FEATURE ARTICLE COMMENTARY

Health information solutions for consumers: Researchand plansJennifer Zelmer, PhD

From banking to blogging, computers have changedthe way that we live our lives. Healthcare is no ex-ception. We take for granted innovations in medical

imaging, for example, or the ability to quickly search mil-lions of research articles for the latest clinical knowledge.However, in other areas we are only beginning to realizethe potential of information and communications technol-ogies to transform health, healthcare, and the patient ex-perience.Many individuals already use the Internet to search for

health information. Over half of the population in manycountries, for example, report having used the Internet forhealth purposes.1 Consistent with the point made by RogerGirard in his article in this issue, most also value the effec-tive use of information technology to support their care.For example, almost all Canadians say that it is somewhator very important that their health records be kept elec-tronically so that they can be easily transferred around thehealth system (97% in a survey conducted by Ipsos Reid inlate 2010). The proportion saying that this is “very impor-tant” is higher among those with chronic conditions (70%)and Canadians aged �55 (73%) than among the popula-tion as a whole (64%).In addition, many Canadians are interested in having

access to their personal health records and to health infor-mation services. This article outlines results of recent re-search in this area and provides an overview of the ap-proach that Canada Health Infoway is taking in a newconsumer health solutions program.

WHAT CANADIANS SAY: SURVEY RESULTS

In November 2010, Canada Health Infoway commissionedIpsos Reid to conduct a survey regarding Canadians’ expec-tations and priorities related to consumer health solutions.The general population sample (n � 1506) included target

From Canada Health Infoway, Toronto, Ontario, Canada.Correspondance: Jennifer Zelmer, PhD, Canada Health Infoway, 150 King

Street West, Suite 1300, Toronto, Ontario, Canada(e-mail: jzelmer@infoway-inforoute.ca).

Healthcare Management Forum 2011 24:144–1460840-4704/$ - see front matter© 2011 Canadian College of Health Leaders. Published by Elsevier Inc. Allrights reserved.

doi:10.1016/j.hcmf.2011.07.009

sub-groups of Canadians with chronic conditions (n � 520)and caregivers (n � 458).The survey showed that most Canadians are already

using the Internet to access health information, but use ofother types of services was less common. For example, 9%of Canadians said that they could e-mail their doctor, andvery few (2%) said that they had access to their medicalrecords. This situation is similar to that in many otherdeveloped countries. The 2010 Commonwealth Fund In-ternational Health Policy Survey found that �10% of adultsin all 11 countries where the survey was conducted hademailed a medical question to their regular doctor or placeof care in the last 2 years.2 Denmark is an exception;on-line consultations with physicians are more common inthat country.A strong majority of Canadians surveyed, however, ex-

pressed interest in on-line health information and services.When asked what types of services they would be mostlikely to use in the next year, the most popular optionswere accessing laboratory test results (81%), making re-quests for prescription renewals (78%), and making ap-pointments with healthcare providers (76%). Overall, care-givers were more likely than the general population to saythat they would be likely to use a variety of health infor-mation and services in the next year.The survey also asked Canadians what would be the

single most valued service, if available. Four services wereprioritized by �10% of survey respondents:

• requesting prescription renewals;• viewing laboratory test results;• making appointments with healthcare providers; and,• consulting with healthcare providers securely on-line

without having to phone or visit their office.

These preferences were consistent for the generalpopulation as a whole and for caregivers specifically.Individuals with chronic conditions, in contrast, weremore likely than the population as a whole to rate accessto laboratory test results as the most valued service andless likely to prioritize the ability to make appointmentson-line.When asked why they chose the health information

and services selected, survey respondents provided avariety of reasons, many of which were specific to thetype of information or service being considered. Overall,

the most frequent mentions were that on-line access will

HEALTH INFORMATION SOLUTIONS FOR CONSUMERS

be more convenient and save them time. For example,survey respondents indicated that being able to accesslaboratory test results on-line would reduce the need totravel for appointments and the amount of time spentworrying about results. A number of survey respondentsalso suggested that on-line services would have a pos-itive impact on the health system by reducing wait timesand the number of visits to health professionals.

