Health Tech Trends

Digital leaders on lessons learned and impact of patient portals

Following on from our deep dive into patient portals, in which we explored current statistics around coverage and functionality, a case study from a portal in practice, and recent research in the area, we’re examining the views of industry professionals.

We asked NHS digital leaders for their views and experience on patient portals, with particular focus on their learnings, the main impacts of a portal, and their thoughts on the future.

Grace Birch, chief information officer at Greater Manchester Mental Health NHS Foundation Trust 

“We haven’t yet implemented a patient portal in our organisation, although we are eager to do so,” said Grace. “As a mental health provider, our patients are in contact with a significant amount of other health and care providers and we have been keen not to introduce yet another portal that they need to access. It was disappointing to see that the current round of national revenue funding that has been made available for patient portals has only been applicable to acute trusts, as a way of supporting the elective recovery agenda. Whilst this is evidently important, patients do not just restrict themselves to one place of care and it is short sighted not to include funding to support portal implementation across the entire patient pathway. Failure to do so increases complexity for our patients.

“Patient portals are going to become increasingly important as we try to ensure that patients are able to take control of their health care. The majority of patients are keen to have access to their records online; and, especially for patients in receipt of mental health services, the ability to have an up to date digital care plan that can be shared (for example, with carers) is becoming a necessity.”

Grace concluded: “I hope that portals will become business as usual, streamlined so that patients only have to log in to one portal and have the right access to all of their relevant data in one place with a single sign on. I expect that this will become more of a two way interaction with patients able to input into their care record and take greater ownership of their health care journey.”

Tamara Everington, chief clinical information officer at Hampshire Hospitals NHS Foundation Trust

“We do have a patient portal. Our main learnings have been that it is potentially a powerful tool for transforming patient engagement in care; that it is hard to start when there is a great deal of baseline variation in practice around basic processes; and that devil is in the detail of getting things right. It requires lots of painstaking work around integrations and process change management,” said Tamara. “Also, linkage to the NHS App is good, but as things are currently configured, you can’t rely on the NHS App to remind people about appointments.”

Looking at the impact of patient portals, Tamara noted how they can empower patients with their own information from secondary/tertiary care, such as appointments, letters, form, pathway plans or results. They provide a platform for structured two-way engagement which can link into workflow and provide support in areas such as waiting list management and service development. In addition, Tamara acknowledged a financial impact with regards to cost saving on printing, posting and administrative time due to the shift to digital.

“In five years’ time, I’d hope to see the patient portal as a dynamic vehicle to evaluate the effectiveness of services in real time as assessed by patients,” Tamara said. “We will stop debating whether or not we should ‘protect’ patients from their results (in my view, we shouldn’t – I think there is more harm done by patients not getting results than the other way round).”

She added: “We will have a problem unless we more clearly define system models of care; who will patients choose to go to and where will that information be stored?” Pointing out that this could compromise the primary care record, Tamara posed a question: “Will we move to a more European model of direct access to specialist care?”

Chris Mason, chief information officer at Wirral University Teaching Hospital NHS Foundation Trust

“At Wirral University Teaching Hospital, we are starting our journey into implementing our patient portal,” Chris said. “We have already released the service in areas like cancer care. Our main lessons learned include the importance of having a smooth sign-up process that is user-friendly and intuitive. We found that patients are more likely to register and use the portal when it is easy to navigate and understand.

“We also learned that the involvement of our clinicians in promoting the patient portal to patients was key to its success. Patients trust their clinicians, and hearing from them about the benefits of using the patient portal helped to increase adoption rates.

“Additionally, we discovered that patients appreciate having access to their medical data and the ability to take a more active role in their own care. Providing patients with tools and resources to help them manage their health and well-being, such as personalised care plans and educational materials, has also been a valuable feature of our patient portal.

“Overall, our experience with a patient portal has taught us that technology can play a critical role in improving healthcare outcomes and that prioritising patient engagement and participation is essential for success.”

Moving on to the main impacts of a patient portal, Chris pointed to improved patient engagement and experience. “Patient portals enable patients to be more involved in managing their healthcare, as they have easy and secure access to their medical records, test results, and care plans. This helps patients feel more in control of their health and fosters a greater sense of collaboration between patients and healthcare teams.”

Other impacts include increased efficiency and cost savings, with patient portals reducing the need for face-to-face appointments for routine matters such as reviewing test results, which can save both healthcare providers and patients time and money. Portal functionality to complete forms and questionnaires online can streamline administrative tasks and reduce the load on staff, he pointed out. Overall, in Chris’s view, patient portals represent a valuable tool for improving patient engagement, enhancing operational efficiency, and driving better clinical outcomes.

Looking to the future, Chris said: “As a chief information officer, I believe that patient portals will undergo significant changes and improvements in the next five years. Firstly, portals will no longer just focus on storing patient records but will also incorporate health factors and wellness measures such as exercise, eating habits, and other health metrics. Technologies such as wearables and other smart devices will continue to evolve and be more integrated with the healthcare system, giving patients an opportunity to monitor their health more actively.

“Secondly, the data from social care and other sectors will feed into these portals, providing a more comprehensive and holistic view of patient health and wellbeing. This could, for example, include environmental health factors like air quality data or even socioeconomic factors like access to healthy foods and green spaces. By integrating these diverse streams of data, patient portals can provide patients and healthcare providers with a more complete picture of patient health, enabling more precise diagnoses and efficient care delivery.

“Lastly, we need to ensure that we make personal healthcare and wellbeing information easy to find and use. The Wayfinder (NHS App) Services project provides excellent foundations for this shift towards more comprehensive and integrated patient portals.

