How Patients Use a Patient Portal: An Institutional Case Study of Demographics and Usage Patterns

Uptake and user characteristics of MyChart within a Canadian community hospital with a diverse patient population: A comparative study

Patient portals offer a convenient way to access health information and increase patient participation in healthcare. To promote broad accessibility and impact of portals, it is essential to understand uptake patterns across patient populations. This study described the characteristics of patient users of a portal called MyChart and compared them to non-users at a large community hospital. We descriptively analyzed (frequency, counts) patient health records to characterize MyChart users and their usage patterns during the first year of its launch from September 11, 2023, to September 112024. We summarized user demographics along with information about how they activated accounts, accessed MyChart, and utilized its features. Using chi-square and t-tests, we compared MyChart user demographics to non-users who visited the hospital in the same time period. A total of 61,306 patients activated MyChart during the first year it was available. On average, MyChart users were 53 years old, 62% female, 64% predicted to have White ethnicity, and preferred to receive healthcare in English (88%). MyChart users tended to be regular healthcare users, with an average of five annual visits prior to creating an account and logged onto the portal on average five times a month. MyChart users were slightly younger than non-users (an average age of 53.5 vs. 56.9 years) and visited the hospital more often (an average of 5.7 vs. 3.1 annual visits). Many patients activated MyChart during the first year of launch, and users closely resembled the broader patient population. To enhance adoption and potential benefits of patient portals, targeted interventions such as accessible educational information tailored to diverse patient groups (e.g., older adults, different ethnicities) could increase their usage.

Investigation of the causal relationship between patient portal utilization and patient's self-care self-efficacy and satisfaction in care among patients with cancer

OBJECTIVE

The objective of this study was to examine the causal relationship between the usage of patient portals and patients' self-care self-efficacy and satisfaction in care outcomes in the context of cancer care.

METHODS

The National Institute's HINTS 5 Cycle 1-4 (2017-2020) data were used to perform a secondary data analysis. Patients who reported being ever diagnosed with cancer were included in the study population. Their portal usage frequency was considered as an intervention. Patient's self-care self-efficacy and satisfaction in care were the primary outcomes considered and they were measured by survey respondents' self-reported information. A set of conditional independence tests based on the causal diagram was developed to examine the causal relationship between patient portal usage and the targeted outcomes.

RESULTS

A total of 2579 were identified as patients with cancer or cancer survivors. We identified patient portals' impact on strengthening patients' ability to take care of their own health (P = .02, for the test rejecting which is necessary for the expected causal relationship, ie, the portal usage impacts the target outcome; P = .06, for the test rejecting which is necessary for the reverse causal relationship), and we identified heterogenous causal relationships between frequent patient portal usage and patients' perceived quality of care (P = .04 and P = .001, for the tests rejecting both suggests heterogeneous causal relationships). We could not conclusively determine the causal relationship between patient portal usage and patients' confidence in getting advice or information about health or cancer care related topics (P > .05 for both tests, suggesting inconclusive causal directions).

CONCLUSIONS

The results advocate patient portals and promote the need to provide better support and education to patients. The proposed statistical method exploits the potential of national survey data for causal inference studies.

Insights and Trends in Open Note Access: Retrospective Observational Study

BACKGROUND

As of 2021, at least 4 out of every 5 hospitals offered patients access to clinical notes via a web-based patient portal, a number that is expected to grow because of the 21st Century Cures Act. There is limited data on how open note use may have evolved over time or which types of clinical interactions were viewed most in the outpatient setting.

OBJECTIVE

This study aims to analyze trends in outpatient open note access over time; characterize usage in terms of age, sex, and clinical interaction type; and assess the method of access to help uncover areas of improvement in patient engagement and identify further areas of research.

METHODS

A retrospective observational study was conducted at Erie County Medical Center from November 1, 2021, to December 31, 2022, to coincide with the time that open notes went live. Outpatient note access and account logs were downloaded from the portal and combined into a single dataset consisting of 18,384 note accesses by 4615 users, with column headings of the patient index, sex, age, note title that was accessed, clinical interaction type, time stamp of note creation, time stamp of access, and method of access (web vs mobile). A separate table was created with sex data for all 35,273 portal accounts. Microsoft Excel and Microsoft Power Query were used to combine and analyze the data.

