This document discusses the shift in perspective from paternalism to whole community health at PeaceHealth St. Joseph Medical Center over 20 years. It summarizes the history from early initiatives like a community health record and immunization registry in the 1990s. In the middle history, patient requests led to roles like navigators and decision support tools. Recent history discusses building interoperable computing and mobile access to personal health data through initiatives like Microsoft HealthVault and state health record banks. The future envisions more user-friendly cloud tools to help families manage health, as well as social software, conversations, and data analysis to support behavior change at the community level.

1. COMMUNITY An Optimum Perspective for a Health Ecosystem (From Paternalism toward Whole Community Health) Marc Pierson MD V.P. PeaceHealth, St. Joseph Medical Center Bellingham, WA

2. Place People History Perspective Shifts Over 20 Years

3. WHATCOM COMMUNITY

4. BELLINGHAM, WASHINGTON

6. It Takes a Community

7. OUR FUTURE How to get upstream of illness?

10. PATIENTS AT THE CENTER Whatcom County, WA 1995 Patient Patient's Home Hospital Physician's Office Payer Pharmacy Home Health Physician Home SNF E D & EMS OP Surg . Radiation etc.

12. A Patient Centric Approximation

14. Coordination Rules, Analytics, Messages EMR 1 - N PAYER CLAIMS DATA 1 - N LAB 1 - N IMAGING ENTERPRISE 1 - N PHARMACY DATA DEVICES 1 - N Patients Providers DEVICES 1 - N DEVICES 1 - N DEVICES 1 - N HV Ecosystem Applications

16. THE HUMAN STACK (A Socio-Technical Perspective) Information Data New Behaviors Commitments Conversations Communication Practices (habits)

17. A Future of Socio-Technical Innovation For and Within Communities Thank You