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Semere W, Karter AJ, Lyles CR, Reed ME, Karliner L, Kaplan C, Liu JY, Livaudais-Toman J, Schillinger D. Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study. JMIR Diabetes 2024; 9:e49491. [PMID: 38335020 PMCID: PMC10891488 DOI: 10.2196/49491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Patient engagement with secure messaging (SM) via digital patient portals has been associated with improved diabetes outcomes, including increased patient satisfaction and better glycemic control. Yet, disparities in SM uptake exist among older patients and racial and ethnic underserved groups. Care partners (family members or friends) may provide a means for mitigating these disparities; however, it remains unclear whether and to what extent care partners might enhance SM use. OBJECTIVE We aim to examine whether SM use differs among older patients with diabetes based on the involvement of care partner proxies. METHODS This is a substudy of the ECLIPPSE (Employing Computational Linguistics to Improve Patient-Provider Secure Emails) project, a cohort study taking place in a large, fully integrated health care delivery system with an established digital patient portal serving over 4 million patients. Participants included patients with type 2 diabetes aged ≥50 years, newly registered on the patient portal, who sent ≥1 English-language message to their clinician between July 1, 2006, and December 31, 2015. Proxy SM was identified by having a registered proxy. To identify nonregistered proxies, a computational linguistics algorithm was applied to detect words and phrases more likely to appear in proxy messages compared to patient-authored messages. The primary outcome was the annual volume of secure messages (sent or received); secondary outcomes were the length of time to the first SM sent by patient or proxy and the number of annual SM exchanges (unique message topics generating ≥1 reply). RESULTS The mean age of the cohort (N=7659) at this study's start was 61 (SD 7.16) years; 75% (n=5573) were married, 15% (n=1089) identified as Black, 10% (n=747) Chinese, 12% (n=905) Filipino, 13% (n=999) Latino, and 30% (n=2225) White. Further, 49% (n=3782) of patients used a proxy to some extent. Compared to nonproxy users, proxy users were older (P<.001), had lower educational attainment (P<.001), and had more comorbidities (P<.001). Adjusting for patient sociodemographic and clinical characteristics, proxy users had greater annual SM volume (20.7, 95% CI 20.2-21.2 vs 10.9, 95% CI 10.7-11.2; P<.001), shorter time to SM initiation (hazard ratio vs nonusers: 1.30, 95% CI 1.24-1.37; P<.001), and more annual SM exchanges (6.0, 95% CI 5.8-6.1 vs 2.9, 95% CI 2.9-3.0, P<.001). Differences in SM engagement by proxy status were similar across patient levels of education, and racial and ethnic groups. CONCLUSIONS Among a cohort of older patients with diabetes, proxy SM involvement was independently associated with earlier initiation and increased intensity of messaging, although it did not appear to mitigate existing disparities in SM. These findings suggest care partners can enhance patient-clinician telecommunication in diabetes care. Future studies should examine the effect of care partners' SM involvement on diabetes-related quality of care and clinical outcomes.
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Affiliation(s)
- Wagahta Semere
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Courtney R Lyles
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Mary E Reed
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Leah Karliner
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Celia Kaplan
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Jennifer Livaudais-Toman
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Dean Schillinger
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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Gleason KT, Wu MMJ, Wec A, Powell DS, Zhang T, Gamper MJ, Green AR, Nothelle S, Amjad H, Wolff JL. Use of the patient portal among older adults with diagnosed dementia and their care partners. Alzheimers Dement 2023; 19:5663-5671. [PMID: 37354066 PMCID: PMC10808947 DOI: 10.1002/alz.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Care partners are at the forefront of dementia care, yet little is known about patient portal use in the context of dementia diagnosis. METHODS We conducted an observational cohort study of date/time-stamped patient portal use for a 5-year period (October 3, 2017-October 2, 2022) at an academic health system. The cohort consisted of 3170 patients ages 65+ with diagnosed dementia with 2+ visits within 24 months. Message authorship was determined by manual review of 970 threads involving 3065 messages for 279 patients. RESULTS Most (71.20%) older adults with diagnosed dementia were registered portal users but far fewer (10.41%) had a registered care partner with shared access. Care partners authored most (612/970, 63.09%) message threads, overwhelmingly using patient identity credentials (271/279, 97.13%). DISCUSSION The patient portal is used by persons with dementia and their care partners. Organizational efforts that facilitate shared access may benefit the support of persons with dementia and their care partners. Highlights Patient portal registration and use has been increasing among persons with diagnosed dementia. Two thirds of secure messages from portal accounts of patients with diagnosed dementia were identified as being authored by care partners, primarily using patient login credentials. Care partners who accessed the patient portal using their own identity credentials through shared access demonstrate similar levels of activity to patients without dementia. Organizational initiatives should recognize and support the needs of persons with dementia and their care partners by encouraging awareness, registration, and use of proper identity credentials, including shared, or proxy, portal access.