RESULTS

During the study period, 4615 portal users viewed 12,150 documents for a total of 18,384 times, averaging 2.6 notes per patient viewed 4 times. Only 13.1% (4615/35,273) of all portal inpatient and outpatient registrants viewed their outpatient notes. There was a female predominance in those who viewed notes (2926/4615, 63.4%; P<.001), while 56.8% (20,047/35,273) of all portal registrants were female. Users in their 30s and 50s accessed more notes than other age groups. The ratio of mobile-to-web access of notes tended to decrease as a function of increasing age, which was not observed in those aged ≥90 years. Notes regarding COVID-19 assessments were the most accessed among all clinical interactions (4725/12,150, 38.9%). Overall, the number of users accessing notes reached a maximum of 1968 before declining to 1027 by the end of the study period.

CONCLUSIONS

Open note access was largely dominated by COVID-19 assessments, and the number of users viewing their notes has declined over time as the pandemic subsided. Furthermore, female patients and those aged in their 30s as well as 50s viewed more notes than other groups. Finally, the percentage of notes viewed via a mobile device tended to decrease as a function of increasing age, showing that web-based access of open notes is an important modality for older patients.

Willingness to Be Contacted via a Patient Portal for Health Screening, Research Recruitment, and at-Home Self-Test Kits for Health Monitoring: Pilot Quantitative Survey

Background

Patient portals are being increasingly used by health systems in the United States. Although some patients use portals for clinical use, patient perspectives on using portals for research-related activities, to complete health screenings, and to request at-home self-test kits are unclear.

Objective

We aimed to understand patient perspectives on using electronic health portals for research; health-related screenings; and patient-initiated, home-based self-testing.

Methods

Patients (N=105) from the Patient Engaged Research Center at a large, urban, midwestern health system completed a 23-item web-based survey on patient portal (MyChart) use and willingness to use the patient portal for research, risk assessments, and self-test kits. Frequencies and percentages were generated.

Results

Almost all participants (102/105, 97.1%) had accessed MyChart at least once, with most (44/102, 43.1%) indicating they logged in at least once per month. Participants indicated logging into MyChart to check laboratory results or other health data (89/105, 84.8%), because they received a message to log in (85/105, 81%), and to message their health care professional (83/105, 79%). Fewer participants logged in to see what medications they had been prescribed (16/105, 15.2%) and to learn more about their health conditions (29/105, 27.6%). Most participants indicated logging into MyChart on a computer via a website (70/105, 66.7%) or on a smartphone via an app (54/105, 51.4%). When asked about how likely they would be to participate in different types of research if contacted via MyChart, most (90/105, 85.7%) said they would be likely to answer a survey, fill out a health assessment (87/105, 82.9%), or watch a video (86/105, 81.9%). Finally, participants would be willing to answer risk assessment questions on MyChart regarding sleep (74/101, 73.3%), stress (65/105, 61.9%), diabetes (60/105, 57.1%), anxiety (59/105, 56.2%), and depression (54/105, 51.4%) and would be interested in receiving an at-home self-test kit for COVID-19 (66/105, 62.9%), cholesterol (63/105, 60%), colon cancer (62/105, 59%), and allergies (56/105, 53.3%). There were no significant demographic differences for any results (all P values were >.05).

Conclusions

Patient portals may be used for research recruitment; sending research-related information; and engaging patients to answer risk assessments, read about health information, and complete other clinical tasks. The lack of significant findings based on race and gender suggests that patient portals may be acceptable tools for recruiting research participants and conducting research. Allowing patients to request self-test kits and complete risk assessments in portals may help patients to take agency over their health care. Future research should examine if patient portal recruitment may help address persistent biases in clinical trial recruitment to increase enrollment of women and racial minority groups.

Using patient portals for large-scale recruitment of individuals underrepresented in biomedical research: an evaluation of engagement patterns throughout the patient portal recruitment process at a single site within the All of Us Research Program

OBJECTIVE

To evaluate the use of patient portal messaging to recruit individuals historically underrepresented in biomedical research (UBR) to the All of Us Research Program (AoURP) at a single recruitment site.

MATERIALS AND METHODS

Patient portal-based recruitment was implemented at Columbia University Irving Medical Center. Patient engagement was assessed using patient's electronic health record (EHR) at four recruitment stages: Consenting to be contacted, opening messages, responding to messages, and showing interest in participating. Demographic and socioeconomic data were also collected from patient's EHR and univariate logistic regression analyses were conducted to assess patient engagement.

