Presented at BYOD - Bring Your Own Doctor, July 17 · 2:00 PM, Centre for Global eHealth Innovation, R. Fraser Elliott Building, 4th Floor, Toronto, Ontario, Canada

1. The Enterprise vs. the Consumer Patient
Martin Sumner-Smith, PhD
17 July 2013
Event: BYOD – Bring You Own Doctor
Toronto

2. About me
Martin Sumner-Smith, PhD
Academic – Biotechnology – Bioinformatics – Enterprise – Advisory
1970’s 1980’s 1990’s 2000’s 2010’s

3. “One of the key drivers for the future lies in
using information to create more
personalised care and standardisation at
the same time. We are witnessing the
‘industrial revolution’ of healthcare,
enabled by IT”
– PA Consulting

4. Your interface to healthcare…

5. Then: Patients completely dependent on doctor

6. Now: Patients access information

7. Soon: Patients generate data

8. Patients gain expert interpretation of data

10. Doctor-tech in 2012
“Just under one-third of doctors reported
emailing with patients in 2012, up from 27% five
years earlier, according to annual studies of
more than 3,000 doctors conducted by
Manhattan Research, a health-care market-
research firm.
Those texting rose from 12% in 2010 to 18% in
2012.”
http://online.wsj.com/article/SB10001424127887324373204578376863506224702.html

11. Physicians resist patient access to data
• “The ultimate one was when the American
Medical Association lobbied to deny patients
access to their genomic data without a doctor.
• But the AMA also conducted a survey of their
own people – US doctors, 10,000 of them –
and 90 percent said they have no comfort
whatsoever in dealing with genomic data.”
Eric Topol, 2012
http://www.theatlantic.com/health/archive/2012/03/destroying-medicine-to-rebuild-it-eric-topol-on-patients-using-data/254215/

12. Thought experiment:
How much data does your doctor have
about you (in GB)?

13. There are more than 300 EHR vendors

14. What other organizations have health
records?

15. http://www.philblock.info/hitkb/e/elements_of_a_typical_EHR_system.html

16. http://braintertainment.blogspot.ca/2009/04/implementing-security-and-iam-for-ehrs.html

17. EHRs are examples of enterprise
software sold by complex systems
vendors

18. Enterprise software characteristics
• Large scale
• Highly complex
• Slow and expensive to implement
• Customized in almost every instance
• Extremely hard to replace/displace
• Often co-existing with
comparable/competitive systems in large
organizations

20. Slide 20
Complex-Systems vs. Volume Operations
Complex
Systems
Volume
Operations
Sweet
Spot
Sweet
Spot
Complexity Volume
Effectiveness
Small
Business
Societal
Projects
Societal
Entitlements
Enterprise Consumer

21. Slide 21
Complex Systems vs. Volume Operations
Complex
Systems
Volume
Operations
Sweet
Spot
Sweet
Spot
Complexity Volume
Effectiveness
Small
Business
Societal
Projects
Societal
Entitlements
Enterprise Consumer
Polarization
The middle
ground is
hard to
occupy

22. Enterprise organizational behaviour

23. Slide 23
People Silos

24. Slide 24
Content Silos

25. Slide 25
Process Silos

26. Other Silos
• Semantic
• Technology
etc.

27. The information is about the patient,
not for the patient

28. Patient supplied data are conspicuously
absent in these designs and
implementations

29. Where do patient data go?

30. • Portals for each device or app
• EHR
• Consolidated vaults
• Or consumer-managed X?

31. Benefits of data consolidation: Synergy
“At 8:03am you used your asthma puffer
while entering the MaRS concourse,
walking at a moderate pace towards the
Tim Horton’s after an unusually long
subway ride. Your pulse was 110, blood
pressure 135/80, temperature 37.2, blood
glucose…”

32. “Based on data collected to date I estimate that
there is 78.9% probability of an allergen to
which you react present at the following
locations…”

33. Established Healthcare
Institutions
Patient/Consumer ?