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Affiliation(s)
- Kelly T. Gleason
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Mingche M. J. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aleksandra Wec
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle S. Powell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talan Zhang
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ariel R. Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dukhanin V, Wolff JL, Salmi L, Harcourt K, Wachenheim D, Byock I, Gonzales MJ, Niehus D, Parshley M, Reay C, Epstein S, Mohile S, Farrell TW, Supiano MA, Jajodia A, DesRoches CM. Co-Designing an Initiative to Increase Shared Access to Older Adults' Patient Portals: Stakeholder Engagement. J Med Internet Res 2023; 25:e46146. [PMID: 37991827 PMCID: PMC10701652 DOI: 10.2196/46146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/02/2023] [Accepted: 07/22/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends-"care partners"-to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. OBJECTIVE We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. METHODS In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders' inputs. RESULTS Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan "People remember less than half of what their doctors say," which was selected from 9 candidate alternatives as resonating best with the full range of the initiative's stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. CONCLUSIONS Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners.
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Affiliation(s)
- Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Liz Salmi
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Kendall Harcourt
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Deborah Wachenheim
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ira Byock
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Matthew J Gonzales
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Doug Niehus
- Providence Medical Group, Portland, OR, United States
| | | | - Caroline Reay
- Providence Medical Group, Portland, OR, United States
| | - Sara Epstein
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Supriya Mohile
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Timothy W Farrell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine and the Center on Aging, University of Utah, Salt Lake City, UT, United States
- Salt Lake City Geriatric Research, Education, and Clinical Center, Veterans Affairs, Salt Lake City, UT, United States
| | - Mark A Supiano
- Division of Geriatrics, Spencer Fox Eccles School of Medicine and the Center on Aging, University of Utah, Salt Lake City, UT, United States
| | - Anushka Jajodia
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Catherine M DesRoches
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
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Reynolds TL, Cobb JG, Steitz BD, Ancker JS, Rosenbloom ST. The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating. Appl Clin Inform 2023; 14:654-669. [PMID: 37611795 PMCID: PMC10446914 DOI: 10.1055/s-0043-1770901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Recent external factors-the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic-have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. METHODS To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. RESULTS Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). CONCLUSION Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.
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Affiliation(s)
- Tera L. Reynolds
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, United States
| | - Jared Guthrie Cobb
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - S. Trent Rosenbloom
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Burgdorf JG, Fabius CD, Wolff JL. Use of provider-sponsored patient portals among older adults and their family caregivers. J Am Geriatr Soc 2023; 71:1177-1187. [PMID: 36573382 PMCID: PMC10089953 DOI: 10.1111/jgs.18187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Millions of older adults co-manage or delegate health responsibilities to one or more family caregivers. Patient portals facilitate health care management tasks, but little is known about portal use arrangements (i.e., individual or joint use) among older adults and their caregivers. METHODS We sought to characterize individual and joint use of the patient portal and to identify how using arrangements varies by individual-, interpersonal-, and community-level factors. We used linked 2017 National Health and Aging Trends Study, National Study on Caregiving, and American Community Survey data for a nationally representative sample of older adults (n = 1417; weighted n = 7.4 million) and their caregivers (n = 2232; weighted n = 20.6 million). Patient portals used by older adults and caregiver(s) were assessed via self-reports. We described portal use arrangements and tested for between-group differences using weighted Wald tests. Caregiver's likelihood of accessing the portal was modeled using weighted, multivariable logistic regression. RESULTS One in ten (10%) community-living older adults were sole portal users, 3% were joint users with one or more caregivers, 14% solely relied on one or more caregivers as portal users, and 74% reported no portal use. Older adults whose portal was only used by caregiver(s) were more likely to be Medicaid-enrolled (20% vs. 1%; p < 0.001), have dementia (43% vs. 5%; p < 0.001), and be homebound (65% vs. 27%; p < 0.001). Caregivers were more likely to use the portal if they were college-educated adjusted odds ratio (aOR): 1.68; p < 0.01) and reported caregiving-related emotional difficulty (aOR: 1.92; p < 0.001) and doing more than their "fair share" (aOR: 1.48; p = 0.03), and were less likely if Black (versus White) (aOR: 0.61; p = 0.01). CONCLUSIONS Patient portals could be a valuable platform for identifying and supporting caregivers of high-need older adults, but existing disparities in portal access must be closed to ensure equitable support.
