17 Aug 2016

The Technology-enabled Nurse: Engaging the 'One Constant' with Patient Portals 


*Reprinted from the May 2016 edition of NIAA's N-Form Newsletter

By Ian Chaves, RN, BScN, MACT
Edmonton, AB. Karla Vermeer, Registered Nurse, sees the significance of patient portals in how they will change the way patients engage with their health and health care providers.
“The one constant in a ‘patient’s medical record of care’ is the patient. Until now, that one constant did not have ease of access to their own health information,” Karla says.
Karla has had extensive experience in the use of EMRs and EHRs. Her previous projects have included the development, pilot implementation, and subsequent role out of Netcare and EClinician. Currently, she is working in a Primary Care Clinic doing Diabetes and complex patient care as a Chronic Disease Management Nurse. In her collective experiences, she observed the importance of patients being engaged in their care. 

Karla remarks, “As nurses we say that chronic diseases are best managed when the patient is involved, but many patients are not or don’t have a way to really be involved. How can a patient really be part of the plan when they don’t have access to their own health information?”   Her work has now brought her to an opportunity to use technology in as a way to engage patients with their own health information – the introduction of patient portals. A patient portal provides a secure tool for patients to access their own health information, track their medication lists, medical history, labs, and diagnostic imaging. Karla has been involved in a couple patient portal projects over the past five years. In her first patient portal foray, she helped develop the provincial untethered Patient Health Portal, which is now the Public Health website myhealthalberta.ca.

In describing this project, Karla states, “An untethered portal is one where a patient has secure access to their health information, but is not necessarily able to communicate directly with their health care provider.”
While lacking a two-way communicative function, it does offer value with a selected view of the patient’s health information. This untethered patient portal laid the groundwork for other new ways for patients to engage, and it would be a matter of time before Karla became involved in the next iteration – the tethered patient portal.

In this past year, Karla has been working with the Edmonton Zone eClinician EMR which hosts a tethered patient portal. Initially piloted in December 2015, it offered patients access to view their own diagnostic imaging and lab results dating back to 2008 and allowed them to access their medical history as recorded within the eClinician EMR.  In addition to all this, it also gave patients the opportunity to send messages to their direct healthcare teams and offered them the option to book appointments online.  

“Our patients are getting timely advice from their health care providers… It can save having to book a clinic visit or save a patient from having to go to Emergency.”  Karla adds, “When it comes to scheduling, we are able to give real-time support to our patients. If it’s a weekend and the clinic is closed, a patient can schedule an appointment online for Monday, for example, and not have to wait for the 9 a.m. Monday phone lines to open to try to get an appointment.”

Further to finding appointments, tethered patient portals also address another issue with appointment scheduling – last moment patient cancellations.

“A patient can cancel their appointment online, freeing up an appointment spot which someone may benefit from, and by the time Monday morning arrives, we don’t have a lost appointment spot or a no show,” Karla says.

In contrast to paper-based systems, patient portals optimize access to digital health information and also begin to link patients to providers in new ways. When you change the way patients communicate with their own health information and health care providers, you change the way patients engage.

Karla remarks, “Nurses may be concerned with a patient that is overdue for a health intervention, or think that a patient does not understand the importance of timely health interventions. When we consider general health management, there are timely clinical indicators and health targets (e.g. screening or risk indicators). But how is a patient to know if he is meeting his own personal health targets or timelines of care if he can’t access his own information? We would not expect this in business or banking or other life management activities.”

A patient portal is a key shift in the paradigm of care, where patients are now partners in their care – a model providing them with their own information and fuelling their engagement. But in doing so, does this change what nurses need to do and how nurses need to engage?

Karla believes it does.

“Nurses need to leverage ways to communicate securely and in a timely fashion with our patients,” Karla says,  “we need to step into the new workflows of including our patients into the plan of care, digitally, so we can support our patients better.”

As a result, nurses find themselves involved in new ways to advocate for patient safety and represent the provider’s voice for safe and efficient workflows when using a patient portal. Karla asserts that this new connection will require new thinking.

“It takes flexibility on behalf of caregivers to think outside the box and integrate new ways to communicate with patients, check their in basket messages, monitoring a health indicator at home (i.e. Home glucose Or INR testing or blood pressure reads, and even sending comments about result notes directly to the patient to help clarify and lab value reading.”

While a patient portal may change how nurses approach providing care in a virtual space, the essence of nursing, how can we best support the care of this patient, continues to underpin it all.

“Nurses and clinicians have been waiting for this long overdue ability to securely communicate with their patients,” Karla adds, “It is an absolute JOY to have a secure way to message our patients”. ​

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