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Global Perspective on PHRs: Consumer Engagement in Health Information Exchange in Europe & the U.S. : 

Global Perspective on PHRs: Consumer Engagement in Health Information Exchange in Europe & the U.S. Presented by Ken Lopez ICW America Chief Product Officer


Agenda ICW America Overview PHR Landscape Overview Examples of PHRs in Europe Examples of PHRs in U.S. PHR Future & the Challenges Ahead

ICW Overview: 

ICW Overview History ICW was founded in 1998 Locations Germany: Walldorf (Global headquarters), Cologne, Berlin (International Briefing Center) USA: Malvern, PA, San Mateo, CA Sofia, Bulgaria; Vienna, Austria; Zurich, Switzerland; São Paulo, Brazil Employees 700+ worldwide Company Focus Patient-Centric Web-based Personal Health Record (ASP model) with controlled access for care providers and patients Open source, open-standards eHealth Framework Platform Integration of source systems for seamless health information exchange (HIE) Care and Disease Manager (CDM): a fully interoperable clinical rules and workflow engine allowing care managers to define and manage the care of patients both at the population and individual level

LifeSensor: A Global PHR Platform: 

LifeSensor: A Global PHR Platform Solution Overview

ICW Overview: 

ICW Overview Healthcare Ecosystem: Our Approach


Agenda ICW Overview PHR Landscape Examples of PHRs in Europe Examples of PHRs in U.S. Future Outlook

Lack of Consensus on PHR Definitions: 

Lack of Consensus on PHR Definitions No universally accepted PHR definition. Markle and AHIMA have tried to offer various definitions for a PHR, yet these are not consensus definitions used world wide. The burgeoning growth of the Personal Health Record market has also created confusion among users. (e.g. EMR, PHR, EHR, EPR) Three most important features Patient Ownership Patient Access Portability

Industry PHR Definitions Not Standardized: 

Industry PHR Definitions Not Standardized AHIP AHIMA Connecting for Health Markle Foundation (Networked PHR Model Solution) HL7 See Appendix for each organization’s definition

PHR Maturity Model: 

PHR Maturity Model

PHR Value Proposition for Stakeholders: 

PHR Value Proposition for Stakeholders

PHR Benefits: 

PHR Benefits A Parent’s Perspective Can aid in the care of multiple generations Care by adult children of elderly parents Care of minor children Care of college age children away from home Can record baseline for future comparisons Relevant x-rays, ekgs, scans, digital photos, etc Can eliminate repetitive health history requests/requirements Critical documentation available when traveling, especially overseas Contains “Emergency Data Set” - important in distress situations Lists medications, allergies, blood type, advance directives, etc. Can empower lifestyle changes for patients with chronic conditions In conjunction with physician/clinician input, tools can provide guidelines and then record results which are shared with the health professional

PHR Benefits: 

PHR Benefits A Physician’s Perspective Enhances patient safety Can enable convenient information exchange with Physician EMR Capability to address HIPAA consent/authorization matters Provides patient health history for new patients Can contain baseline for comparisons to current conditions x-rays, ekgs, scans, digital photos, etc Can record test results (convenient comparison w/ previous results) Critical documentation available in Emergency Department situations Contains “Emergency Data Set” - Information at the Point of Care Lists medications, allergies, blood type, advance directives, etc. Improves patient-physician dialogue/patient honesty Can promote lifestyle changes for patients with chronic conditions In conjunction with physician input, tools can provide guidelines and then record results which are shared with health professional

PHR Distribution Channels: 

PHR Distribution Channels Direct to Consumer Alternative distribution channels Employers Health Insurers Physicians and Hospitals Health Banks

Networked PHRs as Tools for Transformation: 

Networked PHRs as Tools for Transformation Common Framework for Networked Personal Health Information Networked-enabled – improved care management Improves quality of provider-patient interaction Relieves input burden of critical health information Providers build consumer loyalty to their practices or health plans by giving consumers networked PHR capabilities The future of the PHR is a patient-centric model where the consumer is at the center of the integrated medical information network

PHRs – Change Agents for Engaged Consumers: 

PHRs – Change Agents for Engaged Consumers

Individuals Need Accurate and Timely Health Information: 

Individuals Need Accurate and Timely Health Information Consumerism impacts individuals’ need to get information and exercise more control over their health and care decisions Natural disasters (CA wildfires/Katrina), have fast-tracked projects to deliver electronic medical records to displaced residents and providers Healthcare reimbursement accounts (HRAs) and savings accounts (HSAs), increasingly motivate consumers to maintain a record of healthcare services and expenses Wellness incentive & reward programs encourage individuals to track health promotion and status Hospitals, health plans, physicians, government and industry groups are developing electronic medical records to store patient/ consumer and member health histories President Bush has called for an electronic medical record for nearly every American by 2014

