Thank you very much. Thank you for the opportunity.
I'm Dr. Cafazzo from the Centre for Global eHealth Innovation at Toronto General Hospital. We have a mandate, as an academic research facility based at Toronto General, to look at the design and evaluation of future e-health innovations that will transform the health system.
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Our mandate is to address these six chronic conditions that consume 60% of all health spending. If we consider all chronic conditions, that's as much as 80% of all health spending. The main issue we're trying to address is that we have this tendency to spend most of our health care dollars on this bottom right-hand quadrant: very intensive acute care, at a very high cost, and with a very low quality of life. The purpose of the systems and the technologies we're looking at is to facilitate the shift in the spending toward this top left-hand quadrant: the care that is closer to home, that's lower in cost, and that comes with a higher quality of life. Central to this is the mandate of the centre, which is to facilitate patient self-care, where we believe that the patient has a larger role to play if the system is designed to accommodate them.
I want to cite some examples at Toronto General Hospital. Many of you already know that patients with end-stage renal disease must have hemodialysis three times a week in a centre such as Toronto General. About 10 years ago, an experimental program was started. One of the patients who decided to opt for this program was Yvonne Maffei, 27 years old, with end-stage renal disease, and recently married. Her future was within a dialysis unit three times a week. She opted to go with this experimental program of home hemodialysis. Although it sounds crazy, the idea of putting a dialysis machine in a patient's home actually works. Because they had the dialysis machine at home, they could dialyze more frequently. Rather than get 15% renal replacement function within a hospital setting, they could get as much as 50%. The theory was that they could have better outcomes.
Yvonne Maffei was one of 20 patients enrolled in this program. They have to learn how to use the machine and self-cannulate themselves using these two big needles every single day. For Yvonne Maffei, the outcome was significant.
For end-stage renal disease patients, the idea of bringing a pregnancy to term is pretty well unheard of. She not only conceived, but she also brought a full-term baby to term nine months later, which is unprecedented for end-stage renal disease patients. She was not the first. There were many patients subsequently over the next 10 years. This was literally a baby boom amongst home hemodialysis patients, who for the first time would be able to bring pregnancies to term. These children would not have been born if it wasn't for the ability to have the system accommodate patients and allow them to create circumstances for them to care for themselves.
The outcomes over the last 10 years have shown that home hemodialysis has many improved health outcomes. You can see the long list there of improved health outcomes. The most amazing thing is that it costs about $10,000 a year less per patient, per year, to deliver in the home rather than in an institution like Toronto General, so it is a win-win all around.
I want to cite some other examples of creating systems and technologies to unlock the patient's ability to self-care. This particular group includes teenagers, and they're not necessarily known for having the skills to care for themselves. We decided to build a system around their mobile phone for them to be able to manage their blood sugars on a regular basis. With the Hospital for Sick Children we created this application called Bant. It had the ability to wirelessly communicate with their blood glucose meters and capture the blood sugar readings on a regular basis.
We also added a rewards program for these kids to be able to earn experience points. For every reading they took, they earned a times two multiplier for consecutive readings and bonus points when they took five readings in a row. They were able to redeem these points for iTunes redemption codes, which would allow them to buy music and apps. The study we did at SickKids showed that these kids tested 50% more frequently using the app than in the three months previous to using the app. It's a small step in learning how to care for themselves. Perhaps it's not as impressive as giving birth, but it's a step in the right direction for these kids.
Another example is with type 2 diabetes. These patients also had the comorbidity of hypertension—a serious comorbidity. We did the same thing using a BlackBerry and a blood pressure monitor that was Bluetooth-enabled to communicate with their mobile phone. We did a randomized control trial: taking a conventional blood pressure monitor, giving it to a group, and giving another group the blood pressure monitor with the BlackBerry and the app running on it. After a one-year period we saw no change in the group that just had the conventional blood pressure monitor, but with the group that had the BlackBerry app, we saw a 20% drop in their cardiovascular mortality risk.
The other significant aspect of this study is that the physicians had really nothing to do with this outcome. No additional medications were prescribed. There were no additional visits to the family doctor. This was truly patient self-care, allowing the patients to become a lot more self-aware of their condition and more actively managing their care, whereas the patients who just had the blood pressure monitor...largely because hypertension is asymptomatic, they probably forgot to use it after a period of time.
We have been building apps for many years to deal with diabetes, working with the Heart and Stroke Foundation to do a risk assessment, and our newest application is for consumer asthma management.
One of the central key issues we are very concerned about, and one of the things we really need to deal with is patient access to their personal health information.
This is David deBronkart, who visited Toronto a few years ago from Boston with a very simple message to health providers, “Give me my damned data.”
These patients need the ability to have personal health information; they have serious comorbidities. They're managing their condition in the absence of their personal health information. It is legally their right, but there are systemic issues in the system that deny access to these patients to their health information.
Again, if we are to deal with these six chronic conditions, we need to reprioritize ourselves toward the patient in dealing with this immense burden on the health system, and there are patients out there who are more than willing and able to do this.
This is Yvonne Maffei today. Ten years later, she is still on home hemodialysis. She's still inserting those two great big needles into her arm on a regular basis. She's doing great. In fact, she now has two sons. She was not unique. Thousands of patients are doing home hemodialysis all around the world, and she is just a single example of what patients can do if the system is set up in such a way that it allows them to care for themselves.
Thank you.