NZ aged care information service Eldernet has launched a new review system for residential aged care facilities that will allow residents and families to provide feedback on their services.

Eldernet plans to have a nationwide system but has begun with those facilities in the Southern District Health Board region.

The company, which holds contracts with DHBs to report on current residential aged care bed vacancies through its residential care bed vacancy status report (VSR) tool, will moderate the comments to ensure feedback is fair and reasonable and will give facilities the opportunity to respond.

Eldernet said in a statement that a lot of time and effort, and extensive testing has gone into building the software for the project, saying it hoped the service proves to be a way to receive honest, comparable feedback while supporting continued quality and improvement across the sector.

“Rest homes have often been seen as ‘closed’ services – whereby people can’t discuss what goes on behind closed doors,” Eldernet general manager Esther Perriam said in a statement.

“In the many years Eldernet has worked in the sector we’ve seen great examples of exceptional care. We believe that rest homes want to be able to show the great work they do. This new services allows them to do that – families, visitors and older people themselves, can easily let people know that what happens in many of these services is amazing and life enriching.”

Ms Perriam said there may be comments that highlight shortcomings but that negative comments would allow the sector to see what can be done better. “I don’t think that there would be an operator who does not want to offer their residents the very best,” she said.

Many service providers have signalled their wish to be part of this project, Eldernet said, with the Southern DHB region one of the first to be have the service fully available.

Residents and families can write a review about participating facilities by finding it on the www.eldernet.co.nz website and selecting the ‘Review’ tab at the top of the listing.

Formal complaints should be made to Age Concern or other advocacy groups.

A commonly voiced fear that patients will become overly persistent emailers and stalk their GPs around the clock if practices introduce patient portals has been dismissed by early research into the technology’s use in New Zealand.

Tom Love of health policy and analysis research firm Sapere Research Group told the Health Informatics New Zealand (HiNZ) conference in Christchurch yesterday that as well as dismissing fears about persistent emailers, the research showed that another concern – that patients would start bugging their GPs by emailing questions of a clinical nature – is also somewhat unfounded.

The NZ government and the National Health IT Board are keen to see patient portals being more widely used to both improve efficiency within practices and free up practitioners to spend more time with patients rather than paperwork, but also to provide more information to patients more easily.

While it was hoped that all patients would be able to access their GP-held medical information through a portal by last year, uptake of the technology by practices themselves has been much slower than hoped for. Health Minister Jonathan Coleman told the conference that 260 of the estimated 1000 primary care providers were now offering at least a partial portal through which patients can book appointments, request repeat scripts and correspond electronically.

Dr Love’s team was commissioned last year by health IT support organisation Patients First on behalf of the NHITB to do some financial modelling to look at how the introduction of patient portals would affect general practice costs and revenues.

Sapere and Patients First have since developed an interactive modelling tool that practices can use not just to model their bottom line but look at where savings can be made in terms of staffing, whether that be by redeploying admin or nursing staff or delaying employing new admin staff for longer.

(Patients First has also completed a review of the patient portal market in NZ, which includes information on the portals available from GP desktop vendors but also what consumers would like to see offered through the technology.)

However, before the modelling was started Sapere did some primary research, interviewing a number of practices that were using portals to gauge their fears and concerns before proceeding.

“We asked them questions about what had the discussion been like when they made the decision to get a portal, what were they concerned about, and we asked them a bit about their experience with their portal,” Dr Love said. “What had happened? Did they have lots of emails coming through in the middle of the night which they struggled to cope with?”

Dr Love said increased workload was a big worry for GPs. “They could see more work coming but they couldn’t see where the work was going to go, particularly the issue about persistent emailers,” he said.

“There is a lot of concern that you are going to be stalked by patients, although there was one GP who pointed out that you get a lot of frequent consulters anyway and if you are going to be stalked by someone it is actually more convenient to be emailed than in person.”

He said legal liability was also a big concern, particularly around the notion of how to effectively do a consultation over the internet without doing a physical examination. However, Dr Love said most GPs realised they were still in control and retained the ability to tell the patient they had to come in for a face-to-face consultation.

There was also concern over patients sending emails in the middle of the night asking questions of a clinical nature. However, practices reported consistently that it was only about 1.5 clinical queries per patient per annum, he said.

“I was pleasantly surprised to see there was such a consistent number reported. How generalisable that is I think time will tell but it is an encouraging start.”

