There’s a certain symmetry about patient portals: when you ask what’s in it for the patient, and then what’s in it for the doctor, the lists end up being quite similar, according to GP Richard Medlicott. Richard is an advocate of patient portals, using them in his Island Bay practice. He spoke recently about portals at the Conference for General Practice in Dunedin, along with GP Jeff Lowe, from Karori Medical Practice, where 80% of patients have active portals.
First on Richard’s list of benefits is that asynchronous messaging means there’s no risk of getting caught on the telephone with a patient at an awkward time, and the GP can then contact the patient at a planned point in the day. Equally, patients find this one of the biggest benefits: they can send off a message to their GP without having to wait for an appointment.
Richard also says that messaging means there’s no telephone ‘hostage taking’, where an initially straightforward query from a patient about taking their meds, for example, turns into a full-blown consultation about other things.
With patient messages direct to the GP, messages are handled only once, instead of being passed through other members of the practice team, with the risk of nuances getting lost in translation. The GP gets a single source of truth, direct from the patient.
Patient portals help save GPs’ time: if something simple can be dealt with quickly by a message, it avoids a face-to-face appointment, freeing up an appointment slot for another patient. And, from the patients’ perspective, it saves them having to travel in, take time off work, and pay a consultation fee.
That brings us to the knotty question of whether – and what – a GP should charge for. Richard says he doesn’t charge for everything: simple messages and replies are free, but if something was taking quite a bit of time, he would check with the patient and let them know that a charge will apply. He says they are usually okay with that. The patient’s perspective on this is obviously positive, as they can have some no-cost interactions for simple queries and transactional things like repeats.
Richard says that he has found that patient portal messaging can enhance the GP-patient relationship, because both sides like the arrangement, patients like the reassurance and sense of caring, and for both parties it decreases the risk of miscommunication or lack of clarity. Jeff Lowe adds that patients value being able to read the patient notes after a consultation, because they don’t always remember what you said.
Jeff says: “In terms of planned care, portals allow us to activate and inform patients, making interactions far more productive, and helping patients have confidence that they can manage their own care more.” Jeff says.
At Karori medical centre, more than half of patient portal interactions result in the GP giving simple advice by virtual consultation; 19% result in a prescription being given by virtual consultation; and 1 in 10 result in the patient making an appointment to come in.
Most patients in Richard’s practice log in about ten times a year, but he says a few do log in an awful lot, and that these tend to be the older, co-morbid patients. Log ins don’t equate to number of messages – they can be to make an appointment, check results, look at the notes, or message a member of the practice team. One third of prescription repeats at Karori Medical Centre are done by patient portal, and Jeff Lowe says that this is probably the best example he has seen of lean processing, eliminating the need for voice messages to have to be transcribed from the phone, and reducing the errors inevitably associated with that.
Jeff Lowe says that ultimately patient portals give GPs more control over the increasing demand that is currently outstripping their capacity: GPs can get further up the pipeline of acute demand, with interventions that save avoidable and unnecessary visits to emergency departments.