CONSUMER HEALTH SOLUTIONS AT CANADAHEALTH INFOWAY

Infoway’s new Consumer Health Solutions investment pro-gram was established to educate and empower Canadiansby providing electronic access to their health informationand to healthcare services. It focuses on the areas thatCanadians identified as being of highest value and is di-vided into 3 streams: Jurisdiction patient portals, demon-stration projects, and foundational investments.In all cases, benefits evaluation is an important compo-

nent of this program to learn from—and share the expe-rience of—early adopters. This includes understanding theperspectives of individual Canadians and of the healthcareproviders with whom they are beginning to interact on-line. Both Canadian and international experience demon-strates that consumer health solutions can provide highvalue for individuals and the health system. For example,Kaiser Permanente has published data showing significantreductions in office visits and improvements in chronicdisease management with the introduction of new waysfor their members to access health services on-line.3 How-ever, success is not guaranteed and at this relatively earlystage of implementation, it is equally important to learnfrom experiences that are less successful.

Jurisdiction patient portal projects

Infoway will co-invest with a jurisdiction who is ready tomove forward on the development and deployment of aprovince-wide patient portal initiative. It is expected thatthe portal will be integrated with other partnering organiza-

Table 1. Eligible focus areas for consumer health solutions dem

Patient/consumer-initiated e-scheduling Projects in this are(regulated healt

Patient/consumer-initiated e-consults Projects in this areproviders/servic

Patient/consumer renewal ofprescriptions

Projects in this areon-line or by m

Patient/consumer view of health records Projects in this artest results) on-

Access to patient/consumer informationor services by authorized carers

Projects in this areaccess on-line r

tions and solutions as appropriate. The portals will provide

Healthcare Management Forum ● Forum Gestion des soins de s

Canadians access to information from their health records,as well as other value-added services such as appointmentbooking or requesting renewals of prescriptions on-line.Lessons learned from this experience will be widely sharedwith others who may be interested in undertaking similarinitiatives in the future.

Demonstration projects

Infoway will also co-invest in a number of smaller regional/local/focused demonstration projects that focus on specificareas or functions. The intent is to enable the testing anddemonstration of how consumer health solutions can bedeployed.Five investment themes have been identified for initial

investments in Consumer Health Solutions DemonstrationProjects (Table 1). These focus areas were determinedbased on a number of inputs including the survey citedabove and focus groups with Canadians. Other focus areasmay be identified in the future as priorities and evidenceemerge, and as investment dollars allow.

Foundational investments

Foundational investments are intended to help acceleratethe efforts of Infoway and others who are interested indeploying consumer health information strategies. The in-tent is to invest in a few pan-Canadian projects that facil-itate shared learning and foundation building with a viewto supporting future consumer health solutions. The sur-vey cited is the first foundational investment. Other foun-dational projects are being considered, possibly related toareas such as the shared challenge of identity manage-ment to ensure that solutions respect privacy legislationand expectations.

CONCLUSION

Consumer health solutions are relatively new, both inCanada and, with a few notable exceptions, around theworld. Their effective deployment is complex, not only (oreven mostly) because of technological challenges. By in-

ation projects

ll allow Canadians to schedule appointments with cliniciansfessionals) or clinical services on-line or by mobile phone.ll allow Canadians to consult with regulated healthcare-line (usually via e-mail) or by mobile phone.ll allow Canadians to request the renewal of their prescriptionsphone.ll allow Canadians to securely view their records (eg, laboratoryr by mobile phone.ll allow authorized carers (eg, spouses, children, parents), tos and/or services. Consent management is key in this context.

onstr

a wih proa wies ona wiobileea wiline oa wiecord

troducing a program that builds on global experiences and

ante – Fall/Automne 2011 145

Zelmer

an understanding of Canadians’ priorities and preferences,our goal is to accelerate the value that Canadians derivefrom consumer health solutions now and in the future.

REFERENCES

1. World Health Organization/European Commission. Survey on

ehealth. 2007. Available at: Trends.http://web3.custompublish.

146 Healthcare Management Foru

com/getfile.php/551132.357.sersvdpxyp/EHT�preliminary�report�final_5_2.pdf?return�www.telemed.no. Accessed October 10, 2009.

2. Commonwealth Fund. The Commonwealth Fund 2010 Inter-national Health Policy Survey in Eleven Countries: Full Chart-Pack. Available at: www.cmwf.org. Accessed April 10, 2010.

3. Silvestre AL, Sue VM, Allen JY. If you build it, will they come?The Kaiser Permanente Health Connect Model of online health

care. Health Aff. 2009;28:334–344.

m ● Forum Gestion des soins de sante – Fall/Automne 2011