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Affiliation(s)
- Julia G Burgdorf
- Center for Home Care Policy and Research at VNS Health, New York, New York, USA
| | - Chanee D Fabius
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ganta T, Appel JM, Genes N. Patient portal access for caregivers of adult and geriatric patients: reframing the ethics of digital patient communication. JOURNAL OF MEDICAL ETHICS 2023; 49:156-159. [PMID: 35437282 DOI: 10.1136/medethics-2021-107759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that, among other provisions, prevents health entities from engaging in practices that disrupt the exchange of electronic health information-a measure that may increase the usage of patient health portals. Caregiver access to patient portals, however, may lead to breaches in patient privacy and confidentiality if not managed properly through proxy accounts. We present an ethical framework that guides policy and clinical workflow development for healthcare institutions to support the best use of patient portals. Caregivers are vital members of the care team and should be supported through novel forms of health information technology (IT). Patients, however, may not want all information to be shared with their proxies so healthcare institutions must support the development and use of separate proxy accounts as opposed to using the patient's own account as well provide controls for limiting the scope of information displayed in the proxy accounts. Lastly, as socioeconomic barriers to adoption of health IT persist, healthcare providers must work to ensure multiple streams of patient communication, to prevent further propagating health inequities.
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Affiliation(s)
- Teja Ganta
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob M Appel
- Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicholas Genes
- Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
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Armstrong M, Benda NC, Seier K, Rogers C, Ancker JS, Stetson PD, Peng Y, Diamond LC. Improving Cancer Care Communication: Identifying Sociodemographic Differences in Patient Portal Secure Messages Not Authored by the Patient. Appl Clin Inform 2023; 14:296-299. [PMID: 36657471 PMCID: PMC10115514 DOI: 10.1055/a-2015-8679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Misha Armstrong
- Department of Surgery, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Natalie C. Benda
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Kenneth Seier
- Department of Epidemiology- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher Rogers
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter D. Stetson
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yifan Peng
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Lisa C. Diamond
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Benda NC, Rogers C, Sharma M, Narain W, Diamond LC, Ancker J, Seier K, Stetson PD, Sulieman L, Armstrong M, Peng Y. Identifying Nonpatient Authors of Patient Portal Secure Messages in Oncology: A Proof-of-Concept Demonstration of Natural Language Processing Methods. JCO Clin Cancer Inform 2022; 6:e2200071. [PMID: 36542818 PMCID: PMC10476725 DOI: 10.1200/cci.22.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/03/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Patient portal secure messages are not always authored by the patient account holder. Understanding who authored the message is particularly important in an oncology setting where symptom reporting is crucial to patient treatment. Natural language processing has the potential to detect messages not authored by the patient automatically. METHODS Patient portal secure messages from the Memorial Sloan Kettering Cancer Center were retrieved and manually annotated as a predicted unregistered proxy (ie, not written by the patient) or a presumed patient. After randomly splitting the annotated messages into training and test sets in a 70:30 ratio, a bag-of-words approach was used to extract features and then a Least Absolute Shrinkage and Selection Operator (LASSO) model was trained and used for classification. RESULTS Portal secure messages (n = 2,000) were randomly selected from unique patient accounts and manually annotated. We excluded 335 messages from the data set as the annotators could not determine if they were written by a patient or proxy. Using the remaining 1,665 messages, a LASSO model was developed that achieved an area under the curve of 0.932 and an area under the precision recall curve of 0.748. The sensitivity and specificity related to classifying true-positive cases (predicted unregistered proxy-authored messages) and true negatives (presumed patient-authored messages) were 0.681 and 0.960, respectively. CONCLUSION Our work demonstrates the feasibility of using unstructured, heterogenous patient portal secure messages to determine portal secure message authorship. Identifying patient authorship in real time can improve patient portal account security and can be used to improve the quality of the information extracted from the patient portal, such as patient-reported outcomes.
