Patient portals are secure online sites, provided by general practice teams, where patients can access their health information and interact with their general practice.
Patient portals give patients secure online access to their own personal health information 24/7 and enable them to manage aspects of their own health care.
Patient portals save time, increase autonomy and enhance relationships.
Benefits
Portals can allow patients to:
request repeat prescriptions
book appointments
see their lab results
see GP's clinical notes
see their current diagnosis
see a list of their medical conditions
see a list of the medications they are on
see their immunisation and vaccination history
receive reminders and recalls from the practice team
send and receive secure messages to and from their GP or a practice nurse.
e-Health Talk NZ– Podcast
Dr Will Reedy and Dr Jeff Lowe discuss the use of patient portals as a means of consumer empowerment and how to improve uptake of portals in New Zealand.
The IT Health Board appointed eight eHealth Ambassadors with expertise in patient portals in February 2014. Read about their stories and experience with introducing patient portals, what worked, what didn't and their suggestions for improving workflow.
The patient portal is easy to use, gives patients a lot more control over their health care and frees our staff from a number of administrative tasks. We’re also seeing clinical benefits.
GPs thinking about introducing a patient portal may wish to contact an eHealth Ambassadors for their advice. Send all queries to: enquiries@ithealthboard.health.nz with the name of the eHealth Ambassador you wish to contact in the subject line.
OpenNotes is the term given to opening up the health record so that patients can see their own notes and medical record including consultation records, lab results, immunisations, medications and recalls. This is done through a secure online portal, similar to online banking.
Why is shifting to Open Notes important?
More than 60% of patients reported doing better with taking medications as prescribed because of open notes.
More than 77% of patients reported that open notes helped them feel more in control of their care.
More than 86% of patients agreed that open notes would be an important factor in choosing a future doctor or health plan.
Fewer than 8% of doctors reported taking more time to address patients’ questions outside of visits.
Fewer than 20% of doctors reported taking more time writing notes.
The Royal NZ College of General Practitioners and the Ministry of Health's National IT Board have developed a useful implementation guide for general practice clinics.
Written by: Dr Karl Cole, GP & e-Health Ambassador
If the health system is to cope with the challenges of the future, then we need better self-management of long-term conditions.
GP advanced training has always focused on patient centered approach and continuity of care. What is the patient’s agenda? Considering the person bio-psycho-social in environment. Involving them in all management decisions whenever possible. Taking care to make sure patient doctor relationship is balanced. But it is the doctor who has the access to notes, who records what happened in the visit and the management plan. But why isn’t the patient able to have these memory aids? They can legally read and get a copy of notes for review at any time, but what about always having access? They have the most to gain about the accuracy of the record, and its like having an extra person in the care team!
The co-pilot clinician
The doctor needs to make notes to remember what happened. There are legal requirements for this, and the notes can be used in investigations about the quality of care. Also the notes were originally there to help other clinicians get a snapshot of the person's health status.
Many modern day clinicians include their patients in all decisions, why not let them review the medical record? If the doctor needs a reminder of what happened in a consult, why not the patient?
The perfect situation is when the clinician perfectly understands the individuals bio psycho and social factors. But how often does that happen? The perfect patient understands all the relevant options and science behind each diagnosis and needs no help in deciding management. The patient is the only true expert about themselves, and in an ideal world the doctor is a partner or a copilot in the person's health journey.
With this approach, a transparent relationship is vital and supported by open notes, and there should be no surprises!
Open Notes
Watch this lecture from Prof Tom Delbanco on why sharing your notes with patients is so good. The results are astounding, and in the review section you will see the papers. As Prof Tom states, "what other advance in medicine has helped with patient adherence to medicine as much as these results?"
Patient portals are secure online sites, provided by general practice teams, where patients can access their health information and interact with their general practice. The following case studies highlight various general practice teams in New Zealand and their learnings so far.
The team at Island Bay Medical Centre were early adopters of patient portal use. The initiative was championed by GP Richard Medlicott who is also one of eight e-Health Ambassadors available for advice and can be contacted via the Ministry of Health website.
Island Bay MC now have over 4000 of their enrolled population using the patient portal and have recently ‘opened up’ the consultation notes so they can now be viewed by patients via the portal. (Read more about Open Notes)
Clinical Manager, Fiona Kymbrekos says she has noticed an increase in patient interest and follow up conversations about treatment and care since the consultation notes have become available via the portal. There are several different patients portals and the one being used at Island Bay Medical Centre is ManageMyHealth.™
All members of the Island Bay team use the portal to communicate with patients and doctors, nurses and admin staff report positively about the amount of time saved and the improved experience reported by their patients. Just recently a patient forgot to take their medications with them when travelling overseas. The GP was able to email the medication list to the local pharmacist who was then able to dispense the correct medicines to the patient.
Fiona uses many of the ManageMyHealth™ functions such as group emails and reminders about things like flu jabs as well as invitations to events or programmes such as those organised by Arthritis NZ or the local diabetes service.
The Island Bay team are all passionate about the patient portal and continuously encourage patients to join. They have run a number of promotional initiatives over the years.
All team members have embraced the latest idea of wearing ManageMyHealth™ every Thursday and Friday.
Learn more
To hear more about their experience with patient portals, view the webinar.
