Presented by Dr Karolyn Kerr Clevermed Ltd

1. Patient Portals in New Zealand
Dr Karolyn Kerr
Clevermed Ltd

2. clevermed
What is a Patient Portal?
• “healthcare related online applications that
allow patients to interact and communicate
with their health care providers”
Wikipedia
Patient Portals are for people to actively and
collaboratively engage in their health care.
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3. clevermed
What is a Patient Portal?
• One of several different ehealth applications
that can be used to promote consumer
involvement in their care, including:
– Peer-to-peer online support groups/health related
virtual communities
– Self-management/self-monitoring tools
– Decision aids
– Patient portals
– Internet use
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4. clevermed
What is a Patient Portal?
• Stand alone websites selling their services to
healthcare providers, or
• integrated into existing health care provider
website or
• modules added to existing electronic medical
record system.
They all provide the ability for patients to
interact with their health information
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5. clevermed
What is a Patient Portal?
• Tethered personal health records
– Electronic entry point into patients record to view
selected clinical information from their record
– Managed by the health care provider organisation
and available via the internet
• Can:
– Interact with their health care provider
– Undertake tasks like request prescriptions, book
appointments, send secure emails
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6. clevermed
Content of Patient Portals
• Basic
– View medical history
– View laboratory results
– View current medications list
– Download/print medical data in various forms
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7. clevermed
Content of Patient Portals
• Advanced features:
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Repeat prescriptions
Secure communication with providers
Manage guardian/custodial accounts from one origin
Secure enrolment process
View statements and pay online
Manage appointments
Provide e-therapy solutions – education and
support/coaching
– Consultation/e-visits
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8. clevermed
Benefits of Patient Portals
Consumer based ehealth applications are
considered to be an opportunity to transform
the present paternalistic model of health care
toward one that is responsive to consumer
needs and treats each individual as a co-pilot in
a life-long health care process.
(Tang & Lanksy 2005, Wilson, 2009)
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9. clevermed
Benefits of Patient Portals
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Improved efficiency in communications
Immediate access to own records
Records are legible
Can be accessed repeatedly and
independently
• Access to relevant educational material
related to their condition
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10. clevermed
Benefits of Patient Portals
• Little empirical evidence of improved clinical
outcomes, health resource consumption,
adherence to medications, patient physician
communication, and patient satisfaction
• Even patient empowerment
• Small studies, poor quality, limited
information in research articles
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11. clevermed
Adoption of Patient Portals
• Most are initially interested in the idea of
access to their record, less follow through
• Wide variation in reported numbers of actual
adoption
• Impacted by gender and age – females aged
40-60 most likely to adopt
• Those with chronic disease highest users as
well as parents of young children and family
caring for elderly
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12. clevermed
Utilisation of Patient Portals
• Most commonly used for (in this order)
– Medications
– Lab results
– Scheduling appointments
– Secure messaging
– Repeat prescriptions
• Interactive content is a key factor in the
sustained use of portals.
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13. clevermed
Utilisation of Patient Portals
• Dependent on the patient provider
relationship
– Use linked to dissatisfaction with current
communication methods and responsiveness
– Converse true where good communication is
present (patients thought this would mean they
would lose the good communication they
currently have)
– One study in an urban environment
Zuckmund et al 2007
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14. clevermed
Impact of Patient Portals
• Increase in email contact with provider is
often uncompensated
• Large Kaiser study:
– ↓25% visit rate
– ↑eightfold in scheduled telephone visits
– ↑sixfold in email communication
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15. clevermed
Impact of Patient Portals
• Ammenwerth et al 2012 Systematic Review
– No statistically significant changes between
intervention and control group in 2 randomized
controlled trials investigating the effect of patient
portals on health outcomes.
– Significant changes in the patient portal group,
compared to a control group
• quicker decrease in office visit rates and slower
increase in telephone contacts; increase in number of
messages sent; changes of the medication regimen;
and better adherence to treatment.
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16. clevermed
Impact of Patient Portals
• The number of available controlled studies
with regard to patient portals is low. Even
when patient portals are often discussed as a
way to empower patients and improve quality
of care, there is insufficient evidence to
support this assumption.
• The use of patient portals showed no effect on
all measurement scales to operationalise
patient empowerment in one study
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17. clevermed
International Strategies
• UK Department of Health, 2012
– ‘The Power of Information: Putting all of us in control
of the health and care information we need’
– Electronic access to our own care record where we
request it will start with GP records, including test
results, by 2015’
– Information is seen as an essential health service to
improve quality, safety, and effectiveness of care
– Benefits realisation and evidence of value for money
only now being investigated
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18. clevermed
International Strategies
• Australian PCEHR
– Mr Dutton said that after a year in operation,
“only a fraction of Australians have established a
record and for those who have, only a few
hundred doctors have added a shared health
summary”.
Pulse IT Nov 2013
– Usability issues and lack of clinical and consumer
input
– Cumbersome process for consumers to apply for
access
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19. clevermed
International Strategies
• Canada – EHR 2015 – Advancing Canada’s
next generation of healthcare
– 5 Priorities – Priority 4 Begin to facilitate patient
self-care and empowerment
• a national patient portal infostructure to
contain costs –currently disparate
• To be available to all Canadians by 2015
• Cost of $80-120m
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20. clevermed
International Strategies
• USA – HITECH Act -Meaningful use
– funded for
• Patient ability to view online, download, and transmit
their health information
• 5% of patients utilising the service
– Large HMOs can develop and implement across
wide geographical areas
– Buy already developed off the shelf systems
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21. clevermed
Current status in New Zealand
• The IT Health Board's role will be to provide
"light standards" for the patient portals
• Focus on Integrated Family Healthcare centres
providing patients with access to their Primary
Care Records by 2014
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22. clevermed
Current status in New Zealand
• Patient Portals for specific health care issues
– Long term conditions and Maternity as part of
Shared Care Records (not planned for Child Health
Information Platform at this stage)
• Vendors providing patient portals in New
Zealand include Medtech, MyPractice,
Intrahealth, Orion, HSA Global.
• Focus on Primary Care and ED access for
clinicians
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23. clevermed
Current status in New Zealand
• Share care Planning – Long term conditions
Evaluation
– Patients overall felt that little had changed with
regard to their care experience. Because:
• portal was only established late in Phase 2
• limited in functionality.
• difficulty of health professionals to fully engage
patients in their care decisions (time constraints and
perception of having inadequate skills to do this
effectively)
• engagement and a sense of improvement takes time
and that these benefits are not yet apparent
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24. clevermed
Current status in New Zealand
• Active push from some practices towards
increasing virtual consultations/interactions
• Strong interest in combining primary and
secondary health information
• Mostly clinical portals, with patient portal a
later addition (some confusion between the
terms noted)
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25. clevermed
Barriers in New Zealand
• Multiple portals – various vendors offering
portals to the same patient
• Quality checks on portals being offered (to
come in the future)
• Privacy – secure enrolment process based on
all of gov. identity programme (RealMe).
• Access rights decided by patient.
• Public education limited
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26. clevermed
In Conclusion
• Virtual care already being provided, this is a
tool to support increasing virtual care
• Difference between a clinical portal and
patient portal – consumer involvement in the
development of patient portals
• No empirical evidence of improved health
outcomes but improvements in selfmanagement are.
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27. clevermed
In Conclusion
• What we need now is a tool that ties together
the shared care record and their portals with
primary care portals,
• quality and safety clinical guidelines and
• education to support consumers to use the
portals effectively.
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