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Portals can allow patients to:
For more questions see the National Health IT Board FAQ(external link)
OpenNotes is the term given to opening up the health record so that patients can see their own notes and medical record including consultation records, lab results, immunisations, medications and recalls. This is done through a secure online portal, similar to online banking.
The OpenNotes initiative began in 2010 as a 12-month experiment to “investigate patients and doctors’ attitudes about sharing a visit note.” At the end of the year, 99% of patients wanted to continue sharing visit notes and no doctor asked for the notes to be turned off. This led to an international movement that has become known as OpenNotes.
Since this time, numerous studies have demonstrated multiple benefits of sharing visibility of their medical record with patients.
Open Notes is both a technical change as well as a philosophical shift for clinicians to be willing to open up the medical record and share fully with patients. Patients have the right to read or request a copy of their medical notes at any time, however traditionally doing this has been difficult for patients to access and time-consuming for healthcare teams or practices to facilitate.
Technology has completely changed this so that now it is one of the standard modules available through general practice patient portals and can be turned on with a few clicks.
From a patient perspective:
From a health provider perspective, studies show:
Research findings:
Open Notes website(external link)
OpenNotes: Building transparency, trust, and better health outcomes
Podcast(external link) and transcript of podcast(external link) Health Literacy Out Loud, 2016
The Royal NZ College of General Practitioners and the Ministry of Health's National IT Board have developed a useful implementation guide for general practice clinics.
Written by: Dr Karl Cole, GP & e-Health Ambassador
If the health system is to cope with the challenges of the future, then we need better self-management of long-term conditions.
GP advanced training has always focused on patient centered approach and continuity of care. What is the patient’s agenda? Considering the person bio-psycho-social in environment. Involving them in all management decisions whenever possible. Taking care to make sure patient doctor relationship is balanced. But it is the doctor who has the access to notes, who records what happened in the visit and the management plan. But why isn’t the patient able to have these memory aids? They can legally read and get a copy of notes for review at any time, but what about always having access? They have the most to gain about the accuracy of the record, and its like having an extra person in the care team!
The doctor needs to make notes to remember what happened. There are legal requirements for this, and the notes can be used in investigations about the quality of care. Also the notes were originally there to help other clinicians get a snapshot of the person's health status.
Many modern day clinicians include their patients in all decisions, why not let them review the medical record? If the doctor needs a reminder of what happened in a consult, why not the patient?
The perfect situation is when the clinician perfectly understands the individuals bio psycho and social factors. But how often does that happen? The perfect patient understands all the relevant options and science behind each diagnosis and needs no help in deciding management. The patient is the only true expert about themselves, and in an ideal world the doctor is a partner or a copilot in the person's health journey.
With this approach, a transparent relationship is vital and supported by open notes, and there should be no surprises!
Dr Will Reedy and Dr Jeff Lowe discuss the use of patient portals as a means of consumer empowerment and how to improve uptake of portals in New Zealand.
Patient portals and empowerment(external link) 8 April 2021, HiNZ
(Healthify NZ, 2017)
The IT Health Board appointed eight eHealth Ambassadors(external link) with expertise in patient portals in February 2014. Read about their stories and experience with introducing patient portals, what worked, what didn't and their suggestions for improving workflow.
GPs thinking about introducing a patient portal may wish to contact an eHealth Ambassadors for their advice. Send all queries to: enquiries@ithealthboard.health.nz with the name of the eHealth Ambassador you wish to contact in the subject line.
The team at Island Bay Medical Centre were early adopters of patient portal use. The initiative was championed by GP Richard Medlicott who is also one of eight e-Health Ambassadors available for advice and can be contacted via the Ministry of Health website(external link).
Island Bay MC now have over 4000 of their enrolled population using the patient portal and have recently ‘opened up’ the consultation notes so they can now be viewed by patients via the portal.
Clinical Manager, Fiona Kymbrekos says she has noticed an increase in patient interest and follow up conversations about treatment and care since the consultation notes have become available via the portal. There are several different patients portals and the one being used at Island Bay Medical Centre is ManageMyHealth.™
All members of the Island Bay team use the portal to communicate with patients and doctors, nurses and admin staff report positively about the amount of time saved and the improved experience reported by their patients. Just recently a patient forgot to take their medications with them when travelling overseas. The GP was able to email the medication list to the local pharmacist who was then able to dispense the correct medicines to the patient.
Fiona uses many of the ManageMyHealth™ functions such as group emails and reminders about things like flu jabs as well as invitations to events or programmes such as those organised by Arthritis NZ or the local diabetes service.
The Island Bay team are all passionate about the patient portal and continuously encourage patients to join. They have run a number of promotional initiatives over the years.
All team members have embraced the latest idea of wearing ManageMyHealth™ every Thursday and Friday.
Porirua Union Community Health Service (PUCHS) and Hora Te Pai (HTP) are two high need practices based in Porirua and Kapiti Coast. Their enrolled populations share similar characteristics, including high levels of social deprivation, poverty, English as a second language or no spoken or written English. Often families share one cell phone, have no computer or internet in the home and no credit on the phone.
When introducing a patient portal, both teams took a similar approach, taking it slowly and carefully in the beginning. They started with only one or two GPs and nurses actively recruiting people who they know have fewer barriers to accessing the internet At the time of writing, numbers were slowly building as they think innovatively and find solutions to barriers.
Hora Te Pai knew from their own and others experience that if a patient is not fully activated, on the portal, at the time of enrolment and when they are in the practice, the likelihood they will use it once they leave is very low. To overcome security and access concerns they had a tablet secured to a stand and fixed to the reception desk. This has worked well as patients can set themselves up with portal access quickly and easily. There is also always someone trained and on hand to help if needed.
In order to build momentum, both PUCHS and HTP knew that they needed to have visual reminders throughout the practice. ManageMyHealth™ posters and reminders were placed in waiting areas, consulting rooms and staff areas.
The PUCHS team got creative and made a ‘target’ poster to display in the reception area close to the other information about ManageMyHealth™.
Both HTP and PUCHS commented that one of the challenges had been getting GPs and nurses on board with the concept in the beginning. GPs were concerned they would start getting numerous emails from patients via the portal. They were also concerned about how patients would react to some of the information they could access via the portal and if some of the information might cause unnecessary anxiety.
However, as has been the case in most practices where patient portals are being used, this has not transpired.
All three practices are members of Compass Health PHO who are strongly supportive of the implementation of ManageMyHealth™ and have developed a useful start-up guide for General Practice.
The patient portal at Pakuranga Medical Centre (PMC) has saved time and increased efficiency for the practice and its patients, resulting in improved access and a better patient experience.
A patient portal is a secure online facility that allows patients to access their health information at any time and from anywhere with access to the internet. At PMC, patients can use the portal to make appointments, order prescriptions, access test results, and view health information, such as their recalls, allergies and immunisations.
Pakuranga Medical Centre introduced the portal into their practice to relieve pressure on the telephone system and increase access for their patients.
Read more here(external link)
Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.