with in-kind technology and staff support.

The Living Laboratory Community will promote research in consumer technologies that allow patients to monitor their health and let them decide who can remotely access their medical information.

Phase Two of the pilot study began in fall 2012, with the focus being the adoption rate of personal health portal technology among the 250 participants. The main feature of Phase Two is using USB glucometers capable of updating the personal health portal almost automatically when connected to an Internetenabled computer. Plans are in the works to expand the study to the primary care networks in Alberta in the next year.

Alberta is a pioneer in implementing provincial programs for chronic disease management based on the chronic care model. Alberta’s Capital and Calgary health regions have both implemented comprehensive chronic disease prevention and management programs and provide electronic remote patient services to their clients, including a common provincial electronic health record for patient information registries and Health Link Alberta (a 24-hour nursing advice phone line).

Released in 2010, Alberta’s Health Research and Innovation Strategy outlines a vision for improving Albertan’s quality of life by building an integrated, world-class health research and innovation system.

The innovation platform of this strategic plan emphasizes the improvement of Alberta’s health information capacity through the following:

BUILDING

IMPROVING

LINKING

on existing informatics and bio-computing capability in support of health systems research and advances in personalized medicine/health

the collection of and access to anonymous health care data and information to enable research into areas of strategic priority and policy issues

health data with other data on education, income, and housing to support research into the social determinants of health

GROWING AND SUSTAINING the Alberta Health Research Database

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Personal health portals allow for real time communication between patients and health care providers. Health care providers can review results immediately, consult with colleagues and determine appropriate courses of action.

Personal health portals align with Alberta’s health research and innovation strategic plan and its mission “to fuel health research and innovation in Alberta through well-aligned and focused investment in research discoveries and their application to improve health, social and economic outcomes for Albertans.” This technology will play an essential role in the success of establishing an Alberta chronic disease prevention and management program.

It will empower patients to self-manage chronic conditions through advanced monitoring devices such as digital glucometers and oximeters and gives patients and informal care givers the ability to submit data electronically to health care providers.

The use of personal health portals also facilitates better interaction between patients, informal caregivers and health care providers.

The data makes a strong case for the economic and social benefits of personal health portals but the success of such an initiative goes beyond a one-size fits all technology solution.

The conversation needs to be around technology adoption and finding the right approach to developing and delivering this type of care model. The Faculty of Rehabilitation Medicine is working with its partners to do just that through the Consumer Health Technology Living Laboratory Community. Rehabilitation scientists and practitioners play an essential role for people living with disabilities and chronic conditions to gain independence.

The Faculty of Rehabilitation Medicine is looking forward to working more closely with government and health sector officials to ensure a coordinated, common sense approach to community care that will benefit Albertans and use scarce resources to their maximum effect. It’s a conversation that needs to start today.

REHAB

Dialogue Rehab Dialogue is a series of interactive articles published by the University of Alberta Faculty of Rehabilitation Medicine. We invite government, health-care professionals and the community to engage in a discussion on various health-care topics where rehabilitation could or should play a greater role, improving function, reducing pain, maximizing potential and quality of life—and sharing the vision for a healthy Alberta.

www.rehabmed.ualberta.ca