Only 9% of Australians have ever logged in to the My Health Record system, one year into its rollout. Four percent have accessed their digital health record more than once.
A large percentage of public hospitals, pharmacies, and medical practices are connected, but only 33% of private hospitals and less than half of medical and diagnostic labs.
Like most health IT initiatives, I wonder if it’s to do with health literacy or practical relevance that patients and/or providers are not engaged or “bothered” to be engaged. Policy and business model change management also seems to be an issue.
The challenge with health portals/platforms for patients is that they have had little uptake anywhere in the world, and has anyone wondered if we engaged the “right people” during discovery and development?
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If you look at the history of bank customer portals you will find that take up was slow and kicked in when they offer meaningful functionality/services (and information), and really kicked in when the mobile apps started to equal the desktop experience. Of course it still comes down to relevance / need to use the tech…and then there are those that are simply not engaged in their health and wellbeing.
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From the article
…Even those connected were not reaping benefits due to incompatibilities between the practice software used by medical specialists and the My Health Record system.
“Most public hospitals still don’t have connectivity,” Dr Tomlinson said. “I can connect to it, but it’s not something I’m usually able to rely on to find useful information … Not many radiology or pathology results are uploaded."
It would be useful to know what the barriers are: do people know about the app? Is it easy (or hard) to use? Does it contain the right information, in a useful format?
I’m a user of one of the NZ portals, and while it is better than nothing, it’s not what it could, or should be. However, I think that patient portals here are an afterthought for PMS/PAS vendors, because patients aren’t their customers. They won’t get better (and therefore uptake and use may lag) until they take user considerations on board.
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There’s two articles that did some considerations around patient portal ‘barriers’ in the US last year. Pretty sure the themes are consistent here:
https://pxjournal.org/journal/vol6/iss2/6/
https://pxjournal.org/journal/vol5/iss3/8/
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Experience Framework
This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens "], opengraphobject:[360513148542976 : https://pxjournal.org/journal/vol5/iss3/8/ : title=“Improving the patient experience through patient portals: Insights from experienced portal users” : description=“Background: Patient portals have become part of the ecosystem of care as both patients and providers use them for a range of activities both individually and collaboratively. As patients and providers gain greater experience using portals, their use and needs related to portals may evolve. Objective: This study aimed to learn from experienced patient portal users to improve our understanding of their perspectives on portal use for collaboration and engagement as well as explore how using a portal influenced their experiences with primary care providers. Methods: Qualitative study involving 29 semi-structured interviews with family medicine patients from a large Academic Medical Center (AMC). Interviewees were patients with chronic conditions who had been identified by their providers as experienced portal users. Interview transcripts were analyzed using rigorous qualitative methods. Results: Common themes emerged around both logistical and psychological benefits of portal use. Logistical benefits included increased efficiency, improved ability to track their health information, and better documentation of communications and information during and between office visits. Psychological benefits were a greater sense of collaboration in care, increased trust in providers, and enhanced engagement in health care activities. Conclusion: Experienced portal users discussed ways in which patient portals improved both their ability to manage their care and their relationships with providers. Frequent users described a sense of collaboration with their providers and greater trust in the relationship. These findings suggest that portal use may be a mechanism through which patients can increase patient engagement and improve the patient experience.”]
I think you are probably right
But
It would still be useful to enquire in NZ to confirm and/or get local perspectives.
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I think part of the problem here is that Patient Portals dont solve problems for patients. In the main, patients dont see having to call someone to make an appointment a ‘problem’ when it is about their health. Likewise, they dont see phoning someone to talk about test results a ‘problem’. I believe that the issue with portals and the reason uptake and usage is so poor is that they are solving problems for the PROVIDER not for the patient.
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Agree @munrog I think that is exactly the problem.
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If you can improve engagement in individual health and wellbeing then people will look for tools to get information and insight into their health. Just look at the uptake of Sleep Monitoring Apps or Brain Training apps.
Personally I believe that the experiment in portals is a failure because portals dont address the problems patients face and they don’t provide value to the patient. there is no engagement. We could have stopped development once portals had the ability to book appointments online and no one would have been worse off. It is almost as if no one asked the patient what they were interested in in their health.
Engagement requires the presentation of information relevant to the consumer in a format that the consumer of that information understands. Unfortunately portals are dumb. They report data, they dont interpret that data and they dont create information, so the value to the patient is near zero unless they have some medical understanding. For example I probably know more about my current state of health from my Fitbit, my Sleep app or Apple Watch health app than from my access to the data in a patient portal.
Then there is the issue of my data being in so many different places so I need not one, but many health portals if I want a complete view of my health. For example, GP portals such as ManageMyHealth etc only show me what my GP has recorded about me, but what about my hospital record, what about my physio etc.
In a world where we should be aiming to create frictionless digital experiences the advent of portals has not removed the petty irritations such as me needing to change my address with every health provider I interact with (or even every department in my local hospital). Portals havent created a view of my entire health record. They dont interact with any of the myriad devices that might hold relevant health data that I use everyday such as my smart watch etc.
Think of all the things that are barriers to your own understanding of your own health. We’re not all doctors, we cant possibly understand all of the information presented in portals, so how am I supposed to engage when I don’t understand what I am being told? It is much easier, and possibly more relevant to me, to go back to, for example, my sleep app, find out what it tells me about my sleep patterns and match that information to my experience. I have no doubt that such apps with their data collection and interpretation are changing peoples lives, I seriously doubt that anyone has gone out and changed their lives as a result of reading their latest lipid result in a portal because there is little or no interpretation or information included in the presentation of those numbers. At best you might get a graph!
We need to think collectively about how technology can help enable engaged health consumers, but we also need to recognise that health is a very human/social thing and technology alone is not going to be the solution.
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Agreed, its about how the data is presented. A HBA1c result (for example) is great to know, but if its just a number, what does that mean to my health? Something more visual like a traffic light system shows that my result is green=good, to red=bad. Its simple but does the trick. Data in a table is great for medical professionals, but not for Mr or Mrs X. Time to think about who is the portal actually designed for, transcending knowledge and language borders will make it ultimately user friendly.
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There are already better tools available in Medtech than MMH for the same data. For blood tests, I used to get wee bits of paper with numbers and codes (but no explanation). With MMH I now get a wee PDF instead but it’s no more clear. My GP gets a dashboard. Why can’t I get the dashboard?
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Good question and a commonly raised problem/suggestion in the app store feedback on the MMH app.
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Great comments Karen…funny thing is, almost every session I go to at PHO is all about ‘patient at the centre’ and yet the systems and processes just dont work that way
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