PHRs Types: 

PHRs Types AHIP describes main types of PHRs Records populated by medical and pharmaceutical claims data and physician input More sophisticated PHRs, combining medical and health information from members, providers and claims data Mature PHRs, linking to self-management tools designed specifically for members with chronic disease and critical risk factors, such as smoking or obesity, and providing a communication vehicle between patient and physician Networked PHR with EHR integrated medical information

PHR Market Drivers & Restraints: 

PHR Market Drivers & Restraints

Additional Market Drivers: 

Additional Market Drivers Continued Dossia-Like Initiatives (Employer Coalitions) HL7 – PHR Functional Model Specification CCHIT – Security on PHR AHIC Resolutions and work on NHIN prototypes Continua Alliance – Interoperability with Personal Health Devices Medical Home Model

Consumer Perspectives : 

Consumer Perspectives Improves understanding of personal health issues, increases sense of control and supports decision-making Supports timely, appropriate preventive services & wellness activities Strengthens communication with providers and verifies accuracy of information in their records Supports continuity of care across multiple providers and time Reduces hassle through online appointment scheduling and prescription refills Increases access to providers via e-visits Reduces adverse drug interactions and allergic reactions Helps avoid duplicate tests Supports home monitoring for chronic diseases as well as understanding of and appropriate medication use Manage insurance benefits and claims

PHR Benefits for Plan Sponsors : 

PHR Benefits for Plan Sponsors Reduction in costs through appropriate utilization Support wellness and preventive care Provide convenient service Improve workforce productivity Promote empowered healthcare consumers Use and apply advanced analytic/business intelligence of real-time aggregated data to manage employee health Enables “total health” engagement and empowerment

PHR Benefits for Providers : 

PHR Benefits for Providers Improves access to data from other providers and the patients themselves Increases knowledge of potential drug interactions and allergies Avoids duplicate tests Improves medication compliance Provides information to patients for both healthcare and patient services purposes Provides patients with convenient access to specific information or services (e.g., lab results, Rx refills, e-visits) Improves documentation of communication with patients

Medical Cost Trends: 

Medical Cost Trends Growing need to engage and incent consumers to improve individual behavior, such as poor medical compliance and low utilization of DM programs Increased employer demand for wellness incentive programs to motivate healthy employee behavior. Integration of medical and clinical programs to eliminate individual program “silos” and view the member holistically Use of “evidence-based medicine” to deliver care according to the most current, medically-validated medical literature Pay for Performance (P4P)/Value programs reward providers for high quality and cost effective care Industry and employer initiatives, such as BTE and Leapfrog, recognize and reward providers who deliver safe, effective, efficient and patient-centered care

Technology Trends: 

Technology Trends Microsoft HealthVault – Personal Health Information (PHI) Platform a set of search and personal health-record tools that consumers control in terms of the data that's entered and shared with others. Google Health – Developed a prototype online platform for its health offering that incorporates personal medical records, health care-related search features, diet and exercise regimens, a localized "find a doctor" application, and other elements. Quicken Health Online tool that will help you manage your out-of-pocket spending on medical bills and help consumers find and fix billing errors so you don't pay more than you owe. ICW eHealth Framework – Open source, open standards eHealth platform Health 2.0 – User Generated Content

ICW Overview: 

ICW Overview Healthcare Ecosystem: Approach


A Broad Vision of Health 2.0 Reformulating Data for Transparency, Decision Support & Revitalized Health Care Markets Brian Klepper and Jane Sarasohn-Kahn, October, 2007

Examples of PHR Implementations in Europe: 

Examples of PHR Implementations in Europe

European PHR Implementations : 

European PHR Implementations Netherlands - A web based PHR is developed based on the international open standard CEN/ISO-13606(1) and the openEHR information model(2). Scotland - Scotland’s national health information technology strategy seeks “to deliver an Integrated Care Record jointly managed by patients and professional NHS staff with built-in security of access governed by patient. Sweden - The SUSTAINS (Support Users to Access Information and Services) project in Sweden provides useful lessons on ePHRs. The central concept of this project was to create “a copy of Internet banking but for health care.”


Barmer, Germany's largest insurance company, is to begin a national evaluation of the effects personal health records (PHR) have on patient self-care and health service delivery. The trial is believed to be one of the biggest yet patient-controlled PHRs. During the course of the study Barmer will offer the system to all of its seven million members across Germany; some will be offered the system for free, while others will have to subscribe to the service. ICW will supply its LifeSensor web-based PHR which will provide Barmer members with the ability to actively manage and control their health, including accessing their personal health information anywhere and anytime they want.