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Affiliation(s)
- Natalie C. Benda
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Christopher Rogers
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mohit Sharma
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Wazim Narain
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lisa C. Diamond
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Ancker
- Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Kenneth Seier
- Department of Epidemiology- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter D. Stetson
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Misha Armstrong
- Department of Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY
| | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Gleason KT, Peereboom D, Wec A, Wolff JL. Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations: A Scoping Review. JAMA Netw Open 2022; 5:e2248696. [PMID: 36576738 PMCID: PMC9857556 DOI: 10.1001/jamanetworkopen.2022.48696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Family and other unpaid care partners may bridge accessibility challenges in interacting with the patient portal, but the extent and nature of this involvement is not well understood. OBJECTIVE To inform an emerging research agenda directed at more purposeful inclusion of care partners within the context of digital health equity by (1) quantifying care partners' uptake and use of the patient portal in adolescent and adult patients, (2) identifying factors involving care partners' portal use across domains of the System Engineering Initiative for Patient Safety model, and (3) assessing evidence of perceived or actual outcomes of care partners' portal use. EVIDENCE REVIEW Following Arksey and O'Malley's methodologic framework, a scoping review of manuscripts published February 1 and March 22, 2022, was conducted by hand and a systematic search of PubMed, PsycInfo, Embase, and Web of Science. The search yielded 278 articles; 125 were selected for full-text review and 41 were included. FINDINGS Few adult patient portal accounts had 1 or more formally registered care partners (<3% in 7 of 7 articles), but care partners commonly used the portal (8 of 13 contributing articles reported >30% use). Care partners less often authored portal messages with their own identity credentials (<3% of portal messages in 3 of 3 articles) than with patient credentials (20%-60% of portal messages in 3 of 5 articles). Facilitators of care partner portal use included markers of patient vulnerability (13 articles), care partner characteristics (15 articles; being female, family, and competent in health system navigation), and task-based factors pertaining to ease of information access and care coordination. Environmental (26 articles) and process factors (19 articles, eg, organizational portal registration procedures, protection of privacy, and functionality) were identified as influential to care partner portal use, but findings were nuanced and precluded reporting on effects. Care partner portal use was identified as contributing to both patient and care partner insight into patient health (9 articles), activation (7 articles), continuity of care (8 articles), and convenience (6 articles). CONCLUSIONS AND RELEVANCE In this scoping review, care partners were found to be infrequently registered for the patient portal and more often engaged in portal use with patient identity credentials. Formally registering care partners for the portal was identified as conferring potential benefits for patients, care partners, and care quality.
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Affiliation(s)
| | | | - Aleksandra Wec
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L. Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Fields B, Klinedinst T, Silver Seidle J, Li C, Werner NE, Litzelman K. The Positive and Negatives of Caregiving for Older Adults During Coronavirus Disease 2019: Identifying Opportunities for Advancing Social, Health, and Economic Policies. THE PUBLIC POLICY AND AGING REPORT 2022; 32:prac018. [PMID: 38626272 PMCID: PMC9494505 DOI: 10.1093/ppar/prac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison, USA
| | - Tara Klinedinst
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Tulsa, USA
| | - Julie Silver Seidle
- Department of Occupational Therapy, Colorado State University, Fort Collins, USA
| | - Catherine Li
- Department of Health & Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA
| | - Kristin Litzelman
- Department of Human Development and Family Studies, University of Wisconsin-Madison, USA
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11
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Semere W, Makaroun LK, Beach S, Schillinger D, Rosland AM. Family caregivers navigating the health care system: Evolving roles during the COVID-19 pandemic. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2022; 40:268-273. [PMID: 35549487 PMCID: PMC9205262 DOI: 10.1037/fsh0000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has altered access to health care; it remains unclear how patients with chronic illness and disability and their family caregivers are adapting to these changes. In this study, we examined changes in family caregiver roles helping care recipients with chronic illness and disability navigate health care needs during the COVID-19 pandemic. METHODS From April 15 to May 27, 2020, we distributed online and telephone surveys to family caregiver members of a population-based regional research registry. Caregivers reported whether they were helping "more," "less," or the "same" with ten health care activities (e.g., filling prescriptions, attending medical appointments) now, compared to before the coronavirus pandemic. Using multivariable logistic regression models, we examined caregiver and caregiving context characteristics associated with helping more with 1 or more health care activities. RESULTS Of 561 caregiver respondents, mean age was 59 years, 76% were women, and 56% co-resided with care recipients. Many caregivers (59%) reported increased help with 1 or more health care activities since the pandemic. Caregivers reported greater help getting medical supplies (31%) and attending care recipients' phone (21%) and video (16%) medical appointments. Women (OR 1.55; 95% CI 1.02-2.36) and caregivers assisting with short-term physical conditions were more likely to help more with 1 or more health care activities (OR 2.81; 95% CI 1.20-6.59). DISCUSSION Family caregivers reported their responsibilities helping care recipients with chronic conditions and disabilities stay engaged with health care increased since the pandemic. Providers and health systems should consider targeted strategies to support caregivers helping vulnerable patients access necessary care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Wagahta Semere
