Implementation of a patient portal at Karori Medical Centre has significantly changed the dynamic between the GPs and their patients by making the doctors more accessible.
The centre is “leading the charge” towards a more open and equal relationship between patients and their doctors.
Within the practice 11,500 patients are eligible for a portal (over 16 with their own email address) and of those, 10,000 are registered and 7,000 have activated their account. Enrolments are from across the spectrum, covering both low and high socio-economic groups and the young and old.
Using the portal, called Manage My Health, patients can; book appointments; order repeat prescriptions; see test results and recalls; message their GP; and see their medical notes. They can access the portal via a webpage or an app.
One third of appointments are now made online and also one third of repeat prescriptions are e-requests. The doctors say this results in huge resource savings as the practice has reduced the number of phone calls by 1000 a month.
From an average of 1500 emails a month across the practice in October 2017, half got some sort of advice, 7% were told to make an appointment, 7% were told to get a test done and 30% were given a prescription without having to see the doctor.
There is no transactional cost to patients for using the digital service, but Dr Moodie and Dr Lowe say it frees up precious 15-minute consultation spots for those who really need them. It also increases patient satisfaction and makes managing their workload and workflow more efficient.
The practice implemented MMH for its patients in 2014. Dr Moodie first heard about the patient portal concept in 2009 when US speaker Dr Matt Handley from Kaiser Permanente of Washington visited New Zealand to share his experience of opening up access to medical notes to patients.
Dr Moodie says that listening to Dr Handley speak dispelled many of the myths and concerns he had around patient portals increasing his workload and gave him the courage to look at the idea in more detail.
“It sounded like a good idea, so when we had the opportunity we said, ‘yes let’s give it a try’,” Dr Moodie says.
“The whole practice bought into it. All the doctors said: ‘yes we are prepared to go for it’.”
After a short testing period, the doctors also agreed to make ‘open notes’ available to patients, starting from the day they sign up for a patient portal. This means patients can see everything that their doctor writes about their interactions.
Dr Lowe argues that: “if you don’t couple patient portal with open notes you are only delivering half the value that you can.”
“A lot of the information exchange in a consultation, patients don’t remember. Now they have a chance to go back and review the notes and advice you give them in their own time,” Dr Lowe says.
“Patients say they feel far more informed and likely to adopt a management plan and be compliant with treatment if they have access to their notes.”
Patients can also directly message their GP, without going through an intermediary.
“It does change the dynamic relationship between patients and doctors,” explains Dr Lowe.
“It makes us far more accessible, but we’ve found patients are very respectful of that relationship and at no time abuse that or ask silly questions. It’s at the point where it’s frustrating when a patient doesn’t have patient portal because you end up chasing them and trying to phone them.”
Dr Moodie uses the direct message function regularly as a way of checking up on patients. By asking them to send a message to report on how they are doing, time can be saved on a phone call or unnecessary appointment.
Developing a culture
Dr Moodie says the practice developed a “patient portal culture” to push the use of MMH, whereby all staff would promote it to patients at every opportunity.
He says there was some resistance from staff initially, including concern that MMH’s introduction could lead to job losses.
However, resource savings in some areas has meant the practice has developed ‘clinical assistants’ roles with their administrative staff , who now do much more in terms of patient management.
“You have got to give confidence that you will find other interesting things for them to do and we have developed a culture that said that and did that, but it took a lot of time,” says Dr Moodie.
Dr Lowe says the use of digital services such as patient portals is the way of the future and should be encouraged as a way of helping the health system cope with increasing demand.