Part 4: Monitoring and promoting the benefits achieved from patient portals

4.1 In this Part, we discuss:

• whether the Ministry monitors the impact and benefits of patient portals;
• evidence that benefits are being achieved; and
• how further uptake of patient portals could be encouraged.

Summary of our findings

4.2
The Ministry monitored the uptake of patient portals but did not monitor whether the expected benefits were achieved. Therefore, the Ministry did not know what effect patient portals were having on its strategic outcomes.

4.3
We did see evidence of benefits and, despite earlier concerns, patient portals did not appear to negatively affect general practices. These were promising signs.

4.4
There is an opportunity for the Ministry to monitor the intended benefits from using patient portals and show these to general practices that are reluctant to offer patient portals.

Monitoring impact and benefits of patient portals

4.5
The Ministry did not collect statistics to monitor the benefits achieved from using patient portals. However, it did monitor uptake by general practices and people.

4.6
The increase in uptake since June 2015, as shown in Figure 2, provides an opportunity for the Ministry to monitor benefits. This is because the more people who use patient portals, the more likely it is that the intended benefits will be achieved. For example, some general practice staff confirmed that they started to see greater efficiencies when a larger number of their patients were using the patient portals.

4.7
Monitoring the actual use of patient portals is possible. One patient portal, for example, provided reports and statistics that showed how staff and patients were using the portal. This patient portal also had information on the people who had registered to use it but had not activated their account. The Ministry told us that it has started work with vendors and general practices to collect statistical information on the actual use of the different functions of patient portals.

4.8
However, information about uptake alone, or in combination with information about the use of patient portals, does not give the Ministry a full understanding of the effects that patient portals are having on people, general practices, or its strategic outcomes.

Promising signs of benefits being achieved

4.9
Although the Ministry has not collected statistical information about the benefits achieved from implementing and using patient portals, it has gathered anecdotal evidence about the benefits patient portals can deliver for general practices. This is documented in 45 case studies that have been produced since 2015 and have been used to promote patient portals with practices. The case studies included lessons that had been learned, and tips and tricks for implementing portals.

4.10
We also saw some promising signs during our audit that benefits were being achieved. For example, we were told that parents appreciated the convenience of being able to book appointments in the middle of the night when a child was sick, thus ensuring that they got an early appointment the next day.

4.11
People also liked the convenience of ordering repeat prescriptions online and having a list of their prescriptions that they could choose from if they could not remember the name of the medication or how to spell it.

4.12
Some general practices were starting to see that patient portals helped to fix issues that some doctors were already experiencing. For example, through the patient portals, doctors were able to better manage some of their more high-use patients by allowing them to see their information on the patient portal, rather than having the patient visit the general practice most weeks.

4.13
Doctors who were concerned about people overusing the messaging function have the ability to block people from using that function. One PHO told us that it was starting to get data that showed that general practices were not overwhelmed by emails as a result of patient portals.

4.14
Some of the doctors we talked with found that other doctors' concerns about people not understanding or misinterpreting notes were not eventuating. One doctor said they had a very educated and articulate population with a high degree of health literacy, and that those people were highly involved in their own healthcare.

4.15
An interviewee from the consumer panel said that doctors should not assume that people who were poor, old, or not native English speakers would not be able, or want, to use a patient portal. They knew of people who were blind, people who were not native English speakers, and elderly people who wanted to use the patient portal because they thought it would help them.

4.16
The general practices were also finding that the patient portals created efficiencies for them because administration staff had more time for other work. For example, people directly interacting with the doctor through the patient portal for prescriptions meant less work for administration staff. One PHO told us that it was starting to get data that showed these efficiencies as well.

4.17
One doctor told us that people going straight to them for repeat prescriptions also meant there was less room for error.

4.18
One PHO had forecast demand for medical services for the next 25 years. It found that it would probably not be able to meet the expected demand if it continued with only face-to-face consultations.

4.19
However, we were told that using technology such as patient portals was having a major effect on the PHO's general practices' ability to remain sustainable because they were able to move a large number of consultations online. The face-to-face consultations were left for those people who really needed them. This allowed the general practices more scope to proactively engage with at-risk people who, for whatever reason, were not engaging with primary care. The general practices were able to achieve this by restructuring their daily schedule, which the PHO had helped them to do.

4.20
Other interviewees said that general practices were at risk of being overtaken by health application services from other countries. In their view, if general practices did not change to meet modern requirements then people could use these applications to self-diagnose rather than consult a medical professional.

Enhancing access to and control of personal health information

4.21
Under the Health Information Privacy Code 1994, people are entitled to see their own health information. Patient portals substantially help with this. People can easily see their own health records, either in summary or in detail, on the patient portal. This makes patient portals better than paper records or electronic records that need to be printed.

4.22
Staff from the Office of the Privacy Commissioner pointed out that, in this respect, patient portals enhance privacy rights about access to information because people "can just sign in and see" their own information.

4.23
Staff from the Office of the Privacy Commissioner also noted that patient portals can help to improve the accuracy of health information. People can communicate directly with their doctor through the patient portals and ask to fix anything incorrect they see in their notes. People working in general practices told us that they find this particularly useful. People also feel more empowered because they are more involved in their own healthcare. As one doctor told us:

One lady picked up a trend in her blood tests because she mapped it out over time, whereas the blood test had looked normal individually but she had noticed a downward trend and contacted me to ask what was that about. I looked and realised she needed more investigation. So patients are more involved in their healthcare … and usually that's a benefit for both physician and patient.

4.24
General practice staff also appreciated being able to send messages to people directly through a secure website rather than by email, which might not always be secure.

4.25
Patient portals also have an audit trail function that shows who accessed the system and when. This provides a level of protection that paper records do not have because it identifies anyone who may use health information for inappropriate purposes.

Encouraging further uptake of patient portals

4.26
Systematic monitoring of benefits would enable the Ministry to:

• form a clearer picture of the benefits achieved;
• understand patterns, problems, or barriers general practices or people experience when using the patient portals; and
• make or support improvements so that patient portals can best contribute to the Ministry's strategic outcomes.

4.27
The Ministry told us that it is not until at least 40% of people are using the patient portals that the real benefits can be measured, and it can take at least three years to get to this level of use. We acknowledge that, in the first few years of implementing patient portals, it would have been difficult to monitor and collect reliable information about how they were used because of the low uptake.

4.28
With the increase in uptake since June 2015, general practices and PHOs starting to collect data on the use of patient portals, and the promising signs we saw that benefits are being achieved, now is an opportune time for the Ministry to consider how it could systematically monitor the benefits achieved from using patient portals.

4.29
If the Ministry does this, it would enable it to use the information to:

• identify and then address barriers to achieving desired benefits (including uptake and use);
• understand the effect that patient portals are having on the achievement of benefits for people and general practices, and on strategic outcomes; and
• highlight the benefits achieved so far to encourage the continued uptake and use of patient portals by others.

4.30
After we had drafted our report, the Ministry told us that it has started work to collect statistical information to measure the benefits general practices are achieving from patient portals once they have sufficient numbers of patients using them. eHealth ambassadors, general practice managers, nurses, and PHO portal co-ordinators will work with Ministry staff on this. This group will also monitor use and continue to monitor uptake.

4.31
The Ministry intends to use this information to promote the increase of patient registration and use in general practices that already have patient portals. The Ministry will then focus on general practices that have not purchased a patient portal. The Ministry expects uptake to increase as more general practices see the benefits others are receiving.