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, United States
| | - Lena K. Makaroun
- Department of Medicine, University of Pittsburgh School of Medicine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Scott Beach
- Department of Psychology, University of Pittsburgh
| | - Dean Schillinger
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, United States
| | - Ann-Marie Rosland
- Department of Medicine, University of Pittsburgh School of Medicine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
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12
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Cross DA, Adler-Milstein J. Progress toward Digital Transformation in an Evolving Post-acute Landscape. Innov Aging 2022; 6:igac021. [PMID: 35712324 PMCID: PMC9196682 DOI: 10.1093/geroni/igac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Digitization has been a central pillar of structural investments to promote organizational capacity for transformation, and yet skilled nursing facilities (SNFs) and other post-acute providers have been excluded and/or delayed in benefitting from the past decade of substantial public and private sector investment in information technology (IT). These settings have limited internal capacity and resources to invest in digital capabilities on their own, propagating a limited infrastructure that may only further sideline SNFs and their role in an ever-evolving healthcare landscape that needs to be focused on age-friendly, high-value care. Meaningful progress will require continuous refinement of supportive policy, financial investment, and scalable organizational best practices specific to the SNF context. In this essay, we lay out an action agenda to move from age-agnostic to age-friendly digital transformation. Key to the value proposition of these efforts is a focus on interoperability- the seamless exchange of electronic health information across settings that is critical for care coordination and for providers to have the information they need to make safe and appropriate care decisions. Interoperability is not synonymous with digital transformation, but a foundational building block for its potential. We characterize the current state of digitization in SNFs in the context of key health IT policy advancements over the past decade, identifying ongoing and emergent policy work where the digitization needs of SNFs and other post-acute settings can be better addressed. We also discuss accompanying implementation considerations and strategies for optimally translating policy efforts into impactful practice change across an ever-evolving post-acute landscape. Acting on these insights at the policy and practice level provides cautious optimism that nursing home care – and care for older adults across the care continuum – may benefit more equitably from the promise of future digitization.
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Affiliation(s)
- Dori A Cross
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Julia Adler-Milstein
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, California, USA
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13
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Leung T, Lau M, Lehmann CU, Holmgren AJ, Medford RJ, Ramirez CM, Chen CN. The 21st Century Cures Act and Multiuser Electronic Health Record Access: Potential Pitfalls of Information Release. J Med Internet Res 2022; 24:e34085. [PMID: 35175207 PMCID: PMC8895284 DOI: 10.2196/34085] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/07/2021] [Accepted: 12/26/2021] [Indexed: 01/24/2023] Open
Abstract
Although the Office of The National Coordinator for Health Information Technology's (ONC) Information Blocking Provision in the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multiuser electronic health record (EHR) access and proxy access, concerns on the potential for harm in adolescent care contexts exist. We describe how the provision could erode patients' (both adolescent and older patients alike) trust and willingness to seek care. The rule's preventing harm exception does not apply to situations where the patient is a minor and the health care provider wishes to restrict a parent's or guardian's access to the minor's EHI to avoid violating the minor's confidentiality and potentially harming patient-clinician trust. This may violate previously developed government principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate "shadow charting" will be burdensome (and prohibitive) for health care providers. Under the privacy exception, patients have the opportunity to request information to not be shared; however, depending on institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot "improperly encourage or induce a patient's request to block information." Fearing being found in violation of the information blocking provisions, providers may feel that they are unable to guide patients navigating the release of their EHI in the multiuser or proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations that care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multiuser or proxy access situations.
