Research from the Journal of Primary Care into GP and patient perspectives on the use of patient portals, has revealed the concerns some doctors held when first embarking on providing online access to personal medical records.
The survey, carried out by Dr Susan Wells, College Fellow and Associate Professor at the University of Auckland, also found apprehension about increased workloads, higher patient expectations about access to a doctor, and changes in the way patient care was documented.
"It was interesting that the hesitation we discovered in embracing patient portals from GPs wasn't reflected in the data we collected from patients themselves, which was overwhelmingly positive," says Susan. "Patient interviewees were eager to be able access personal medical information so they could play an active role in managing their own health and understand more about any treatment they were receiving.
"It was notable that the overall approach from patients was one of collaboration, not a desire to question or change what their doctor had written about them."
Susan carried out the research in 2014, during the early stages of patient portal implementation, after being appointed e-Health Ambassador for Patient Portals by the Ministry of Health.
She had previously spent a year in America investigating the systems in place there after receiving the New Zealand Harkness Fellowship in Health Policy and Practice, which enabled her to attend the prestigious Harvard Medical School in Boston.
That piece of research looked at 16 different systems that catered for between 100,000 and up to five million patients.
"American doctors and medical clinics were very much leading the pack when it came to using the internet to provide an efficient interface with patients where they could book appointments, request repeat prescriptions and view lab results as well as access their medical records," says Susan. "It was great to experience the benefits patient portals can bring to both sides of the relationship."
Susan has long held an interest in advancements in public health, after spending 10 years as a GP. She is now a Public Health Physician with a focus on quality improvement, evidence based health-care and health informatics.
"Six independent systemic reviews have shown that patient portals are a hugely positive tool, enabling patients to understand their medical conditions and treatment plan,"she says. "GP concerns about patients becoming confused or over-whelmed have been proven to be unfounded.”
The research was carried out after the National Health Technology Plan set a target that 90% of people enrolled in a primary health organisation should have a patient portal available and that 10% should have accessed their health information via this channel by the end of 2014. In May that year just 7% of general practices had implemented the necessary technology.
"It was a pretty ambitious target,"says Susan. "But the implementation rates were still low so we set out to discover the attitudes and expectations of patients and GPs in this early adoption phase."
Subsequent research, due to be published by the end of 2020, revisits the issue as well as asking what is next for doctors, nurses and other primary health care providers when it comes to offering services through a patient portal.
"While we are still analysing the raw data, it is possible to say that New Zealand has made great strides in this area in the past five years," says Susan. "Around 65% of general practices now have a patient portal, although they do vary greatly in the functions that have been made available.
“The Ministry of Health has reported that, as of September 2019, 898,132 Kiwis are using patient portals offered by 653 general practices. Of these, 118 practices offer open clinical notes, 30 can facilitate video conference consults and 310 offer access to laboratory results.”
"While there is still room for improvement, it is very pleasing to see more and more GPs getting on-board and finding out for themselves the real advantages a patient portal can bring to their practice."
She advises any doctor or clinic yet to introduce a patient portal to their practice to dip a toe in the water with just a few functions to start with.
"Providing the functionality of booking appointments online has really revolutionised the way some practices manage the day to day business of seeing patients," she says. "It has proved to be a huge time saver for receptionists and, surprisingly for some, it is has not been over-used or abused by patients, although we did come across one instance where a patient had booked a weekly doctors appointment as an ongoing part of his regular schedule!"
Other portal features include providing access to a list of currently prescribed medicines, immunisation records, visit notes and diagnoses, the ability to order repeat prescriptions, diagnostic test results, , access to specialist letters and the ability to contact doctors and practice nurses via secure messaging or email.
"While the implementation process can be challenging, using the portal does get easier as time goes on for staff and patients alike. The real benefits and efficiency come when around 40% of your patient list is registered, so that's a milestone to aim for," says Susan.
"Technology is a wonderful way of enhancing the patient experience and offering a greater standard of care without asking for more time from doctors themselves. I am excited to see where we are in two, five, 10, even 20 years from now."