RESULTS

Between October 2022 and November 2023, a total of 59 592 patients received patient portal messages inviting them to join the AoURP. Among them, 24 445 (41.0%) opened the message, 8983 (15.1%) responded, and 3765 (6.3%) showed interest in joining the program. Though we were unable to link enrollment data with EHR data, we estimate about 2% of patients contacted ultimately enrolled in the AoURP. Patients from underrepresented race and ethnicity communities had lower odds of consenting to be contacted and opening messages, but higher odds of showing interest after responding.

DISCUSSION

Patient portal messaging provided both patients and recruitment staff with a more efficient approach to outreach, but patterns of engagement varied across UBR groups.

CONCLUSION

Patient portal-based recruitment enables researchers to contact a substantial number of participants from diverse communities. However, more effort is needed to improve engagement from underrepresented racial and ethnic groups at the early stages of the recruitment process.

Patient- and Provider-Level Factors Associated with Patient Portal Usage Among Medicaid Recipients

Background: Patient portals can improve access to electronic health information and enhance patient engagement. However, disparities in patient portal utilization remain, affecting disadvantaged communities disproportionately. This study examined patient- and provider-level factors associated with portal usage among Medicaid recipients in a large federally qualified health center (FQHC) network in Texas. Methods: Deidentified electronic medical records of patients 18 years or older from a large Texas FQHC network were analyzed. The dependent variable was a binary flag indicating portal usage during the study period. Independent variables included patient- and provider-level factors. Patient-level factors included sociodemographic, geographic, and clinical characteristics. Provider characteristics included primary service line, provider type, provider language, and years in practice. Because the analysis was at the individual level, a multivariable logistic regression model focused on adjusted associations between independent variables and portal usage. Results: The analytic sample consisted of 9,271 individuals. Compared with individuals 18-39 years, patients 50 years and older had lower odds (50-64 OR: 0.60, p < 0.001; 65+ OR: 0.51, p < 0.001) of portal usage. Males were less likely to use portals (OR: 0.44, p = 0.03), and compared to Non-Hispanic Whites, Non-Hispanic Black (OR: 0.86, p = 0.02) and Hispanics (OR: 0.83, p < 0.001) were significantly less likely to use portals. Individuals with 1 or more telemedicine consults had a two-times greater odds of portal usage (OR: 1.97, p < 0.001). Compared to individuals who had clinic visits in December 2018, portal usage was significantly higher in the pandemic months (March 2020-November 2020, all p's < 0.01). Importantly, the behavioral health service line had the greatest odds (OR: 1.52, p < 0.001), whereas the dental service line had the lowest odds (OR: 0.69, p = 0.01) compared to family practice. No other provider characteristics were significant. Conclusion: Our finding of significant patient-level factors is important and can contribute to developing appropriate patient-focused health information technology approaches to ensure equitable access and maximize the potential benefits of patient portals in health care delivery.

Exploring potential drivers of patient engagement with their health data through digital platforms: A scoping review

BACKGROUND

Patient engagement when providing patient access to health data results from an interaction between the available tools and individual capabilities. The recent digital advancements of the healthcare field have altered the manifestation and importance of patient engagement. However, a comprehensive assessment of what factors contribute to patient engagement remain absent. In this review article, we synthesised the most frequently discussed factors that can foster patient engagement with their health data.

METHODS

A scoping review was conducted in MEDLINE, Embase, and Google Scholar. Relevant data were synthesized within 7 layers using a thematic analysis: (1) social and demographic factors, (2) patient ability factors, (3) patient motivation factors, (4) factors related to healthcare professionals' attitudes and skills, (5) health system factors, (6) technological factors, and (7) policy factors.

RESULTS

We identified 5801 academic and 200 Gy literature records, and included 292 (4.83%) in this review. Overall, 44 factors that can affect patient engagement with their health data were extracted. We extracted 6 social and demographic factors, 6 patient ability factors, 12 patient motivation factors, 7 factors related to healthcare professionals' attitudes and skills, 4 health system factors, 6 technological factors, and 3 policy factors.

CONCLUSIONS

Improving patient engagement with their health data enables the development of patient-centered healthcare, though it can also exacerbate existing inequities. While expanding patient access to health data is an important step towards fostering shared decision-making in healthcare and subsequently empowering patients, it is important to ensure that these developments reach all sectors of the community.

