Perspectives of New Zealand patients and GPs at the beginning of patient portal implementation
Susan Wells 1 3 , Faith Mahony 1 , Ying Huang 1 , Karen Day 2
+ Author Affiliations
- Author Affiliations
1 Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
2 Section of Health Systems, School of Population Health, University of Auckland, New Zealand
3 Corresponding author. Email: s.wells@auckland.ac.nz
Journal of Primary Health Care 11(4) 315-326 https://doi.org/10.1071/HC19016
Published: 22 November 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: New Zealand health policy encourages patient access to their electronic medical records via portals.
AIM: To discover patient and general practitioner (GP) perspectives of access to electronic medical records and e-messaging in the early portal implementation phase.
METHODS: In 2014, Auckland primary health organisations and an Accident & Medical organisation were asked to invite their GPs to complete an online survey and consent for a researcher to attend their waiting room and invite patients to complete a survey.
RESULTS: In total, 421 patients (13% Māori, 18% Pacific, 7% Asian, 53% NZ European/Other) participated from 13 general practices. Most (77%) knew they were entitled to see their medical records and 90% were interested in viewing them. Over two-thirds thought that viewing their records online and e-messaging their practice was a good idea. Over 80% disagreed that they would be worried, confused or embarrassed by seeing their records, with 59% expecting portals to facilitate understanding of their medical conditions. Internet security and privacy concerned 40% of patients. Among 83 GPs who completed the survey, six (7%) had already implemented portals. Few were comfortable to open up the whole health record, especially visit notes. While GPs thought that portal access may help patients better understand their plan of care, their main concerns related to causing confusion and worry. Portal implementation was expected to change GP documentation and increase practice workload and costs without demonstrable benefit to practices.
DISCUSSION: At the beginning of portal adoption, patients were interested. GPs were more reticent, unsure whether the benefits would outweigh the downsides for their patients and practice workload.
KEYwords: patient portals; personal health records
References
[1] Vilhelmson B, Thulin E, Elldér E. Where does time spent on the Internet come from? Tracing the influence of information and communications technology use on daily activities. Informat Communicat Soc. 2017; 20 250–63.| Where does time spent on the Internet come from? Tracing the influence of information and communications technology use on daily activities.Crossref | GoogleScholarGoogle Scholar |
[2] Office of the Privacy Commissioner. Health Information Privacy Code 1994. Wellington: Privacy Commissioner Te Mana Matapono Matatapu; 1994 [cited 2015 May 25]. Available from: https://www.privacy.org.nz/the-privacy-act-and-codes/codes-of-practice/health-information-privacy-code/
[3] Ministry of Health. Patient portals. Wellington: Ministry of Health; 2018 [cited 2018 October]. Available from: http://www.health.govt.nz/our-work/ehealth/other-ehealth-initiatives/patient-portals
[4] National Health IT Board. National Health IT Plan: enabling an integrated healthcare model. Wellington: Publisher; 2010. [cited 2018 October]. Available from: http://www.ithealthboard.health.nz
[5] Patients First. Patient Portals PMS Review 2. Briefing 1 of the 2014 PMS Review Briefing Series. Wellington: Patients First and National Institute of Healthcare Innovation; 2014.
[6] Ferreira A, Correia A, Silva A, et al. Why facilitate patient access to medical records. Stud Health Technol Inform. 2007; 127 77–90.
| 17901601PubMed |
[7] Honeyman A, Cox B, Fisher B. Potential impacts of patient access to their electronic care records. Inform Prim Care. 2005; 13 55–60.
| 15949176PubMed |
[8] Ball MJ, Smith C, Bakalar RS. Personal health records: empowering consumers. J Healthc Inf Manag. 2007; 21 76–86.
| 17299929PubMed |
[9] Bichel A, Erfle S, Wiebe V, et al. Improving patient access to medical services: preventing the patient from being lost in translation. Healthc Q. 2009; 13 61–8.
