Scotland’s national hospital is working with long-term partner Orion Health on a Patient Portal project that could lead to significant changes in the way it engages with patients and their local clinical teams.
Created in 2002 as Scotland’s flagship health facility, the Golden Jubilee Foundation is unique within the NHS; a national resource independently run by its own NHS Board, it is helping to re-define the concept of the public hospital.
Set in a modern, purpose built environment, the facility combines a high quality hospital with hotel, conference facilities and centres for research, clinical skills and innovation.
This integrated approach creates an ideal environment for innovation and a vibrant network for the spread of learning and best practice which has resulted in a culture of continuous improvement and creativity, with patients firmly at the heart of everything they do.
It is a regional and national heart and lung centre, a ‘one stop shop’ for cataract surgery, a major diagnostic centre and a centre of excellence for orthopaedics. To take just one example, most of its hip replacements are carried out as 48-hour stays; but it has recently done its first 24-hour operation.
A game-changing initiative
Because of the nature of its work, Golden Jubilee National Hospital (GJNH) sees patients from all over Scotland. So, it needs effective ways of communicating with them and with their local clinical teams. To support this, since April 2017 it has been using a Patient Portal from Orion Health.
Head of eHealth, Sally Smith, told Orion Health’s UK and Ireland Customer Conference in October 2017: “Working with patients from across Scotland is essential to what we do; and the Patient Portal is a game changer for us.”
GJNH Clinical and Patient Portal
The GJNH Clinical Portal was deployed in 2011 and has steadily grown to become the hospital’s strategic patient record system.
Although this project began initially as a read-only Portal, giving clinicians a single view of patient data, the hospital is about to embark on an ambitious EPR programme. This programme will see it use Orion Health’s technology to support the electronic capture of clinical data, implement patient care pathways, and through Orion Health’s Medicines Management platform - linked to the national Emergency Care Summary (ECS) system - will facilitate a more efficient and safer medicines reconciliation and electronic discharge process for the services and patients.
More recently, the GJNH Clinical Portal has been linked to other clinical portals across the West of Scotland. This has allowed its clinicians to access and share information held in the Orion Health portals used by NHS Ayrshire and Arran, NHS Dumfries and Galloway, NHS Lanarkshire, and NHS Greater Glasgow and Clyde serving a regional population of 2.2m.
The GJNH Patient Portal sits alongside the Clinical Portal and is hosted by Orion Health’s hosting partner. Patients are enrolled onto the Orion Health Patient Portal through an invitation sent to them by their GJNH clinician. If they accept the invitation, they are sent an email inviting them to register with a user name and password that can be used to log-on to the Patient Portal securely, from outside the hospital’s computer network.
A phased approach
In the first phase of this project, the Patient Portal is currently being used to enable a small cohort of patients from across Scotland - who use the GJNH Scottish Adult Congenital Cardiac service (SACCS) - to upload a summary of their records and appointments that they have agreed with their consultant, which was accessible via a smartphone.
GJNH eHealth programme manager, Gerry Newlands, explained that this group has been carefully chosen. The SACCS Service supports patients who live with congenital heart disease, once they turn 16. Due the nature of these patients’ medical conditions, they can become ill very quickly. If this happens, they are often taken to their nearest hospital or centre of care, where the clinical teams treating them may not have previously had access to their history or notes.
With access to their medical record on a device or desktop, they can share this information with those treating them. To make this easier, the Patient Portal has been designed so patients can access it via a smartphone or a tablet. Newlands argued: “This should really improve the care they are given.”
Anecdotal feedback from patients has been encouraging, with one patient describing a recent experience of an unscheduled emergency episode of care. The patient presented at a hospital outwith their local Health Board where the receiving consultant and clinical team had no background knowledge of his care plan or understanding of his condition, and he had difficulty describing the detail. With access to the Patient Portal, the patient was able to get out his smartphone and show the clinical team his record. They were then able to provide the appropriate care based on the information and deliver a positive outcome.
John MacPhie, a patient from the Scottish Highlands, explained the benefits of Patient Portal. He said: “I was recently in Raigmore Hospital in Inverness and the doctor asked what I had. It was easier for me to just bring out my phone and show him how I’ve been keeping for the last six months, the medication I was on and what operations I’ve had since I was born.
“Portal has given me peace of mind – my medical records are on me at all times which can be accessed really quickly without the need to search for files. It is also helpful that both my wife and sister have access to my digital records in case there is a situation where I can’t provide the information myself.”
Rethinking the patient journey
At the same time, patients can use the Patient Portal to access information about their upcoming appointments at Golden Jubilee National Hospital and supporting details, such as a map and travel details.
The ehealth team have ambitious plans, where in a second phase of the project, it would start embedding the Patient Portal into patient pathways.
“At the moment, when a patient is booked in for a hip replacement, we send them a booklet to fill in,” Newlands said. “We want to reach out to patients, and invite them to upload that information electronically, using questionnaires, to capture patient information pre and post operatively. We would also like to improve the patient experience and have discussed with the client the option to send the patient links to educational YouTube links via the Patient Portal, that inform the patient of the planned operation and what to expect.
“At the other end of the pathway, because we do so many hip and knee operations, we talk about a tsunami of return outpatient follow up appointments at 1, 5 and 7 year intervals. We hope the Patient Portal will allow us to electronically triage those follow-up patients and see only the complex cases, thereby freeing up hospital capacity and improving patient experience in not having to make the sometimes long and costly journeys back to Glasgow.
“We want to send out follow-up questionnaires and, perhaps, let them upload pictures of things like infected wounds, so they can get advice on dealing with them, without having to travel in.”
Ultimately, the hospital wants to extend the Patient Portal to many more groups of patients. Yet, inevitably with all new technologies there are perceived challenges. Where perhaps understandably, some clinicians who may have known their patients since they were children, worry how they will handle access to sensitive information about their condition – and who they will share it with.
The inclusion of the patient in the circle of care and allowing them to view and augment their own Patient Portal medical record will bring a new dimension to how data is shared. Not least how information governance will need to be managed appropriately and safely. However, the potential that this type of technology has to manage the increasing drive to deliver person-centred care and drive real change in the way healthcare is delivered in the 21st century is great.
A journey, not a destination
The project team at GJNH has lots more ideas: a health library, to enable patients to look up information about their condition; video consultations, OTC medications input by the patient and educational material to help them interpret lab results. Technically, a lot of this can be done with the Orion Health Patient Portal, with some work by the Orion Health team.
The issues lie in rethinking healthcare for the digital world. “It has been a journey,” Newlands said. “We are really keen to continue that journey, by moving onto phase two and using the Patient Portal as part of the patient journey. That is a key step for us.”
To find out more about Orion Health’s solutions for patient engagement, click here.