Modular Structure of the Personal Health Record: 

Modular Structure of the Personal Health Record


LifeSensor Fitness


LifeSensor Nutrition

MIGROS Retail Chain - Switzerland: 

MIGROS Retail Chain - Switzerland Largest Retail chain in Switzerland – (e.g. WalMart) Household name in Switzerland 7 Million – Swiss Population Implementing 1 Million LifeSensor PHRs Rollout to Employees Offering product bundle for retail customers

Gesundheitsinitiative – Rhein-Neckar: 

Gesundheitsinitiative – Rhein-Neckar RHIO Implementation The Health Initiative Rhine-Neckar started to introduce an electronic health card in May 2007 in connection with the LifeSensor personal health record throughout the metropolis region Rhine-Neckar, Germany. The project is based on the health card field test in Walldorf that was started by ICW in 2005. In first phase, physicians and pharmacists in the communities Schwetzingen, Walldorf and Wiesloch participate as partners in the Health Initiative Rhine-Neckar. ICW‘s health card system already provides all the mandatory applications of the future German health card like ePrescriptions and medical reports while supplementing the system with the added value of a personal health record.


Research & Development Project “Partnership for the Heart” Remote Patient Monitoring for Patients with Congestive Heart Failure

Complete Remote Patient Monitoring System: 

Complete Remote Patient Monitoring System


- Founded in 1710 - 11 Nobel prize winners - 15,000 employees - 9,600 students - 110 departments - turn over 2006: 1.1 billion € - scientific budget 2006: 112 million € Charité-Universitätsmedizin Berlin Facts

Congenital Heart Defects (CHD) – Epidemiological Background : 

Congenital Heart Defects (CHD) – Epidemiological Background CHD are the most frequent Malformations 1% of all Newborns suffer from CHD CHD influences Infant Mortality Natural Course of Disease (80% Mortality) Gold Standard is Cardiac Surgery During Infancy (85% Survival Rate)

Patient measuring devices: 

Patient measuring devices Concept Technical development Clinical trial Project perspectives

PfH patient monitoring system: 

PfH patient monitoring system Patient Medical Partners Concept Technical development Clinical trial Project perspectives


Agenda ICW Overview PHR Landscape Overview Examples PHRs in Europe Examples of PHRs in U.S. Future Outlook


Examples of PHR Implementations in U.S.

U.S. Specific Implementations: 

U.S. Specific Implementations Kaiser Permanente rolled out its electronic health record to seven of its eight regions, allowing members to access: lab results schedule appointments refill prescriptions e-mail physicians receive physician notes about medications BCBSA/AHIP PHR Project Aetna/Active Health (PHR with Decision Support) Cleveland Clinic

Memorial Hospital of Rhode Island - MHRI: 

The hospital is home to a community clinic, co-operated by the hospital and the Warren Alpert Medical School of Brown University, called the Center for Primary Care and Prevention (the Center). The Center has 12,000 active patients and 60 physicians with a total patient population of 100,000. Key Objective to Build a Patient and Family Centered Health Care System. Incorporate LifeSensor PHR into a model to support a virtual medical home and integrate the LifeSensor PHR with Memorial’s EMR to enable secure and authorized electronic record exchange between physicians and their patients. Create a HIE providing interoperability with their existing solution: GE Centricity EMR myMedicationAdvisor® (MMA), a patient-oriented web application for medication management owned by Abacus, used by MHRI/CPCP HeartAge®, a patient and clinical decision support tool owned by MHRI Memorial Hospital of Rhode Island - MHRI

The Long-Term Vision: 

The Long-Term Vision Test a 21st century patient-centered, eHealth model of care link patients’ PHR to their providers’ EMR Rollout LifeSensor Diabetes to Diabetic patients Provide relevant information at the point of care Improve quality of care Improve patient safety create a secure platform (eHealth Framework) Build capabilities for enterprise-wide communications enable a secure health information exchange environment extend connectivity beyond the enterprise for authorized health information exchange with and between other qualified stakeholders


Lifesensor LifeSensor Professional

LifeSensor Diabetes: 

LifeSensor Diabetes


Agenda ICW Overview PHR Landscape Overview PHRs in Europe PHRs in U.S. PHR Future & the Challenges Ahead

PHR Future and the Challenges Ahead: 

PHR Future and the Challenges Ahead Barriers to PHR adoption have been well documented Lack of portability Continuing consensus on “vision of interoperability” - Interoperability challenges to overcome Level of effort to manually update records if not prepopulated with electronic data from payers or providers Consumers still have high concerns regarding privacy & security Improved awareness of PHR concept by consumers PHR models will continue to evolve PHR standards will play a critical role Improvement in Care & Disease Management via workflow and rules engine technologies Digital forms will continue to evolve


Preparing for the Future Thank you for your Attention Email Address Ken.lopez@icw-global.com




PHR Data Domains **Self-Reported Information

Major Payers PHR Offering: 

Major Payers PHR Offering

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