| Improving patient access to medical services: preventing the patient from being lost in translation.Crossref | GoogleScholarGoogle Scholar | 20057252PubMed |
[10] Ross SE, Lin C-T. The effects of promoting patient access to medical records: a review. J Am Med Inform Assoc. 2003; 10 129–38.
| The effects of promoting patient access to medical records: a review.Crossref | GoogleScholarGoogle Scholar | 12595402PubMed |
[11] Bloch S, Riddell CE, Sleep TJ. Can patients safely read their psychiatric records? Implications of freedom of information legislation. Med J Aust. 1994; 161 665–6.
| Can patients safely read their psychiatric records? Implications of freedom of information legislation.Crossref | GoogleScholarGoogle Scholar | 7830632PubMed |
[12] Rogers EM. Diffusion of Innovations. 4th edn. New York: The Free Press; 1995.
[13] Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead. Ann Intern Med. 2012; 157 461–70.
| Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead.Crossref | GoogleScholarGoogle Scholar | 23027317PubMed |
[14] Delbanco T, Walker J, Darer JD, et al. Open notes: doctors and patients signing on. Ann Intern Med. 2010; 153 121–5.
| Open notes: doctors and patients signing on.Crossref | GoogleScholarGoogle Scholar | 20643992PubMed |
[15] Walker J, Leveille SG, Ngo L, et al. Inviting patients to read their doctors’ notes: patients and doctors look ahead: patient and physician surveys. Ann Intern Med. 2011; 155 811–9.
| Inviting patients to read their doctors’ notes: patients and doctors look ahead: patient and physician surveys.Crossref | GoogleScholarGoogle Scholar | 22184688PubMed |
[16] Pyper C, Amery J, Watson M, et al. Access to electronic health records in primary care-a survey of patients’ views. Med Sci Monit. 2004; 10 SR17–22.
| 15507869PubMed |
[17] Ross SE, Todd J, Moore LA, et al. Expectations of patients and physicians regarding patient-accessible medical records. J Med Internet Res. 2005; 7 e13
| Expectations of patients and physicians regarding patient-accessible medical records.Crossref | GoogleScholarGoogle Scholar | 16236699PubMed |
[18] Urowitz S, Wiljer D, Apatu E, et al. Is Canada ready for patient accessible electronic health records? A national scan. BMC Med Inform Decis Mak. 2008; 8 33
| Is Canada ready for patient accessible electronic health records? A national scan.Crossref | GoogleScholarGoogle Scholar | 18652695PubMed |
[19] Ministry of Health. PHO Enrolment Demographics 2017 Q4 (October to December 2017). Wellington: Ministry of Health; 2017 [cited 2018 January 8]. Available from: https://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisations/enrolment-primary-health-organisation
[20] Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15 1277–88.
| Three approaches to qualitative content analysis.Crossref | GoogleScholarGoogle Scholar | 16204405PubMed |
[21] Carryer J, Kooienga S. Patients’ experience and understanding of E-portals in rural general practice: an ethnographic exploration. J Prim Health Care. 2017; 9 262–68.
| Patients’ experience and understanding of E-portals in rural general practice: an ethnographic exploration.Crossref | GoogleScholarGoogle Scholar | 29530137PubMed |
[22] Gu Y, Day K. Propensity of people with long-term conditions to use personal health records. Stud Health Technol Inform. 2013; 188 46–51.
| 23823287PubMed |
[23] Goldzweig CL, Orshansky G, Paige NM, et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med. 2013; 159 677–87.
| Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review.Crossref | GoogleScholarGoogle Scholar | 24247673PubMed |
[24] Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res. 2015; 17 e148
| Patient portals and patient engagement: a state of the science review.Crossref | GoogleScholarGoogle Scholar | 26104044PubMed |
[25] Vodicka E, Mejilla R, Leveille SG, et al. Online access to doctors’ notes: patient concerns about privacy. J Med Internet Res. 2013; 15 e208
| Online access to doctors’ notes: patient concerns about privacy.Crossref | GoogleScholarGoogle Scholar | 24072335PubMed |
[26] Tudor Hart J. Commentary: three decades of the inverse care law. BMJ. 2000; 320 18–9.
