There are some significant eHealth insights from the late, great actor Patrick Swayze.

No, they are not related to parenting approaches (though I agree that no one should put babies in a corner). Nor is there healthcare wisdom found in some of his other famous quotes like ‘ditto’ in Ghost or ‘adios amigos’ in Breaking Point.

The wisdom that Patrick Swayze has to share about healthcare can be found in one of his lesser known movies, Roadhouse. I can’t take credit for this analogy. I heard it while attending a Connecting South West Ontario, (cSWO)  leadership meeting. So all credit goes to the facilitator of that session, but it did leave an impression on me that I felt was worth sharing.

For those who are unaware of the classic late 80’s movie Roadhouse, Swayze plays bouncer supreme Dalton. He travels from town to town cleaning up establishments of ill repute. The film is a typical of the late 80’s genre: a vehicle for a heart-throb to go shirtless for nearly two hours. But a shirtless Swayze is where we find our healthcare insight.

While cleaning up the bars across America, Dalton hasn’t gone unscathed. He finds himself in a “new town, same story” which inevitably lands him in the local emergency room. While Dalton’s love interest, Doc, attends to his wounds he hands over a file with his entire medical history, which includes the records of his many previous emergency visits.

This transfer of information, although a footnote in the film, is the crux of the challenge many patients in Ontario face today. We do not have the equivalent file that Dalton hands to his provider. When patients arrive in a new hospital, new office, or see a new provider it’s the same story: the patient has to re-tell their medical history. This re-telling is often from memory and from the patient perspective. The attending provider then compiles the patient information from a variety of sources, not all electronic, which causes delay and patient risk. Dalton demonstrates one other key element missing from the current system. He is knowledgeable about his history and can advocate for the treatment he feels he needs.

How does this relate to eHealth in Ontario?

What Dalton hands over to Doc is what is known as the PHR or personal health record. The PHR is a cumulative patient history that is managed and held by the patient.

In recent years the term patient-centred care has become more of a focus in Ontario. What patient-centred care means is that patients take an active role in their healthcare. Patients that are knowledgeable about their conditions are better able to advocate for their own health needs and make informed choices. In 2010 the Ontario Medical Association published a paper calling for Ontario to take a patient-centred approach to healthcare. How does this differ from the current approach in Ontario? The College of the Family Physicians of Canada provided a good comparison between the traditional approach versus patient centered approach.

pc-vs-trad-care

Why is patient-centred care important?

When patients are more involved in their care it has shown positive outcomes, both to the patient as well as health system utilization. Reductions in re-admission rates, medication error, complications are all improvements associated with a patient-centred approach.

phr-bene

Patients can improve their overall health when they take an active role. It’s important to note that this isn’t an act of healthcare downloading responsibility to patients, the results have shown positive and more importantly it’s what patients want. Even when faced with the most difficult health challenges, patients want to be part of the process. The Committee on Improving the Quality of Cancer Care found that no matter how difficult the conversation, patients want to have it.

pat-want-pc

 

So how do we get to a PHR in Ontario?

Change is happening in Ontario and beyond. There are patient portals emerging in both public and private spaces. MyChart is a capability offered by Sunnybrook Hospital in Ontario and has been expanding its footprint to MacKenzie Health, Toronto’s Mount Sinai Hospital and the Children’s Hospital of Eastern Ontario. Private organizations offering patient health record solutions are emerging in both primary care as well as patient-direct services that can be leveraged by healthcare organizations. Dr. François Loubert, who is also president of the Association of medical clinics in Quebec, has begun using such a technology. Using a PHR enables Dr. Loubert to remotely monitor his patients that are suffering from chronic conditions. To become more efficient Dr. Loubert is able to obtain important health data from pre-visit questionnaires. Receiving this data ahead of time enables Dr. Loubert to spend more time with his patients managing their health needs and concerns. Without the PHR capability much of Dr. Loubert’s time was spent having the patient re-tell their story.

What patients don’t want in a PHR

As organizations mobilize to offer patient-centred solutions patients may be left with too many options. For those old enough to remember there was a time not long ago in Ontario where every hospital visit resulted in a printed plastic hospital card. If a patient had gone to more than one institution they would be provided an additional card. Parents would often carry numerous cards for their children. This is not a desired outcome for patient-centred solutions. The burden of logging into multiple portals across hospitals, primary care, specialists should not be passed to the patient. A fragmented approach would result in a fragmented record and the existing risks in the system would continue.

Strategy needed

There is need for a provincial strategy. Ideally this would build on capabilities that have already proven useful. A solution that provides a single location where patients can own and maintain their health record and participate in their healthcare should be the goal. With this goal achieved patients could simply hand over their PHR to their providers when asked about their history and state ‘ditto’.