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Affiliation(s)
| | - May Lau
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX, United States
| | - Christoph U Lehmann
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Data Sciences and Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - A Jay Holmgren
- Department of Medicine, Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, CA, United States
| | - Richard J Medford
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Charina M Ramirez
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX, United States
| | - Clifford N Chen
- Division of Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX, United States
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14
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Xie J, McPherson T, Powell A, Fong P, Hogan A, Ip W, Morse K, Carlson JL, Lee T, Pageler N. Ensuring Adolescent Patient Portal Confidentiality in the Age of the Cures Act Final Rule. J Adolesc Health 2021; 69:933-939. [PMID: 34666956 DOI: 10.1016/j.jadohealth.2021.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Managing confidential adolescent health information in patient portals presents unique challenges. Adolescent patients and guardians electronically access medical records and communicate with providers via portals. In confidential matters like sexual health, ensuring confidentiality is crucial. A key aspect of confidential portals is ensuring that the account is registered to and utilized by the intended user. Inappropriately registered or guardian-accessed adolescent portal accounts may lead to confidentiality breaches. METHODS We used a quality improvement framework to develop screening methodologies to flag guardian-accessible accounts. Accounts of patients aged 12-17 were flagged via manual review of account emails and natural language processing of portal messages. We implemented a reconciliation program to correct affected accounts' registered email. Clinics were notified about sign-up errors and educated on sign-up workflow. An electronic alert was created to check the adolescent's email prior to account activation. RESULTS After initial screening, 2,307 of 3,701 (62%) adolescent accounts were flagged as registered with a guardian's email. Those accounts were notified to resolve their logins. After five notifications over 8 weeks, 266 of 2,307 accounts (12%) were corrected; the remaining 2,041 (88%) were deactivated. CONCLUSIONS The finding that 62% of adolescent portal accounts were used/accessed by guardians has significant confidentiality implications. In the context of the Cures Act Final Rule and increased information sharing, our institution's experience with ensuring appropriate access to adolescent portal accounts is necessary, timely, and relevant. This study highlights ways to improve patient portal confidentiality and prompts institutions caring for adolescents to review their systems and processes.
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Affiliation(s)
- James Xie
- Information Services, Stanford Children's Health, Stanford, California.
| | - Tom McPherson
- Information Services, Stanford Children's Health, Stanford, California
| | - Austin Powell
- Information Services, Stanford Children's Health, Stanford, California
| | - Paul Fong
- Information Services, Stanford Children's Health, Stanford, California
| | - Adam Hogan
- Information Services, Stanford Children's Health, Stanford, California
| | - Wui Ip
- Information Services, Stanford Children's Health, Stanford, California
| | - Keith Morse
- Information Services, Stanford Children's Health, Stanford, California
| | | | - Tzielan Lee
- Information Services, Stanford Children's Health, Stanford, California
| | - Natalie Pageler
- Information Services, Stanford Children's Health, Stanford, California
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15
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Wolff JL, Dukhanin V, Burgdorf JG, DesRoches CM. Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity (Preprint). JMIR Aging 2021; 5:e34628. [PMID: 35507405 PMCID: PMC9118085 DOI: 10.2196/34628] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Growing reliance on the patient portal as a mainstream modality in health system interactions necessitates prioritizing digital health equity through systems-level strategies that acknowledge and support all persons. Older adults with physical, cognitive, sensory, and socioeconomic vulnerabilities often rely on the involvement of family and friends in managing their health, but the role of these care partners in health information technology is largely undefined and poorly understood. This viewpoint article discusses challenges and opportunities of systematic engagement of care partners through shared access to the patient portal that have been amplified in the context of the COVID-19 outbreak and recent implementation of federal information blocking rules to promote information transparency alongside broader shifts toward care delivery innovation and population aging. We describe implementation considerations and the promise of granular, role-based privacy controls in addressing the nuanced and dynamic nature of individual information sharing preferences and fostering person- and family-centered care delivery.
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Affiliation(s)
- Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Vadim Dukhanin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Julia G Burgdorf
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
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16
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Raj M, Iott B. Evaluation of Family Caregivers' Use of Their Adult Care Recipient's Patient Portal From the 2019 Health Information National Trends Survey: Secondary Analysis. JMIR Aging 2021; 4:e29074. [PMID: 34605766 PMCID: PMC8524330 DOI: 10.2196/29074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/14/2021] [Accepted: 06/19/2021] [Indexed: 01/26/2023] Open
Abstract
Background Patient engagement is critical for realizing the value of telehealth modalities such as the patient portal. Family caregiver engagement may also be critical for facilitating the use of the patient portal among adult patients, including older adults. Objective This study aims to analyze the 2019 Health Information National Trends Survey to characterize family caregivers’ use of their care recipient’s patient portal in terms of sociodemographic, health, and caregiving characteristics and caregivers’ use of their own portal. Methods We conducted a secondary analysis of cross-sectional data from the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 3. This survey was administered to 5438 US adults between January and May 2019. We analyzed data from 320 respondents who were identified as family caregivers. We created measures to reflect family caregivers’ use of their care recipient’s and their own portal, caregiver demographic and caregiving characteristics, and care recipient health characteristics. Results Over half of the caregivers (179/320, 55.9%) reported using their own portal at least once, whereas only one-third (105/320, 32.8%) reported using their care recipient’s record in the previous 12 months. Caregivers using their own portal were significantly more likely to use their care recipient’s portal (odds ratio 11.18; P<.001). Conclusions Policies should enable patients to designate family caregivers who can access their patient portal. Providers could screen caregivers for challenges in their caregiving responsibilities that may be addressed through the portal so they can better support their adult relatives. Interventions to support family caregivers, especially older caregivers, in using their own portal may facilitate their use of their care recipient’s portal.
