It is imperative for the system to change from being reactive to proactive, with an increased focus on prevention, and earlier detection and diagnosis. In parallel, we need to recognise that a holistic approach to care is essential where two-thirds of adults aged over 65 are expected to be living with multiple health conditions by 2035.1 Managing people with multiple chronic conditions and complex care needs is a challenge for health and care systems and anecdotally there is frequent feedback from people about their suboptimal experience of coordinated care.
The people best placed to act on their multiple conditions are the individuals themselves and/or their carers. They are the only ones that have a holistic perspective of their care, especially across multiple services. For them to effectively manage their conditions, they need access to their healthcare records and the ability to drive their care via a shared care plan that is based on their goals and what matters to them. This self-management is done in partnership with – and supported by – their primary care team, multi-disciplinary and specialist teams, community providers such as pharmacists, and voluntary, community and social enterprise (VCSE) services if and when they are required.
Patient or resident portals are one way of engaging and supporting people to be empowered in their care and self-management, which are associated with improved health outcomes.2 As Claire Morgan, patient partner for St George’s University Hospitals NHS Foundation Trust says, "I have long wanted to access my medical records in the same way I access my bank statements…”
Through an app or web-based access, portals provide the capability for individuals and/or their carers to securely access and view their electronic health and care information. This allows them to input information that directly integrates into their record (after professional review) – such as completing online assessments, PROMs3 and PREMs4 - request prescriptions and engage in bidirectional messaging with care teams. They are also able to receive notifications, view and manage appointments, access test results, and read clinical documentation – such as clinic and discharge letters, educational resources, condition and appointment information – and more.
Portals are also a key enabler in the modernisation of outpatient services through supporting virtual consultations and online assessments, enabling effective and safe triage of patients for various care pathways, PIFU5 and streamlining pathways. These digitally enabled pathways can reduce the need for follow-ups and free up time for care professionals to offer enhanced in-person interactions for those patients who would benefit most from this appointment type.
There are many cited benefits to these new appointment types, such as patient convenience, parking and transport (cost or finding a driver), not having to take time off work or find childcare, and reducing carbon footprint. Portals support personalisation of care and work as an enabler for joined-up, personalised care. For example, portals can reduce anxiety for people on cancer surveillance programmes through having timely access to their test results.6
“From when I used to attend for my follow-up PSA blood test to when I was seen in clinic was an anxious time. With the new process I have none of the stress of coming to clinic. Whilst I love seeing Gill and her team, I understand their time is better off spent seeing people at the beginning of their journey and the appointment I was taking up can be given to someone else. The portal was easy to register on and easy to use. I can contact the team if I have any issues. I cannot stress enough how much this reduced my anxiety.”
Trevor Sinclair, urology cancer patient, Wirral University Teaching Hospital
However one size doesn't fit all. Although it may improve equity for many people, virtual appointments may also risk introduction of access issues, e.g. for people who lack digital skills or access. When implementing patient portals, there are several considerations that health and care organisations or systems should factor into the care redesign process and how portals can augment the therapeutic relationship. Examples of factors to consider include: reason for requiring assessment and treatment (e.g. acute problem or long-term condition), a first consultation or follow-up, type of specialism or service, availability of a digital alternative that is as/more effective (i.e. what does the evidence show), and most importantly, individual preferences and choice.
Involving patients and public representatives/partners as the end users from the start in the design decisions and localisation when implementing patient portal solutions is essential to keeping the patient at the centre. Organisations that have used a coproduction approach in their deployments have valued the perspective and healthy challenge these key team members bring to ensure that the portal is considered within the wider context of health and care service provision.
As with most technology solution deployments, it’s important to invest in the change process to optimise benefit for care professionals and individuals and/or their carers. It’s not ‘just a piece of tech’ being deployed; it provides the next generation engagement methodology. Clinical networks and services are excited about the potential of portals to transform care pathways and are working together to reimagine workflows across the various services patients interact with.
NHSE’s plans to use the NHS App as the ‘front door’ for patient portals are progressing at pace. A substantial proportion of the population downloaded the NHS App during the pandemic to access COVID vaccination certificates, and people now request prescriptions and appointments from care providers, such as GP practices, that are already integrated. The recent government announcement7 outlines ambitions for the NHS App and timelines for additional functionality to be delivered by 2024 with development support for the established portal suppliers to integrate.
Although portals are increasingly being used to support engagement with health and care services, their full potential in supporting self-management is yet to be realised. As Claire Morgan says, “a patient portal is an important tool, but it shouldn't be the centre – the patient should be the centre”.
3 Patient Reported Outcome Measures (PROMs) measure a patient’s health status or health-related quality of life from the patient perspective at a single point in time. They are collected through short, self-completed questionnaires.
4 Patient Reported Experience Measures (PREMs) are questionnaires that focus on the patients’ experiences of the care they receive.
5 Patient Initiated Follow-Up (PIFU) is when a patient initiates an appointment when they need one, based on their symptoms and individual circumstances. https://www.england.nhs.uk/outpatient-transformation-programme/patient-initiated-follow-up-giving-patients-greater-control-over-their-hospital-follow-up-care/