Practice efficiency

In addition to the primary research Sapere undertook, it also had a number of what Dr Love called ‘design assumptions’ about how a portal might work based on previous research done with integrated family health centres.

This data includes a number of detailed time diaries that tell you how much time it takes for a practice nurse or a receptionist or a doctor to do a lot of the daily tasks that happen in practices.

“We had some quite hard quantitative information on the impact that a portal might have if you were able to streamline some of those processes,” he said.

What the research found was that much of the clear benefit of a portal arises from low-level tasks, particularly repeat scripts.

“It’s really interesting when you start getting into the detailed numbers about how much time is involved in general practices about producing repeat prescriptions,” he said. “How many phone calls between patients and a receptionist, between a receptionist and a nurse, how much that conversation goes around between different individuals in a practice before it gets to the GP who signs their name on the script. It is actually quite time consuming.

“Then you get the thorny question of doctor workload and substitution. Is a portal just going to be more work, … [or is it] going to start to substitute from the grind of your 32 consultations during the day?

“That’s very much open. It demonstrates the intimacy of a patient portal – it has to exist in the context of the model of care that the practice wants to run and the way you use it can be very different. It certainly enables you to substitute certain elements of doctor workload if that’s something you want to pursue as a practice and increasingly many practices do.”

Financial gains

Dr Love said there was no doubt that the main financial gains to be made from patient portals was in releasing resources for other work, such as releasing practice nurses to run clinics or not being so resource-intensive in terms of admin staff.

Dr Love said this is a sensitive issue but it can involve hard, cold cash. “We had one practice that was growing very quickly, and for them an ePortal meant that they could delay employing an additional staff member by probably 18 months,” he said. “That’s real money and is very important to them.”

From the modelling, Dr Love’s team can show that if the work that is coming in from a portal does not substitute for existing GP work, then the portal will require more GP time.

“It’s not an enormous amount of GP time and we can work it out more or less in absolute terms for practices of different sizes,” he said.

“Where you see really good gains is with your nursing and administration staff. That is where you see quite significant reductions in the amount of time involved. For a large practice, you are talking two or three admin staff. That is quite substantial.

“If you start substituting some of the general practitioner workload activities, then you can have even bigger gains. There is also a better gain for bigger practices – the bigger you are, the more you will gain proportionately.”

However, he did warn that charging patients for the convenience of using a portal had, with a few exceptions, not worked very well for practices. The financial modelling shows that scale is important to get the gains, and charging might be counter-productive despite the financial investment that practices have to make in licensing portal software.

“We had a number of practices that had set up portals and had charged patients for that service, which, with a couple of exceptions, hadn’t worked that well and tended to be a barrier to uptake,” Dr Love said. “This in itself is a problem, because the scale of uptake is really important.

“We saw some of this when it gets to the modelling, but it also certainly comes through anecdotally from practices that the scale of uptake of a patient portal is really important. If you are running a portal for five per cent of your patients, you are running two systems and it is actually taking more resources to run than it is worth.

“If you are running 50, 60 or 70 per cent of your patients, [providing] repeat scripts, lab results, those sorts of things through a portal, then you are really starting to see gains from it. Scale of uptake is important and that’s really where the [issue of] charges is a tricky one. If you are going to reduce the uptake by imposing a charge then you might be cutting off your nose to spite your face.”

The introduction of an IT platform by the Midlands Health Network that can track a child’s health milestones from birth to six has been able to identify over 6000 kids in the Waikato who have missed oral health checks over the last year, potentially saving the district health board millions in the cost of anaesthetising children for tooth extractions.

Midlands Health Network’s service manager for child health Bronwen Warren told the Health Informatics New Zealand (HiNZ) conference in Christchurch yesterday that the National Child Health Information Platform (NCHIP) that has been rolled out in the Waikato had also scored some early wins in linking up newborns with GPs, identifying newborns who had missed metabolic screening tests and ensuring children are immunised as close to the schedule as possible.

NCHIP has been built by Orion Health in association with the Best Practice Advocacy Centre and is set to roll out in Tairawhiti next month, followed by Taranaki in January and the Lakes region in March. The gradual roll-out is part of plans for a national system that will eventually cover all children up to the age of 18.