“In conclusion, patient portals will continue to evolve, providing patients with a more comprehensive view of their health, improving the coordination and delivery of care, and creating opportunities for proactive health monitoring and care. However, with a greater reliance on digital we must ensure that those key barriers to digital inclusion are addressed, promoting accessibility and allowing citizens to feel confident managing their own health in a digital environment.”

Matt Kybert, deputy chief information officer at Imperial College Healthcare NHS Trust

“In North West London we have had the Care Information Exchange since 2016. In April 2023 we passed the milestone of 500,000 registered users of the system,” said Matt. Through the Care Information Exchange, he explained, information is available to patients from the four acute trusts as well as social care.  Information that patients may see includes blood test results, X-ray and scan reports, letters and discharge summaries, appointments and social care. He added that the platform is powered by Patients Know Best.

“A big turning point was integration with the NHS app in 2021,” Matt continued. “That allowed sign up using the NHS login and access via the NHS account on desktops or the NHS app. We were able to invite patients to register at key times in their care. For example, Imperial College Healthcare invites patients when they have an appointment booked, attend an appointment, are admitted, or go to A&E. Since we started that in 2021, registered users have been growing at around 200,000 per year.”

Matt also noted that they have struggled to find a supplier capable of providing access to data such as blood test results alongside transactional capabilities such as allowing patients to book appointments.

The main impact of a patient portal is helping patients to feel more in control of their care, he said. As for the future, Matt expects to see “a convergence of patient portals. Patients will have access by the single digital front door of the NHS app to data from a range of different health and care settings as well as transactional capabilities to manage their care.”

Nikki McNulty  (digital matron and midwife) and Feras Izzat (consultant obstetrician, gynaecologist and deputy chief clinical information officer) at University Hospitals Coventry and Warwickshire NHS Trust

“In December 2020, University Hospitals Coventry & Warwickshire maternity services rolled out a new digital system for pregnant women to register their pregnancy and access their maternity notes digitally via a patient portal which is linked to the maternity Electronic Patient record (EPR),” Nikki and Feras said. “The My pregnancy Notes health portal is provided by K2 Medical Systems and is linked to the full maternity electronic pregnancy health record, which supports clinical and administrative management of the women’s maternity journey. This digital transformation replaced the previous paper-based records; commonly referred to as ‘the green notes’.

“My Pregnancy Notes allows the women to be more involved in their care and provides clinicians with more information, including preferences and birth plans. Women have access to up-to-date information about their care and the leaflets and information they need, whenever they need it.

In October 2023 we are replacing the current maternity patient portal with Oracle Cerner’s offering in line with a Trust wide EPR implementation and patient portal.”

Nikki and Feras shared some of their main learnings:

  • The value of any portal is only as good as the information being shared on it by the trust. Regular training and education are needed to ensure the shift in digital solutions within healthcare is being cascaded.
  • We know that not every family has access to devices to access healthcare information electronically. Therefore, we obtained funding to loan tablets to women enabling them access to the portal combating the issue of digital inequalities these were provided for use for the duration of their maternity journey to ensure we are inclusive to all patient needs.
  • We know that not every family has access to Wi-Fi; therefore, we have teamed up with the local council initiative #CovConnects to get families online to access their maternity records.
  • Promoting the use of the portal requires regular communication with the multi-disciplinary teams to keep all staff members up to date with the latest technology within healthcare as the digital transformation within our department happened with high pace.
  • In this day and age, where most of our daily activities involve some form of digital interaction, it is not uncommon to forget something like carrying paper pregnancy notes wherever we go. The benefit of having a digital portal has improved consultations and care as the information is always available and all in one place.
  • Data quality issues have been highlighted using My Pregnancy Notes as women will notice anything they are unfamiliar with or errors in the documentation and they will provide immediate feedback that will allow us to correct any issues.
  • Patient centred outcomes – the patient voice needs to be weaved into the development of any patient portals to ensure they are user friendly and fit for purpose.

Next, looking at main impacts, they pointed to the two-way communication functionality on the portal improving communications for the pregnant woman with a midwife; reducing walls to the maternity unit; and enabling non-medical questions to come to staff to be answered within a 48-hour period around other clinical priorities.

In addition, clinical information can be shared with patients from the maternity EPR; records are up to date at point of care; and clinicians do not have to double enter data onto paper handheld notes and duplicate information.

The portal has also led to reduced Did Not Arrive ‘DNA’ appointments, as patient can see the date and time of their maternity appointments and contact the hospital to reschedule as needed.

They added that plans and preferences for birth can be updated and viewed at any point, and women can feedback about their antenatal care, labour and birth experiences at their own leisure. They can share their digital notes with other professionals outside of the trust and inform the trust of transfer of care, moving location or miscarriages. There are also cost savings due to reduction of paper and printing.

Finally, moving onto explore how they think patient portals will look in five years’ time, Nikki and Feras said that they hope to see a focus on wellness, with more patient and clinician remote monitoring; and individualised portals with streamlined information, rather than all patient information leaflets available to all. They added that portals should be fully functional to include all health care appoints in one convenient place. They expect to see convergence of patient portals with a single point of access (such as the NHS App), noting that currently there are a myriad of competing portal on the market all with separate ways to access information. There should be more digital engagement for staff and for patients, and personalised care should be trust-wide, not just in maternity.

“A woman’s maternity journey can be complex and unpredictable during her nine months encounter with health professionals,” Nikki and Feras concluded. “Maternity patients are different to other health services and specialists because the teams require access to the maternity notes often. The traditional practice of carrying paper handwritten maternity notes around in a folder is outdated. In addition, relying on a single set of paper-based notes carries risks such as human error of forgetting them, damage or loss, therefore moving to a digital solution is much more reliable.”

Many thanks to all our contributors for sharing their thoughts.