SIIReN - System Integration & Innovation Research Network

Primary Health Care System

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“The Feasibility of Using A Patient-Controlled Health Record "
Presenters:  Lisa Dolovich and David Price, McMaster University
November 17, 2011


The current system of healthcare delivery in Canada is not sustainable. Exploring mechanisms for fundamental change is critical to developing the kind of disruptive innovation needed to maintain the health of Canadians far into the future. Clinicians, health administrators or organizations and in some cases health researchers have traditionally held the role as “protectors” or “regulators” of health information. This role is being questioned as an increasing number of patients are taking advantage of Personal Health Records or Patient Controlled Health Records (PCHR) that are available online to collect and manage their own health information. A ‘patient-controlled’ or ‘patient-directed’ model requires a commensurate paradigm shift of the established health care system that can better meet the needs of the patient, who will be interacting with the system in a very new and different way. PCHRs integrated with EMRs offer an opportunity to use information technology to optimize the clinical value of community-based PHC to support better prevention and management of chronic diseases across multiple groups including vulnerable populations.

This set of projects describes the feasibility of a PCHR to improve hypertension self-management, collect and use drug safety and effectiveness data, and record symptoms from a variety of medical conditions.

Patients from an FHT were enrolled into each study. Patients used specially designed modules in a patient-controlled health record (PCR) module (MyOSCAR; integrated with a family practice electronic health record (EMR). The PCHR modules allowed patients to:

  1. Record and monitor their blood pressure
  2. Develop personalized goals and action plans
  3. Complete a 53 item Patient Oriented Symptom Index (POSI) rating each symptom as absent, present (but neither bothersome or intolerable), bothersome or intolerable
  4. Send email messages to the clinic
  5. Report an adverse drug reaction to Health Canada
  6. Verify a medication list

Initial pilot testing enrolled 54 patients in the hypertension study and 10 patients in the drug safety and effectiveness study. A second larger pilot of 200 people will be enrolled in summer 2011 with a larger rollout to take place in fall 2011. Nearly all patients in the blood pressure study intervention group entered at least one BP reading into their MyOSCAR record (93%). The majority of participants targeted physical activity in their personal action plan (71.0%), followed by diet (47.6%) and body mass index (28.5%). Overall 40 symptoms improved, 26 symptoms worsened and 145 symptoms remained the same amongst the patients who started a new medication and completed the program from baseline to the final follow up.

A PCR linked to a health care provider EMR provided a mechanism for patients to record, monitor and communicate their home measurements such as blood pressure or symptoms. This process may prove useful for individual and population based chronic disease management and drug safety and effectiveness monitoring.

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