1. Willingness to adopt the paradigm shift

2. Physician Value Simplified workflow Reduced Liability Improved Pt. Compliance Higher Clinical Outcomes Proven Cost Benefit Ability to ‘once again’ practice medicine Payer Value Ability to expand population across State Lines Capacity to create products that attract physicians and patients A new paradigm where they are seen as team collaborator in population health improvement Accurately weighted clinical outcome, member, physician satisfaction and cost efficiency metrics Patient Value Better quality of life Decrease cost out of pocket Actual rewards for careful self management Supportive community and employer New community of friends with similar conditions Ability to understand the quality of our products

3. Data and Information Hi Jeff, Here is some great educational material (click here): Your employer has awarded you many self care credits and has allocated six hours per month for health improvement activities and won’t fire you: AND PLEASE FORGET ALL OF THE FORMS WE HAVE BEEN SENDING. A patient (me) and my tools communicate through my I-Phone to the Web using a single PHR interface What I want! Secure message

4. Hi there! Will you please follow us down this rabbit hole?

5. Coronary Artery Stent 2007 Help me! I can’t breathe! My chest hurts! Well, you have great insurance, lets take you to the lab and fix that nasty blood vessel Here, Read this and you will be all set

6. Coronary Artery Stent 2007 Help me! I can’t breathe! My chest hurts! Well, you have great insurance, lets take you to the lab and fix that nasty blood vessel Here, Read this and you will be all set

7. Coronary Artery Stent 2015 Help me! I can’t breathe! My chest hurts! Well, I don’t even need to check to see if you have a source of payment; lets get going! Here, Read this and then go to lifestyle retraining Medical Home Coordinates The Best Care

8. A personal ‘real time’ example of what is available to Jeff Harris in March 2011

9. Selecting providers

10. Activating Patients

11. My PHR

12. How I connected my system Located physician with knowledge of health data interchange and motivation to heal Located surgeons who would treat me as equal Located tools online that worked and were interoperable Created my own accounts {HealthVault, Connected to Connected to CVS, SPINN secure Communication and LabCorp Keep redundant record at Duke

13. Duke Health View

17. Dukes Vital Sign Communication and Film Education

18. Example of one-way communication at Duke

19. Not Good

20. Duke’s p-HR home page

22. Decision Support

24. Details of record source

25. Who ordered drug Medication Reconciliation Where did record come from Is this patient staying with medical home or Dr. Shopping

26. Family History

27. Providers and Contacts

28. Monitoring

29. Now data tools for smart phones

30. My Droid Diabetes Meal and Insulin Managers

31. Self maintenance personal note

32. What Scenarios are Patients Face Apparently Healthy Educate on reform Educate on Medical Home Episodic Care Participate in care coordination Educate on provider selection and best practices Chronic Care Participate in interdisciplinary coordination Learning self mastery

33. Diabetic Gangrene Prior To Amputation Diabetic with healthy feet Good Self Management My feet forever please