Anne O’Hanlon, product director at Orion Health, told the final session of the UK and Ireland Customer Conference 2022 that she wanted to talk about the “irony of population health management” – once she had presented the “latest and greatest version of Orion Health Engage.”
Engage 5.12
Engage is Orion Health’s patient portal, and a lot of work has been done on it to respond to customer requirements. Customers can now add their own colour scheme to the “out of the box” product to reflect their branding. Patients can now register themselves to use the portal, using the kind of credentials that are familiar from banking and consumer services. O’Hanlon acknowledged that “English customers are going to be saying: what about NHS Login?” and said that it’s coming.
However, there’s some complexity. First, NHS Login users can enter different levels of information and get different levels of access to health and care information, so there need to be different routes into Engage, depending on what they have done. Users need to have done the full, ‘P9’ identity check, taking a video of their face, to get access to their full, shared care record. Second, some people need proxy access for elderly parents or other dependents, and at the moment that is registered by GPs.
Once these issues are addressed, however, patients will be able to use a new feature of Engage called ‘privacy and permissions’ which has been taken out of the portal’s circle of care functionality, so they can easily manage their access. Anne said this should be particularly useful to children as they become adults “and they have a different relationship with their clinicians and their records.”
Other new features in Engage 5.12, which is released this week, include improved crash reports, with information on what happened just before a crash, a new content management system, to make it easier to add news and other information feeds, and a new version of forms, Forms 0.1, which comes with features to make it easier to create forms and for patients to fill them in online or offline.
Again, Anne said this would give patients more of a consumer experience. “I went to get my car service recently, and my garage sent me a Google form, and I sighed and filled it in, and that meant they had the information they needed. Clinicians will be able to do the same thing: they can send the patient a form and get them to fill it in and send it back, and have the information go into the record.”
But she said there are also benefits for healthcare providers. Southern Cross Healthcare in New Zealand has used the new forms technology to streamline the number of forms it is sending out and what information has to be repeated on them. It is also using the information provided to triage patients and follow-up on their care.

A trip down memory lane
O’Hanlon asked her audience how many people were at the Orion Health customer conference in 2014: when the term population health management was first used. “What has happened since then is that there has been huge change,” she said: primary care trusts have been replaced by sustainability and transformation partnerships and then integrated care systems. And it’s not just the NHS; similar changes have been made to accountable care systems in the US and the organisation of services in New Zealand.
At the same time, the demands being put on their health and care systems have changed. For example, “the triple aim has become a quadruple aim, so we not only have to become more efficient, and deliver better care for patients, and address inequality, but deliver for our staff.” And the tech landscape has changed: the NHS, like other systems, has tried to introduce digital first thinking, but initiatives like local health and care record exemplars have come and gone, there are now many apps on the market, and Covid has complicated the picture.
The fragmented present
The result? “More fragmentation than ever.” So , just as systems are trying to put the patient at the centre, and using technology to do it, “none of it joins up.” The lesson: “We need to rethink the process from end to end, from the patient perspective.” But this won’t be easy. To show why not, Anne used another consumer example.
Recently, she said, she went into Tesco to buy a smoothie “because I just love them, and in New Zealand we can’t get them.” If the audience did the same, she asked, would they use self-service check-outs? A poll of the room showed they definitely would. But online discussions show customers are divided. “Some people don’t like them, because they remove the human interaction of queuing. But some people, including some people with disabilities, love them, because they don’t want to interact with people, they just want to do their shopping and get out of there.”
So, healthcare systems can’t make assumptions. When they do consumer research, they need to recognise that people will want lots of different routes into services.” And that, she said, brought her to her punchline: “The irony of population health management is that when it is done well, you end up with more fragmentation.” Which leaves patients with the challenge of navigating and increasingly complex system. Unless that system can adapt, and find ways to automatically give patients good advice, or advise them on the next-best step to take.
As an example of how not to do it, Anne recounted a personal story of being worried about her son, and trying to get a referral into New Zealand’s healthcare system. And as an example of how to do it, she recounted how she eventually dropped his symptoms into the Ada symptom checker; which told her not to worry. “It told me that what I needed to do next was nothing; and all that stress just went away.”
Portals and digital front doors
Orion Health has been working with the Ada symptom checker, because it has been working with Ontario’s healthcare system on a digital front door. Anne said a DFD is different to a patient portal – although the two can be linked. A DFD is consumer facing; it makes advice services and apps available “to people who are well most of the time.” Whereas a patient portal is a way for people who need health and care to interact with services.
Orion Health has released a Digital Front Door that NHS customers could adopt. It has sections that can be populated with news feeds, “information that your local teams have decided is the best and most relevant information locally”, blogs, and links to other apps, such as the GP apps that already give patients access to transactional services and records. This will be developed in the future, to address that “irony of population health management” which is that “everything is a hot mess for patients” by making it easier for patients to navigate the system and for citizens to get “a more holistic experience.”
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