JMIR Publications

ABSTRACT

Background:

In publicly funded health systems, digital health technologies are strategies aiming at improving the quality and safety of healthcare service delivery, as well as enhancing patient experiences and outcomes. In Canada, federal and provincial governments and health organizations have invested in digital health technologies and innovation across its provincial and territorial health systems, including Personal Health Records (PHRs) with a variety of electronic service (e-service) functionalities.

Objective:

Patients’ access to their own information via secure, web-based PHRs and integrated virtual care services are promising mechanisms supporting patient engagement in healthcare. We draw on current evidence to develop an economic model estimating the demonstrated and potential value of these digital health initiatives.

Methods:

We first synthesized results from a variety of Canadian and international studies on the outcomes for patients and service providers associated with PHRs across a continuum of services ranging from viewing information (e.g., lab results) online to electronic prescriptions renewal, to email or video conferencing with care teams/providers. We then developed a quantitative model of estimated value, grounded in these demonstrated benefits and citizen use (2016-2017). In addition to estimating costs saved from patient and system perspectives, we used a novel application of a compensating differential approach to assess the value of improved health and well-being resulting from PHR use.

Results:

Patients’ access to a range of digital PHR functions generated value for Canadians and health systems increasing health system productivity, and improving access to, and quality of healthcare provided. As opportunities to interact and engage with healthcare providers via PHR functions increase, the marginal increase in value generated by utilization of PHR functionalities increases. Online prescription renewal generated the largest share of the total current value from the patient perspective; from the health systems perspective, Canadians’ ability to view their information online was the largest value-share. With implementation of PHRs with more integrated virtual care services, value generated from populations with chronic illnesses such as severe and persistent mental illness and diabetes, could amount to between $800M to $1B per year across Canadian health systems.

Conclusions:

PHRs with higher interactivity could yield substantial potential value from wider implementation in Canada, and increased adoption rates in certain target groups – namely, high-frequency health system users and their caregivers. Further research is needed to tie PHR use to health outcomes across PHR functions, care settings, and patient populations.