Quality of Answers of Generative Large Language Models Versus Peer Users for Interpreting Laboratory Test Results for Lay Patients: Evaluation Study

BACKGROUND

Although patients have easy access to their electronic health records and laboratory test result data through patient portals, laboratory test results are often confusing and hard to understand. Many patients turn to web-based forums or question-and-answer (Q&A) sites to seek advice from their peers. The quality of answers from social Q&A sites on health-related questions varies significantly, and not all responses are accurate or reliable. Large language models (LLMs) such as ChatGPT have opened a promising avenue for patients to have their questions answered.

OBJECTIVE

We aimed to assess the feasibility of using LLMs to generate relevant, accurate, helpful, and unharmful responses to laboratory test-related questions asked by patients and identify potential issues that can be mitigated using augmentation approaches.

METHODS

We collected laboratory test result-related Q&A data from Yahoo! Answers and selected 53 Q&A pairs for this study. Using the LangChain framework and ChatGPT web portal, we generated responses to the 53 questions from 5 LLMs: GPT-4, GPT-3.5, LLaMA 2, MedAlpaca, and ORCA_mini. We assessed the similarity of their answers using standard Q&A similarity-based evaluation metrics, including Recall-Oriented Understudy for Gisting Evaluation, Bilingual Evaluation Understudy, Metric for Evaluation of Translation With Explicit Ordering, and Bidirectional Encoder Representations from Transformers Score. We used an LLM-based evaluator to judge whether a target model had higher quality in terms of relevance, correctness, helpfulness, and safety than the baseline model. We performed a manual evaluation with medical experts for all the responses to 7 selected questions on the same 4 aspects.

RESULTS

Regarding the similarity of the responses from 4 LLMs; the GPT-4 output was used as the reference answer, the responses from GPT-3.5 were the most similar, followed by those from LLaMA 2, ORCA_mini, and MedAlpaca. Human answers from Yahoo data were scored the lowest and, thus, as the least similar to GPT-4-generated answers. The results of the win rate and medical expert evaluation both showed that GPT-4's responses achieved better scores than all the other LLM responses and human responses on all 4 aspects (relevance, correctness, helpfulness, and safety). LLM responses occasionally also suffered from lack of interpretation in one's medical context, incorrect statements, and lack of references.

CONCLUSIONS

By evaluating LLMs in generating responses to patients' laboratory test result-related questions, we found that, compared to other 4 LLMs and human answers from a Q&A website, GPT-4's responses were more accurate, helpful, relevant, and safer. There were cases in which GPT-4 responses were inaccurate and not individualized. We identified a number of ways to improve the quality of LLM responses, including prompt engineering, prompt augmentation, retrieval-augmented generation, and response evaluation.

Patterns of Access to Radiology Reports and Images Through a Patient Portal

Access to radiology reports and images through a patient portal offers several advantages. The purpose of this study was to characterize patient's interactions with their radiology results. This was a retrospective study that evaluated radiography, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, exams performed between July 2020 and June 2021 for patients aged 12 and older. Exam information, access logs of radiology reports and images, and patient demographics were obtained from the electronic health record and image viewing software. Descriptive statistics were computed. The study included 1,685,239 exams. A total of 54.1% of reports were viewed. MRI and PET reports were viewed with the greatest frequency (70.2% and 67.6%, respectively); 25.5% of exam images were viewed, with the greatest frequency for MRI (40.1%). Exams were shared a total of 17,095 times and downloaded 8409 times; 64% of reports were viewed for patients aged 18-39 and 34% for patients aged 80 and greater. The rate of reports viewed was greater for patients with English as their preferred language (57.1%) compared to other languages (33.3%). Among those viewed, 56.5% of reports and 48.2% of images were viewed multiple times; 72.8% of images were viewed on smartphones, 25.8% on desktop computers, and 1.4% on tablets. Patients utilize a portal to view reports and view and share images. Continued efforts are warranted to promote the use of portals and create patient-friendly imaging results to help empower patients.

Patient Portal Enrollment for Discharged Pediatric Emergency Department Patients: A Multidisciplinary Quality Improvement Project

Introduction

Patient portal enrollment following pediatric emergency department (ED) visits allows access to critical results, physician documentation, and telehealth follow-up options. Despite these advantages, there are many challenges to portal invitation and enrollment. Our primary objective was to improve patient portal enrollment rates for discharged pediatric ED patients.

