In the first few blogs on the PHR, we explored challenges and opportunities in adoption and use of PHRs in Canada. We now turn our attention to questions around funding of PHRs:

Should Canadians be investing in tools to aid in capturing and retaining their personal and clinical health information, even where illness seems a distant eventuality?  

As tax payers, Canadians are already investing in their health by paying taxes, both at jurisdictional level and national level.  In Canada, our personal and corporate tax payer dollars fund approximately 70% of overall Canadian healthcare expenditures. Canadians are already using their personal funds to cover the ‘other’ 30% by acquiring private insurance and out of pocket funds in important health related targets including drugs, dentistry, optometry, psychology. We should set aside the notion that Canadian health services are 'free' as consequence of the Canada Health Act. Every Canadian contributes funds for their healthcare regardless of their economic status, everyone is reflected in Canada’s public healthcare expenditures. This is true across Canada including those living in jurisdictions that discontinued direct premium charges for public health insurance. 

The question then becomes: What is the best mechanism for funding high quality PHRs? Who pays and who benefits?  

We are funding our health services, in pursuit of wellness, preventative health and illness care. Common sense says that we should also be investing in the means to capture and retain our personal health information, expand to include our digital clinical information as it is offered by health providers, and to include other important information such as social determinants to round out our health information profile.  

But there is some good news on the horizon:

  • Canadian health policy and decision makers have required more attention to the investment of consumers health. The phrase ‘Patients First’ has made its way into many strategy plans and subsequent business cases for meaningful investments across Canada.
  • In recognition of an aging population across Canada, government policy focus for seniors has identified the importance of expanding people's ability to remain with their families and community, at home, to delay moving into a continuing care facility, to ‘age in place’. Clearly having access to a complete PHR significantly improves the ability of people to age in place by enabling either the consumer or their care givers and relatives to contribute meaningfully to the care plan and to communicate amongst the team. One recent project in Northern Ireland illustrates that patients with Dementia can stay at home when their relatives can access the clinical record via a PHR.
  • Canada Health Infoway’s 2017-2018 Corporate Business Plan reflects action plans fueled by the recent Federal budget announcement to continue to expand investments in consumer health in Canada. One of the four goals in this plan is to “Connect Canadians with their health information so that they can more actively manage their health and wellness”. Infoway will launch a new program to expand Canadians’ access to their health information through their preferred digital device. To accomplish this, Infoway will establish and expand patient platforms across Canada by leveraging and nationally scaling the kind of capabilities already available in a number of jurisdiction patient health platforms.
  • Many health informatics and medical equipment vendors are creating new products to aid patients living at home. An example of this is Orion Health’s remote patient monitoring solution, that enables patients with chronic disease who require added supports to manage their condition at home with an emphasis on self-maintenance, and assurance of clinical monitoring. This application takes advantage of a patients prior investment in equipping their home with smart, blue-tooth enabled monitoring appliances such as weight scales, blood pressure monitors and glucometers.
  • The majority of Canadians have purchased smart phones and service contracts that are capable of supporting digital capture and display of select personal health information and capable of connectivity to Internet and sharing of this data with others. In addition to these mobile devices, many Canadians are purchasing wearable devices to capture metrics on daily and accumulative activities. Further, there is an expanding domestic market to enhance and make our homes ‘smarter’, with voice activated devices with slaved devices to make our at-home experience more livable.

Dr. Kevin Leonard, University of Toronto, was the principal organizer of the 2011 Patient Destiny Forum. Kevin argued passionately that to many audiences patients should have control of their own health information especially for chronic patients who had need in-depth knowledge as they engaged with their care team about attributes of their illness.  Participants of the Patient Destiny Forum in 2011 received a wrist band that was identical to a wristband given to patients admittance to an in-patient hospital unit. The purpose of wearing these wrist bands was to continually remind us, regardless of our professional status, that we are ALL PATIENTS at times in our life journey; at our birth, our death, and various moments in-between. 

We hope you enjoyed this blog series on PHRs.