Using portals to prevent people from becoming patients

It might send shivers of horror down many a GP's spine, but allowing patients to access clinical notes has the effect of improving patient/doctor relationships as well as adherence to medications and recommendations.

Andrew Miller, who was named as one of seven eHealth ambassadors earlier this year as part of the National Health IT Board's push for nationwide use of patient portals, told the HINZ conference in Auckland last month that using technologies such as Open Notes and patient portals also has the effect of cleaning up clinical notes and fundamentally changing the way they are written.

Dr Miller, a GP from the Bush Road Medical Centre in Whangerei, offers the ManageMyHealth patient portal through his practice and allows patients to read his notes. The other doctors in the practice also read the notes, which Dr Miller says has “massively” changed the way they are written.

Dr Miller said that as information sharing improves, doctors will begin to tidy up their notes and lift their game.

“We have Open Notes in my practice [and] our patients read every single thing I write,” he said. “Every doctor in our practice reads what the other doctor wrote about them and that has massively changed how notes are written.

“They’re written more colloquially, they’re written in a way that is understandable, patients can go back and look at what we’ve written, show their family members, show their friends, and that in itself makes a huge difference.”

Dr Miller, who admits to having a “wild streak of geek” in him, has been using IT in some form or another for the last 20 years and believes that it has the ability to change the whole paradigm of how health is delivered, particularly in areas like Northland where distances are large but people and resources are few.

However, he believes the change will be evolutionary rather than revolutionary because the health system does not have the capacity to change overnight.

“In Northland we’re just left to our own devices, so we’ve got quite a lot of things going on out there,” he said. “We’re an area with very few people interfering with what we’re doing, and we just get on and do it.”

While Northland has had a number of successes, such as the implementation of eReferrals, what New Zealand eHealth in general doesn't do too well is share these successes.

Dr Miller said that after nine months of planning in 2009, an eReferral system was implemented that meant that by 2013, 100 per cent of referrals are done electronically. However, no one came up to ask how it was done, he said.

“I don’t know if we’ve got a very good way at the moment of sharing successes and working out how we can stop reinventing the wheel,” he said. “The other thing that we’re not very good at is looking at how this affects the person. I’m not talking about patients, I’m actually talking about people. I think that most people don’t want to become patients if they can avoid it.

“Hopefully patients are going to start demanding that we provide them with this as part of a transformed, integrated system. We are about the only practice in Whangerei operating a portal and people are saying to other doctors around town how come you haven't got a portal. My own GP hasn't got a portal.

“One thing we do in Northland is we just try things out. People are quite willing to make mistakes up north and learn from them and just get on with the thinking. You probably learn more in a week of doing something than sitting around for a year and talking about it.”

Dr Miller said the problem of lack of health literacy in patients could be overcome in part by using portals and IT tools, as evidenced by their use in leading healthcare systems such as Kaiser Permanente in the US.

All of this, however, depends on funding. “Love without a budget is not true love,” he said. “What I’m talking about doesn’t come without cost. We’re going to have to pay both vendors to make nice products and we’re going to have to pay practices to use these products, and be realistic about the fact that we can’t expect people to work for nothing. Although that sounds mercenary, it is true.”

Posted in New Zealand eHealth

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