Methods

A multidisciplinary team of staff from two ED sites developed successful portal enrollment interventions through sequential Plan-Do-Study-Act cycles from October 2020 to October 2021. Interventions included a new invitation process, changes to patient paperwork on ED arrival, staff portal education, and changes to discharge paperwork and the portal website. The team utilized statistical process control charts to track the percentage of eligible discharged patients who received a portal invitation (process measure) and enrolled in the patient portal.

Results

Before the study's initiation, less than 1% of eligible patients received patient portal invites or enrolled in the patient portal. Statistical process control charts revealed significant changes in enrollment and baseline shift at both a large academic ED campus and a satellite ED site by May 2021. Improvements in invitation rates were also observed at both campuses. Changes were sustained for over 6 months at both locations.

Conclusions

High-reliability interventions and a multidisciplinary approach allowed for significant and sustained improvement in patient portal invitation and enrollment rates in eligible pediatric ED patients. Future study will examine enrollment patterns across patient demographics and further high-reliability interventions.

Annotation and Information Extraction of Consumer-Friendly Health Articles for Enhancing Laboratory Test Reporting

Viewing laboratory test results is patients' most frequent activity when accessing patient portals, but lab results can be very confusing for patients. Previous research has explored various ways to present lab results, but few have attempted to provide tailored information support based on individual patient's medical context. In this study, we collected and annotated interpretations of textual lab result in 251 health articles about laboratory tests from AHealthyMe.com. Then we evaluated transformer-based language models including BioBERT, ClinicalBERT, RoBERTa, and PubMedBERT for recognizing key terms and their types. Using BioPortal's term search API, we mapped the annotated terms to concepts in major controlled terminologies. Results showed that PubMedBERT achieved the best F1 on both strict and lenient matching criteria. SNOMED CT had the best coverage of the terms, followed by LOINC and ICD-10-CM. This work lays the foundation for enhancing the presentation of lab results in patient portals by providing patients with contextualized interpretations of their lab results and individualized question prompts that they can, in turn, refer to during physician consults.

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

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.

An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis

BACKGROUND

Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited.

OBJECTIVE

This study aimed to explore the factors associated with portal messaging use by rural patients.

METHODS

We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density.

RESULTS

A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income.

CONCLUSIONS

Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.

Impact of a switch to immediate release on the patient viewing of diagnostic test results in an online portal at an academic medical center

Patient portals allow patients to access their personal health information. The 21st Century Cures Act in the United States sought to eliminate 'information blocking', requiring timely release upon request of electronic health information including diagnostic test results. Some health systems, including the one in the present study, chose a systematic switch to immediate release of all or nearly all diagnostic test results to patient portals as part of compliance with the Cures Act. Our primary objective was to study changes in the time to view test results by patients before and after implementation of Cures Act-related changes. This retrospective pre-post study included data from two 10-month time periods before and after implementation of Cures Act-related changes at an academic medical center. The study included all patients (adult and pediatric) with diagnostic testing (laboratory and imaging) performed in the outpatient, inpatient, or emergency department settings. Between February 9, 2020 and December 9, 2021, there was a total of 3 809 397 diagnostic tests from 204 605 unique patients (3 320 423 tests for adult patients; 488 974 for pediatric patients). Overall, 56.5% (115 627) of patients were female, 84.1% (172 048) white, and 96.5% (197 517) preferred English as primary language. The odds of viewing test results within 1 and 30 days after portal release increased monthly throughout both time periods before and after the Cures Act for all patients. The rate of increase was significantly higher after implementation only in the subgroup of tests belonging to adult patients with active MyChart accounts. Immediate release shifted a higher proportion of result/report release to weekends (3.2% pre-Cures vs 15.3% post-Cures), although patient viewing patterns by day of week and time of day were similar before and after immediate release changes. The switch to immediate release of diagnostic test results to the patient portal resulted in a higher fraction of results viewed within 1 day across outpatient, inpatient, and emergency department settings.

Patterns of Health Portal Use by Regular Portal Users Among Patients With Cancer: Results From the UWCCC Survivorship Program

PURPOSE

We sought to evaluate the patterns of portal usage among patients with cancer who regularly log in to the portal. These data will inform approaches to facilitate portal use among patients with cancer.

PATIENTS AND METHODS

We conducted a retrospective analysis of patient portal usage by patients with cancer at the University of Wisconsin Carbone Cancer Center. Our analysis focuses on patterns of portal use by regular users (≥ 2 portal logins/year, > 3 months) receiving ongoing oncology care between January 1, 2017, and December 31, 2019. Demographics, cancer characteristics, number of oncology visits per month, and portal usage data were extracted. Regular portal users were grouped and compared on the basis of their frequency of use. A linear mixed-effects model was used to determine if the frequency of oncology visits influenced the number of logins.