| 10671038PubMed |
[27] Goel MS, Brown TL, Williams A, et al. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med. 2011; 26 1112–6.
| Disparities in enrollment and use of an electronic patient portal.Crossref | GoogleScholarGoogle Scholar | 21538166PubMed |
[28] Sarkar U, Karter AJ, Liu JY, et al. Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access. J Am Med Inform Assoc. 2011; 18 318–21.
| Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access.Crossref | GoogleScholarGoogle Scholar | 21262921PubMed |
[29] Yamin CK, Emani S, Williams DH, et al. The digital divide in adoption and use of a personal health record. Arch Intern Med, 2011; 171 568–74.
| The digital divide in adoption and use of a personal health record.Crossref | GoogleScholarGoogle Scholar |
[30] Statistics New Zealand. Internet Service Provider Survey: 2014. Wellington: Statistics New Zealand; 2014.
[31] Witry MJ, Doucette WR, Daly JM, et al. Family physician perceptions of personal health records. Perspect Health inf Manag. 2010; 7 1d
| 20697465PubMed |
[32] Nazi KM. The personal health record paradox: health care professionals’ perspectives and the information ecology of personal health record systems in organizational and clinical settings. J Med Internet Res. 2013; 15 e70
| The personal health record paradox: health care professionals’ perspectives and the information ecology of personal health record systems in organizational and clinical settings.Crossref | GoogleScholarGoogle Scholar | 23557596PubMed |
[33] Vydra TP, Cuaresma E, Kretovics M, et al. Diffusion and use of tethered personal health records in primary care. Perspect Health Inf Manag. 2015; 12 1c
| 26755897PubMed |
[34] Ludwick DA, Doucette J. Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. Int J Med Inform. 2009; 78 22–31.
| Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries.Crossref | GoogleScholarGoogle Scholar | 18644745PubMed |
[35] Davis Giardina T, Menon S, Parrish DE, et al. Patient access to medical records and healthcare outcomes: a systematic review. J Am Med Inform Assoc. 2014; 21 737–41.
| Patient access to medical records and healthcare outcomes: a systematic review.Crossref | GoogleScholarGoogle Scholar | 24154835PubMed |
[36] Mold F, de Lusignan S, Sheikh A, et al. Patients’ online access to their electronic health records and linked online services: a systematic review in primary care. Br J Gen Pract. 2015; 65 e141–51.
| Patients’ online access to their electronic health records and linked online services: a systematic review in primary care.Crossref | GoogleScholarGoogle Scholar | 25733435PubMed |
[37] Zanaboni P, Ngangue P, Mbemba GIC, et al. Methods to evaluate the effects of internet-based digital health interventions for citizens: systematic review of reviews. J Med Internet Res. 2018; 20 e10202
| Methods to evaluate the effects of internet-based digital health interventions for citizens: systematic review of reviews.Crossref | GoogleScholarGoogle Scholar | 29880470PubMed |
[38] Rathert C, Mittler JN, Banerjee S, et al. Patient-centered communication in the era of electronic health records: What does the evidence say? Patient Educ Couns. 2017; 100 50–64.
| Patient-centered communication in the era of electronic health records: What does the evidence say?Crossref | GoogleScholarGoogle Scholar | 27477917PubMed |
[39] Wells S, Rozenblum R, Park A, et al. Organizational strategies for promoting patient and provider uptake of personal health records. J Am Med Inform Assoc. 2015; 22 213–22.
| 25326601PubMed |
[40] Love T, Boyle R. Resource impacts of ePortals for general practice. Wellington: Sapere Research Group; 2015.
[41] Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010; 10 231
| Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions.Crossref | GoogleScholarGoogle Scholar | 20691097PubMed |
