Portals need more study, writer says

Further studies are needed before New Zealand proceeds down the path of all patients accessing their medical information electronically, one of the Ministry of Health’s "eHealth ambassadors" says.

Patient portals — an electronic gateway for medical information — were launched in New Zealand three years ago and 47% of GPs and 10% of New Zealanders aged over 18 are enrolled.

The portal — through which patients can do things such as view medical records, book appointments and renew prescriptions — are a key element of Southern District Health Board’s draft primary and community care strategy, now subject of public consultation.

"The increasing comprehensiveness of this record over the next decade will eventually allow collection of information from consumer devices, genetics and other factors related to an individual’s health," the SDHB plan said.

However, Dr Sue Wells, writing in the latest issue of the Journal of Primary Health Care, suggests there are still significant issues which need to be considered before the use of portals widens.

"The New Zealand patient portal journey in general practice is in its early stages and holds much promise for new models of care," Dr Wells said in a guest editorial.

"However, we require more studies evaluating uptake, indicating how to use this technology more effectively and identifying applications that are especially beneficial to support health literacy, teamwork and long-term condition self-management."

Dr Wells’ views parallel findings in a recent auditor-general review of patient portals, which said more statistical analysis was needed to see if they were delivering what was promised.

Her editorial raised two key challenges to be addressed: opening up consultation notes to patients and setting clear rules around parental access to the records of their children.

"Opening up the electronic patient record, especially the consultation or visit notes, is a major patient-provider relationship change that has many GPs alarmed and apprehensive," Dr Wells said.

However, studies in the United States suggested the greater openness between doctors and patients improved communication and made patients more likely to adhere to treatment plans, she said.

Access to children’s records had not been a major issue yet, as most patients who had registered for portals had been 18 or older, Dr Wells said.

A logical next step would be for parents and caregivers to be given proxy access to children’s health information, providing it was in the child’s best interests.

"However, at some point this arrangement may not be appropriate; for example, when a 5-year-old grows to be 15 and needs to confidentially discuss sexual health issues with their doctor.

"While health information privacy and informed consent are not new, patient portals are a new medium for information disclosure and need to be considered within the same legal and ethical framework."

● The SDHB public meeting to discuss its draft primary and community health plan will be held today, at 3.30pm, in the Hutton Theatre at Otago Museum. The meeting was postponed after flooding in Dunedin earlier this month.



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