RESULTS

We identified 2076 regular portal users. The median number of portal logins/year was 72 for the entire cohort. Age and race were associated with frequency of portal logins. There was no difference in frequency of portal login on the basis of cancer type or stage. Each additional oncology office visit in a month increased the frequency of portal logins by 3.05 ± 0.11 (SE) within the same month. Messages and test result functionalities were used by 98.7% and 98.9% of the regular users, respectively. Regular users who logged in to portal more frequently used all five studied portal functionalities.

CONCLUSION

Patients with cancer who use portals regularly use it more in proximity to an oncology office visit and use multiple available portal functionalities. These findings can direct strategic planning to facilitate portal utilization among those not engaged with this tool.

The association between information technology sophistication and patient portal use: A cross sectional study in Eastern North Carolina

Even with the extolled benefits of patient portals, there has been some challenges to ensuring patient portal use. This study examines if a patient's level of information technology (IT) sophistication, defined as the degree of use of diverse information technologies by an individual, is associated with their use of a patient portal. Patients previous experience and exposure to other similar technologies like desktop computer, laptop, internet, smart phone, or social media explains their willingness to use information technology for their health. Data on a cross-sectional survey of 565 individuals in Eastern NC was available for analysis. Multinomial regression analyses revealed that IT sophistication is important in determining whether patients will use a patient portal. It specifies that patients with low IT sophistication compared to those with high IT sophistication were more likely to have never activated their patient portals (RRR = 2.2155, p < 0.009), or to have activated but never used a patient portal (RRR = 3.5869, p < 0.010). The findings of this study should aid healthcare leaders as they strive to improve patient engagement. They should continue to promote the benefits of the patient portal and consider offering personalized support programs for patients with low IT sophistication.

Patients Managing Their Medical Data in Personal Electronic Health Records: Scoping Review

BACKGROUND

Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients' medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR.

OBJECTIVE

This scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients' health and health care services.

METHODS

We searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query.

RESULTS

Of the 182 eligible papers, 37 (20%) provided sufficient information about patients' data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients' passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction.

CONCLUSIONS

The findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.

Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis

BACKGROUND

The patient portal allows patients to engage with their health care team beyond the clinical encounter. While portals can improve patient outcomes, there may be disparities in which patients access the portal by sociodemographic factors. Understanding the characteristics of patients who use the portal could help design future interventions to expand portal adoption.

OBJECTIVES

This study aimed to (1) examine the socioeconomic factors, comorbid conditions, and health care utilization among patients of a large academic primary care network who are users and non-users of the patient portal; and (2) describe the portal functions most frequently utilized.

METHODS

We included all adult patients at Atrium Health Wake Forest Baptist who had at least two primary care visits between 2018 and 2019. Patients' demographics, comorbidities, health care utilization, and portal function usage were extracted from the electronic health record and merged with census data (income, education, and unemployment) from the American Community Survey. A myWakeHealth portal user was defined as a patient who used a bidirectional portal function at least once during the study period. We used multivariable logistic regression to determine which patient characteristics were independently associated with being a portal user.

RESULTS

Of the 178,720 patients who met inclusion criteria, 32% (N = 57,122) were users of myWakeHealth. Compared to non-users, users were more likely to be 18 to 64 years of age, female, non-Hispanic White, married, commercially insured, have higher disease burden, and have lower health care utilization. Patients residing in areas with the highest educational attainment had 51% higher odds of being a portal user than the lowest (p <0.001). Among portal users, the most commonly used function was messaging clinic providers.

CONCLUSION

We found that patient demographics and area socioeconomic factors were associated with patient portal adoption. These findings suggest that efforts to improve portal adoption should be targeted at vulnerable patients.