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Affiliation(s)
- Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, United States
| | - Bradley Iott
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
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17
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Family Caregiver Access of Online Medical Records: Findings from the Health Information National Trends Survey. J Gen Intern Med 2021; 36:3267-3269. [PMID: 33269423 PMCID: PMC7710154 DOI: 10.1007/s11606-020-06350-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/11/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022]
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18
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Evaluating the Balance Between Privacy and Access in Digital Information Sharing. Crit Care Med 2021; 50:e109-e116. [PMID: 34637416 PMCID: PMC8797001 DOI: 10.1097/ccm.0000000000005234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Access to personal health records in an ICU by persons involved in the patient’s care (referred to broadly as “family members” below) has the potential to increase engagement and reduce the negative psychologic sequelae of such hospitalizations. Currently, little is known about patient preferences for information sharing with a designated family member in the ICU. We sought to understand the information-sharing preferences of former ICU patients and their family members and to identify predictors of information-sharing preferences.
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19
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Ip W, Yang S, Parker J, Powell A, Xie J, Morse K, Aikens RC, Lee J, Gill M, Vundavalli S, Huang Y, Huang J, Chen JH, Hoffman J, Kuelbs C, Pageler N. Assessment of Prevalence of Adolescent Patient Portal Account Access by Guardians. JAMA Netw Open 2021; 4:e2124733. [PMID: 34529064 PMCID: PMC8446820 DOI: 10.1001/jamanetworkopen.2021.24733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Importance Patient portals can be configured to allow confidential communication for adolescents' sensitive health care information. Guardian access of adolescent patient portal accounts could compromise adolescents' confidentiality. Objective To estimate the prevalence of guardian access to adolescent patient portals at 3 academic children's hospitals. Design, Setting, and Participants A cross-sectional study to estimate the prevalence of guardian access to adolescent patient portal accounts was conducted at 3 academic children's hospitals. Adolescent patients (aged 13-18 years) with access to their patient portal account with at least 1 outbound message from their portal during the study period were included. A rule-based natural language processing algorithm was used to analyze all portal messages from June 1, 2014, to February 28, 2020, and identify any message sent by guardians. The sensitivity and specificity of the algorithm at each institution was estimated through manual review of a stratified subsample of patient accounts. The overall proportion of accounts with guardian access was estimated after correcting for the sensitivity and specificity of the natural language processing algorithm. Exposures Use of patient portal. Main Outcome and Measures Percentage of adolescent portal accounts indicating guardian access. Results A total of 3429 eligible adolescent accounts containing 25 642 messages across 3 institutions were analyzed. A total of 1797 adolescents (52%) were female and mean (SD) age was 15.6 (1.6) years. The percentage of adolescent portal accounts with apparent guardian access ranged from 52% to 57% across the 3 institutions. After correcting for the sensitivity and specificity of the algorithm based on manual review of 200 accounts per institution, an estimated 64% (95% CI, 59%-69%) to 76% (95% CI, 73%-88%) of accounts with outbound messages were accessed by guardians across the 3 institutions. Conclusions and Relevance In this study, more than half of adolescent accounts with outbound messages were estimated to have been accessed by guardians at least once. These findings have implications for health systems intending to rely on separate adolescent accounts to protect adolescent confidentiality.