NCHIP is a shared data repository, with access available to six different provider groups involved in the care of a child up to the age of six, including the national immunisation register, lead maternity care (LMC) midwives, Well Child/Tamariki Ora providers, hearing and vision teams, oral health providers and GPs. GPs can access the system through an icon on their desktop if they are using Medtech32.

It also involves a Child Health Coordination Service (CHCS) based in Hamilton. All Waikato newborns are now being registered on NCHIP at the same time they are registered for the national immunisation register, and are then followed up to ensure they are immunised at six weeks, three months and five months.

The system also provides a shared view of the 27 other milestones a child should complete by the time they are six, such as Well Child checks, hearing and vision checks and B4school checks. Children who have not been enrolled in a general practice are also followed up.

The system also includes an eReferral function from the LMC to the GP and the Well Child provider, but the plan is to include more referral capability.

While there are plans over time to add more information from other service providers and the data of all children up to the age of 18, at present it is designed to ensure that no child falls through the cracks.

Ms Warren gave the example of a GP who contacted the service recently looking for contact details for the family of a seven-month-old child who had missed an immunisation at five months. There were three known addresses for the mother but she could not be contacted at any of them.

As the service has partnered with the Ministry of Social Development and the Ministry of Education, each agency is able to contact the others to see if they have any information about a particular child. One had a phone number at a fourth address, and the mother was able to be contacted.

“She was reminded that the baby was due for another immunisation and that child was taken to the general practice that afternoon and immunised,” Ms Warren said.

While individual stories are powerful, Ms Warren said the new platform had been able to support providers across the board. For instance, it has been able to connect more than 300 newborns with their family’s GP, at a rate of about 10 to 12 per week.

“We have noticed that modern mothers will opt to not register their child at their family GP but at the general practice that is nearest to their work,” she said. “We’ve had a number of conversations with general practice and the families in order to correct that.”

It has also identified more than 60 newborns for whom there were no metabolic screening results, and more than 6000 children who had missed out on dental checks, she said.

“We did a cross-match from our data to [the oral health service’s] data, and we found them 6000 children. Currently in the Waikato, the DHB is spending $2.5 million per year to anaesthetise young children and take their teeth out. We are really hopeful that we can reduce that number.”

The system is about to roll out to Tairawhiti, where it is being interfaced with the national Maternity Clinical Information System (MCIS) as well as the Titanium electronic record software used by oral health providers.

Ms Warren said NCHIP was also being aligned with Midland PHO’s mobile immunisation service, B4school check and school clinics. “At the moment they are very siloed – different data systems, different staff doing a discrete role – so we are looking at how we can integrate that and essentially walk the talk that we are speaking to our providers about.”

Data from 27,000 children aged nought to six was uploaded in May, and Ms Warren said next year the plan was to add the six- to 18-year-olds. “There are fewer milestones for the age bracket but the Ministry is talking about contributory measures around health targets,” she said. “I have a few ideas on that.”

Public health nurses and clinicians in hospital accident and emergency departments can also access the information as long as they have the child’s NHI number. Ms Warren said this would support things like opportunistic immunisations.

And while only clinicians have access at the moment, Ms Warren said there were long-term plans to provide access to the system to parents through patient portals, although that would prove a challenge in terms of integration, she said.

Orion Health has completed the roll-out of its Enterprise and Consult technologies to two hospitals in The Medical City (TMC) hospital group in the Philippines as part of a longer-term plan to install the technology throughout TMC’s hospitals and clinics.

Orion Health first signed an agreement with TMC, which runs an 800-bed hospital in Manila as well as one in Iloilo and in the Clark Freeport Zone in Pampanga, in June 2014. TMC also runs a number of outpatient centres and clinics throughout the country.

The roll-out involves the implementation of Orion Health’s Enterprise health information system and its Consult platform, formerly known as its Concerto clinical portal. The new system will give doctors, nurses and administration staff access to a single system across the TMC network.

The technology is replacing some legacy IT systems in the clinics and bespoke software in the hospitals.

Orion Health CEO Ian McCrae said the company was committed to establishing a presence in the region.

“Large hospital systems like The Medical City reach numerous patients every year, and we are honoured to be their partner to fill the gaps and bring advanced healthcare solutions to people all over the Philippines,” Mr McCrae said.

The new system has gone live at TMC Iloilo and TMC Clark, with the others to be implemented in the next 12 months.