Fear and loathing in the early days of patient portals

Not-for-profit health IT organisation Patients First has released a review of the New Zealand patient portal market, finding that while the technology is now readily available and is beginning to be adopted, there are many barriers to be overcome, including what a consumer representative characterised as “fear and loathing” from healthcare practitioners.

The review, the first in a series of four planned briefing papers, does not use the scoring system used in Patients First's previous review of practice management systems (PMSs) as portals are still considered a nascent technology.

Instead, it provides an overview of what functions are currently available, what patients themselves want from portals and raises some questions about portals that the review panel says need to be addressed “in order to reach the tipping point which will move us from 'why?' to 'why not?'”

The review provides a definition of what a patient portal is, differentiating the concept from current shared care portals that patients do not have access to such as Canterbury's eSCRV, the Northern Region Shared Care project and the Northland DHB Care Insight project.

It compares the functions available in the three products on the market – Medtech's ManageMyHealth, MyPractice's Health365 and Intrahealth's Accession – and also compares New Zealand's “organic”, demand-driven and market-led approach to a national roll-out with the centralised, fully funded models that have been tried, and some would say failed, in the UK and Australia.

The panel finds that the organic approach, with demand led by patients and uptake in general practice encouraged by the National Health IT Board's ambassadors program, should work if there is “demonstrable benefit that is cost neutral or cost saving”.

While the review finds that there are not necessarily any architectural barriers to wider use, it does recommend that standards be introduced to untether patient portals from the vendor-specific PMS and allow data from other sources to be able to feed into existing products.

According to figures provided by the vendors, as of June this year, ManageMyHealth has been implemented in 235 general practices and Health365 eight. Accession is not yet being used in New Zealand, although Intrahealth says it is being used in its main market in Canada. (The other PMS vendor, Houston Medical, is currently working with Medtech to integrate ManageMyHealth into Houston's VIP.net.)

Patients First CEO Jayden MacRae said that although the technical capability to offer portals is now there, less than 25 per cent of general practices in New Zealand are using them regularly.

“Most patients will see the benefits of these systems when they can book appointments, review test results, order repeat prescriptions and send short electronic messages to their general practice online,” Mr MacRae said. “Giving patients access to their own information is the first step towards a more interactive electronic experience.

“There are still many areas of uncertainty around how electronic interactions will integrate in current work flows in practices and this is one of the prime reasons uptake has been modest.”

What the review predominantly looks at is the questions that need to be asked at this early stage of the roll-out. These include whether patients should have full access to their EMR, and if so, what issues does that give rise to for clinicians. “Should consumer-generated data be added to portals, and if so, would it be useful?”

It also asks questions about the commercial viability of patient portals, raising the issue of payment models and whether consumers should contribute to the cost, as well as questions on whether patient portals increase or decrease clinician workload.

While the review forecasts that it is likely that within five to 10 years a significant proportion of the population, patients and clinicians alike, will be using portals in everyday practice, it also looks at the perceived barriers to adoption in general practice.

These include concerns over the additional workload of “email” consults, the uncertain financial effects of different ways of consulting – for example, through secure messaging rather than face to face – and a lack of general interest from the GP community and from patients.

These barriers are also covered in an appendix by Jo Fitzpatrick, a consumer representative from the National Health IT Board's consumer panel.

“Patient portals have the potential to change the face of primary care and health care in general,” Ms Fitzpatrick writes. “While the possibilities are exciting, the reality is more sobering.

“It is easy to leap ahead to a dizzying array of possibilities and potentialities but these are accompanied by an equally dizzying array of challenges and barriers. It is important to tread carefully and walk before we run. The path forward is one of small steps ...”

Ms Fitzpatrick urges that the value to the patient of better communication with healthcare providers not be forgotten in the discussion on barriers to implementation, and that while cost is one of those barriers, she warns that there is “no consumer enthusiasm or expectation” that these costs will be borne by patients.

However, the biggest barrier to the use of portals, she says, is “the fear, and sometimes loathing, from anxious health practitioners who imagine a future fraught with the multiple challenges of change”.

“While this fear is not unfounded, it is one we can discuss and resolve together. We need to start the journey towards patient portals, one small step at a time, always ensuring that we are all comfortable with the incremental changes involved.”

The review is available online at the Patients First website (pdf). The next three briefing papers will cover cloud and hosted PMSs, PMS prescribing modules and practice support.

Posted in New Zealand eHealth

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