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Affiliation(s)
- Wui Ip
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Information Services, Stanford Children's Health, Palo Alto, California
| | - Samuel Yang
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Hospital Medicine, The Ohio State University College of Medicine, Columbus
| | - Jacob Parker
- Information Management Division, Rady Children's Hospital, San Diego, California
| | - Austin Powell
- Information Services, Stanford Children's Health, Palo Alto, California
| | - James Xie
- Information Services, Stanford Children's Health, Palo Alto, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Keith Morse
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Information Services, Stanford Children's Health, Palo Alto, California
| | - Rachael C. Aikens
- Department of Biomedical Informatics, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Lee
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Manjot Gill
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Hospital Medicine, The Ohio State University College of Medicine, Columbus
| | - Shravani Vundavalli
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Yungui Huang
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jeannie Huang
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Jonathan H. Chen
- Center for Biomedical Informatics Research, Stanford University, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey Hoffman
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Cynthia Kuelbs
- Information Management Division, Rady Children's Hospital, San Diego, California
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Natalie Pageler
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Information Services, Stanford Children's Health, Palo Alto, California
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20
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DesRoches CM, Salmi L, Dong Z, Blease C. How do older patients with chronic conditions view reading open visit notes? J Am Geriatr Soc 2021; 69:3497-3506. [PMID: 34405397 DOI: 10.1111/jgs.17406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/11/2021] [Accepted: 07/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND We examine the experiences with and perceptions of the effect of reading clinical outpatient visit notes on patients with multiple chronic conditions at three healthcare organizations with significant experience sharing clinical notes with patients. METHODS A cross-sectional survey was conducted via patient portals at three diverse healthcare organizations in the United States: Beth Israel Deaconess Medical Center (Boston, MA), UW Medical Center (Seattle, WA), and Geisinger Health System (Danville, PA). Participants were aged 65 and older patient portal users who read at least one clinical note over the 12 months before the survey. We examined the effect of note reading on patient engagement and managing medications. RESULTS The majority of respondents had read two or more clinical notes in the 12 months before the survey. Patients with more than two chronic conditions were more likely than those with fewer or none to report that reading their notes helped them remember their care plan, take their medications as prescribed, and understand and feel more in control of their medications. Very few patients reported feeling worried or confused about their health or medications due to reading their notes. CONCLUSIONS Older patients with chronic conditions are particularly vulnerable to misremembering and mismanaging their care and medication plans. Findings from this study suggest that these patients and their care partners could receive important benefits from accessing their notes. Healthcare organizations should work to maximize patient's engagement with their health information both through the patient portal and through other methods to ensure that patients and the healthcare systems reap the full benefit of the increased transparency of medical records.
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Affiliation(s)
- Catherine M DesRoches
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Liz Salmi
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Zhiyong Dong
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Charlotte Blease
- Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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21
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Tapuria A, Porat T, Kalra D, Dsouza G, Xiaohui S, Curcin V. Impact of patient access to their electronic health record: systematic review. Inform Health Soc Care 2021; 46:192-204. [PMID: 33840342 DOI: 10.1080/17538157.2021.1879810] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patient access to their own electronic health records (EHRs) is likely to become an integral part of healthcare systems worldwide. It has the potential to decrease the healthcare provision costs, improve access to healthcare data, self-care, quality of care, and health and patient-centered outcomes. This systematic literature review is aimed at identifying the impact in terms of benefits and issues that have so far been demonstrated by providing patients access to their own EHRs, via providers' secure patient portals from primary healthcare centers and hospitals. Searches were conducted in PubMed, MEDLINE, CINHAL, and Google scholar. Over 2000 papers were screened and were filtered based on duplicates, then by reading the titles and finally based on their abstracts or full text. In total, 74 papers were retained, analyzed, and summarized. Papers were included if providing patient access to their own EHRs was the primary intervention used in the study and its impact or outcome was evaluated. The search technique used to identify relevant literature for this paper involved input from five experts. While findings from 54 of the 74 papers showed positive outcome or benefits of patient access to their EHRs via patient portals, 10 papers have highlighted concerns, 8 papers have highlighted both and 2 have highlighted absence of negative outcomes. The benefits range from re-assurance, reduced anxiety, positive impact on consultations, better doctor-patient relationship, increased awareness and adherence to medication, and improved patient outcomes (e.g., improving blood pressure and glycemic control in a range of study populations). In addition, patient access to their health information was found to improve self-reported levels of engagement or activation related to self-management, enhanced knowledge, and improve recovery scores, and organizational efficiencies in a tertiary level mental health care facility. However, three studies did not find any statistically significant effect of patient portals on health outcomes. The main concerns have been around security, privacy and confidentiality of the health records, and the anxiety it may cause amongst patients. This literature review identified some benefits, concerns, and attitudes demonstrated by providing patients' access to their own EHRs. This access is often part of government strategies when developing patient-centric self-management elements of a sustainable healthcare system. The findings of this review will give healthcare providers a framework to analyze the benefits offered by promoting patient access to EHRs and decide on the best approach for their own specialties and clinical setup. A robust cost-benefit evaluation of such initiatives along with its impact on major stakeholders within the healthcare system would be essential in understanding the overall impact of such initiatives. Implementation of patient access to their EHRs could help governments to appropriately prioritize the development or adoption of national standards, whilst taking care of local variations and fulfilling the healthcare needs of the population, e.g., UK Government is aiming to make full primary care records available online to every patient. Ultimately, increasing transparency and promoting personal responsibility are key elements of a sustainable healthcare system for future generations.
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Affiliation(s)
- Archana Tapuria
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Talya Porat
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Dipak Kalra
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Glen Dsouza
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sun Xiaohui
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Vasa Curcin
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
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