Patient Portal

1. Patient Portal Dr John Steyn Clinical eHealth Adviser, NHS Lothian GP at Blackhall Medical Centre 1984-2011

2. Patient Portal • Internet access to your “medical” information

3. Who wants this ? • Politicians • Some / many patients • Some Doctors

4. Patient Portal • Internet access to your “medical” information • What is wrong with email?

5. What do you want ? • Entire “medical” record • Data Protection Act • references to third party • deleterious or injurious

6. What do you really want? • Repeat prescriptions • One-off prescriptions • Appointments • Letters / last encounter • Email correspondence

7. Why is it taking so long to deliver ? • Secure • Size – 750,000 users • Usernames and passwords • Source of information • England v Scotland

8. Patient Portal Source • Secondary Care • TRAK is hospital software • Paper records still used • SCI Store – results and letters • SCI Gateway - referrals

9. Patient Portal Source • Primary Care • Vision / EMIS is GP software • Docman – document management software • Paper record (partial) in some • 128 practices

10. Patient Portal Source • Primary Care sends to Out of Hours • ECS Emergency Care Summary • KIS Key Information Summary • ePCS Palliative Care Summary

11. Patient Portal Source • Out of Hours • NHS 24 • Lothian Unscheduled Care Service (LUCS) • Scottish Ambulance Service (SAS)

12. Patient Portal in Lothian • Secondary Care only • Appointments – view / “change”

13. Patient Portal in Lothian • Appointments – view / “change” • Results – values v text • Primary and Secondary initiated • What is normal ? Age - Medication • Value v interpretation / comment • Text

14. Text example – is this really helpful? • Penile Swab • Micro Culture + Sensitivities • Moderate numbers of Staphylococcus aureus isolated • Clarithromycin S Flucloxacillin S

15. Text example – better to have result AND comment / plan from clinician • CT Scan • There are new numerous subtle low attenuation lesions within the spleen. Although unusual, these may represent metastatic deposits. There are rounded soft-tissue density nodules within both lungs, appearances of these is in keeping with metastases.

16. Patient Portal in Lothian • Letters - new • Need to ensure no references to third party • Letters – old - need to check all previous content – is effort worth the “read-only” once ? Most recent contact is most relevant entry….

17. Patient Portal in Lothian • Email – secure – viewed in Portal • Multiple conditions – who to ? • Additional service – time….

18. Patient Portal in Lothian • Secondary Care initially • Appointments – view / change • Results – values (Y) v text (N) • Letters - new • Email – further work required

19. PSA tests from GP • April 08 - March 09 20,289 tests • Jan 13 - Dec 13 27,607 tests Increased by 36%

20. NICE 2014 summary • MRI – magnetic resonance imaging –– more routinely offered • negative transrectal biopsy to determine if further biopsy • proven prostate cancer if staging would affect management

21. NICE 2014 summary • Low risk – eg PSA<10 and Gleason </= 6 and clinical stage T1-T2a • Radical prostatectomy, radical external beam radiotherapy, brachytherapy, watchful waiting • active surveillance – MRI, PSA every c3-4 months, monitor velocity and doubling time, digital rectal examination every c6-12 months, prostate re-biopsy at c12 months

22. NICE 2014 summary • Intermediate & high-risk localised prostate cancer having radical radiotherapy should have ADT (androgen deprivation therapy) as well – not either / or

23. NICE 2014 summary • (More) active support PSA testing, monitoring and managing side-effects of treatment – recognise early to improve quality of life • Good communication between GP and hospital specialist, and vice versa is vital….

24. Any questions ??