High need practices are also finding patient portals useful
Porirua Union Community Health Service (PUCHS) and Hora Te Pai (HTP) are two high need practices based in Porirua and Kapiti Coast. Their enrolled populations share similar characteristics, including high levels of social deprivation, poverty, English as a second language or no spoken or written English. Often families share one cell phone, have no computer or internet in the home and no credit on the phone.
When introducing a patient portal, both teams took a similar approach, taking it slowly and carefully in the beginning. They started with only one or two GPs and nurses actively recruiting people who they know have fewer barriers to accessing the internet At the time of writing, numbers were slowly building as they think innovatively and find solutions to barriers.
Hora Te Pai knew from their own and others experience that if a patient is not fully activated, on the portal, at the time of enrolment and when they are in the practice, the likelihood they will use it once they leave is very low. To overcome security and access concerns they had a tablet secured to a stand and fixed to the reception desk. This has worked well as patients can set themselves up with portal access quickly and easily. There is also always someone trained and on hand to help if needed.
In order to build momentum, both PUCHS and HTP knew that they needed to have visual reminders throughout the practice. ManageMyHealth™ posters and reminders were placed in waiting areas, consulting rooms and staff areas.
The PUCHS team got creative and made a ‘target’ poster to display in the reception area close to the other information about ManageMyHealth™.
Both HTP and PUCHS commented that one of the challenges had been getting GPs and nurses on board with the concept in the beginning. GPs were concerned they would start getting numerous emails from patients via the portal. They were also concerned about how patients would react to some of the information they could access via the portal and if some of the information might cause unnecessary anxiety.
However, as has been the case in most practices where patient portals are being used, this has not transpired.
All three practices are members of Compass Health PHO who are strongly supportive of the implementation of ManageMyHealth™ and have developed a useful start-up guide for General Practice.
Pakuranga Medical Centre
The patient portal at Pakuranga Medical Centre (PMC) has saved time and increased efficiency for the practice and its patients, resulting in improved access and a better patient experience.
A patient portal is a secure online facility that allows patients to access their health information at any time and from anywhere with access to the internet. At PMC, patients can use the portal to make appointments, order prescriptions, access test results, and view health information, such as their recalls, allergies and immunisations. Pakuranga Medical Centre introduced the portal into their practice to relieve pressure on the telephone system and increase access for their patients.
OpenNotes is the term given to opening up the health record so that patients can see their own notes and medical record including consultation records, lab results, immunisations, medications and recalls. This is done through a secure online portal, similar to online banking.
The OpenNotes initiative began in 2010 as a 12-month experiment to “investigate patients and doctors’ attitudes about sharing a visit note.” At the end of the year, 99% of patients wanted to continue sharing visit notes and no doctor asked for the notes to be turned off. This led to an international movement that has become known as OpenNotes.
Since this time, numerous studies have demonstrated multiple benefits of sharing visibility of their medical record with patients.
Key points
OpenNotes include the notes health providers have written and the results of most tests a patient has had. (Not all hospital or specialist ordered results are yet visible through the portal)
These portals are secure, which means that a patient's health information stays confidential to you and your health practitioners.
As of September 2017, more than 472,894 Kiwis were using patient portals and they were offered in 509 general practices.
View a map to find out which medical clinics are offering a patient portal and if they are using OpenNotes yet.
If you are a patient and your doctor doesn’t have a patient portal and OpenNotes, ask them when they will be available to you.
“Open notes create partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information.”
Culture change
Open Notes is both a technical change as well as a philosophical shift for clinicians to be willing to open up the medical record and share fully with patients. Patients have the right to read or request a copy of their medical notes at any time, however traditionally doing this has been difficult for patients to access and time-consuming for healthcare teams or practices to facilitate.
Technology has completely changed this so that now it is one of the standard modules available through general practice patient portals and can be turned on with a few clicks.
What are the benefits of OpenNotes?
From a patient perspective:
Studies show that most patients remember less than half of what they discuss with their medical professional. Seeing your doctor’s notes helps you remember what you discussed and what action points you agreed.
Having more information about your health care helps you to understand your health condition better and stay more in charge of managing your own health.
OpenNotes can make your care safer. You can make sure there are no mistakes in the notes and they can remind you when you need to have check-ups.
If you want to share your health information with someone who is helping look after you, OpenNotes makes this easy to do.
From a health provider perspective, studies show:
Improved communication
Improved patient recall following visits
Improved patient motivation/engagement in their own health and healthcare
More efficient care
Improved accuracy of medical notes
Improved patient safety
An approximately 75% improvement in adherence to treatment
Better relationships with your patients
Improved trust and both clinician and patient satisfaction
Facilitates patient centred care, self-management support and shared decision-making
When introducing a patient portal, both teams took a similar approach, taking it slowly and carefully in the beginning. They started with only one or two GPs and nurses actively recruiting people who they know have fewer barriers to accessing the internet At the time of writing, numbers were slowly building as they think innovatively and find solutions to barriers.
Both HTP and PUCHS commented that one of the challenges had been getting GPs and nurses on board with the concept in the beginning. GPs were concerned they would start getting numerous emails from patients via the portal. They were also concerned about how patients would react to some of the information they could access via the portal and if some of the information might cause unnecessary anxiety.