Patient Portals in New Zealand


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Presented by Dr Karolyn Kerr
Clevermed Ltd

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Patient Portals in New Zealand

  1. 1. Patient Portals in New Zealand Dr Karolyn Kerr Clevermed Ltd
  2. 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. © Clevermed Limited
  3. 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 © Clevermed Limited
  4. 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 © Clevermed Limited
  5. 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 © Clevermed Limited
  6. 6. clevermed Content of Patient Portals • Basic – View medical history – View laboratory results – View current medications list – Download/print medical data in various forms © Clevermed Limited
  7. 7. clevermed Content of Patient Portals • Advanced features: – – – – – – – 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 © Clevermed Limited
  8. 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) © Clevermed Limited
  9. 9. clevermed Benefits of Patient Portals • • • • 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 © Clevermed Limited
  10. 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 © Clevermed Limited
  11. 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 © Clevermed Limited
  12. 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. © Clevermed Limited
  13. 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 © Clevermed Limited
  14. 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 © Clevermed Limited
  15. 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. © Clevermed Limited
  16. 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 © Clevermed Limited
  17. 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 © Clevermed Limited
  18. 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 © Clevermed Limited
  19. 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 © Clevermed Limited
  20. 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 © Clevermed Limited
  21. 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 © Clevermed Limited
  22. 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 © Clevermed Limited
  23. 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 © Clevermed Limited
  24. 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) © Clevermed Limited
  25. 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 © Clevermed Limited
  26. 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. © Clevermed Limited
  27. 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. © Clevermed Limited