Secure Messaging and COVID-19: A Content Analysis of Patient-Clinician Communication During the Pandemic

Background: Coronavirus disease 2019 (COVID-19) immediately impacted patient-clinician communication, particularly in the oncology setting. Relatedly, secure messaging (SM) usage greatly increased, yet it is unknown what was discussed and whether the technology was utilized to disseminate information. Aims: This study aimed at identifying the most frequently discussed topics using SM as well as at understanding how the communication process transpired during the early stages of the pandemic. Materials and Methods: A mixed-methods design was utilized, consisting of a content analysis of more than 4,200 secure messages, aggregated into 1,454 patient-clinician discussions. Data were collected from February 2020 to May 2020. Discussions were from various oncology departments and included physicians, physician assistants, and nurses. Based on the identified categories, a thematic analysis was conducted to understand the nuances occurring within discussions. Results: Out of the 1,454 discussions, 26% (n = 373) related to COVID-19. Of the COVID-19 discussion, the most frequently coded category was "changes, adjustments, and re-arranging care" (65%, n = 241), followed by "risk for COVID-19" (24%, n = 90), "precautions inside the hospital" (18%, n = 66), and "precautions outside the hospital" (14%, n = 52). Natural language processing techniques were used to confirm the validity of the results. Thematic analysis revealed that patients were proactive in rescheduling appointments, expressed anxiety about being immunocompromised, and clinicians were uncertain about providing recommendations related to COVID-19. Conclusions: The COVID-19 outbreak revealed the need for responsive and effective public health communication. The SM can disseminate information from trusted sources, clinicians, but can be better utilized to deliver tailored information for specific patient populations.

Changes in patient portal adoption due to the emergence of COVID-19 pandemic

Even though patient portals are recognized as a promising mechanism to support greater patient engagement, questions remain about access and utilization. This study aims to identify factors related to portal adoption in 2019 and 2020 (before and during the COVID-19). Cross-sectional data from the Health Information National Trends Survey (HINTS) cycles- 2019 HINTS 5 cycle 3 (N = 5,438) and 2020 HINTS 5 cycle 4 (N = 3,865) were analyzed using STATA-SE version 17 to factors predicting portal adoption. Next, HINTS 5 cycles 3 and 4 were pooled to identify changes in portal feature use and ease of usage among portal users, and barrier to portal use among non-users. Respondents who were college graduates, high income, and married were more likely to adopt patient portals during 2019 and 2020. Aged 75+ and Hispanic respondents reported less frequency of portal access in 2020 versus 2019. Men were more likely to adopt patient portals in 2019 versus women in 2020. Portal users were more likely to use the portal-system features in 2019 versus 2020. Portal non-users reported having multiple-health records as less of a barrier in 2020 compared to 2019. Patient engagement needs heightened attention during the COVID-19 pandemic.

Outpatient portal use in prenatal care: differential use by race, risk, and area social determinants of health

To report the relationship of outpatient portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women. Regression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using log files and clinical data. Overall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like Visit (scheduling) and My Record (test results). We also found significant interactive associations between race/ethnicity, clinical risk, and SDoH. Non-Hispanic Black women and those living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas. More research must be conducted to learn of OPP use implications for pregnant women with specific clinical diagnoses.

The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review

Background

Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear.

Objective

The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction.

Methods

We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes.

Results

Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal.

Conclusions

Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency.

Patterns and predictors of cancer-specific patient health portal usage among patients with cancer: results from the UWCCC Survivorship Program

Background

Portals can assist patients in managing their healthcare. Understanding how patients with cancer use portals can facilitate improvements in patient engagement in cancer care. This study sought to determine if patients with cancer used portals differently for cancer versus noncancer purposes. The effects of geographic residence (rural vs. urban residence) and cancer stage on portal usage were also investigated.

Methods

We conducted a retrospective analysis of portal usage by patients seen at an NCI‐designated cancer center between 2015 and 2019. Demographics, cancer characteristics, and portal usage (number of successful logins, messages sent, and results viewed) were extracted. Messages sent and results viewed in the portal were deemed oncologist‐specific and cancer specific if sent to or ordered in medical oncology departments, respectively.

Results

The analysis included a total of 5950 patients with cancer. Patients were less likely to send and view oncologist‐specific messages compared to non‐oncologist‐specific messages. They were also less likely to view cancer results compared to noncancer results. Compared to urban counterparts, patients residing in rural areas had lower odds of having any logins and logged in less frequently during the year of diagnosis. Compared to patients with non‐metastatic disease, individuals with metastatic disease were more likely to become frequent portal users.

Conclusions

Patients may use portals differently for cancer versus noncancer purposes; urban residence and metastatic cancer were associated with more frequent usage. Further investigation can inform interventions to increase accessibility for groups at a disadvantage related to the use of this technology and to help patients better leverage portals to manage their cancer.

Pharmacy Customers' Experiences of Use, Usability, and Satisfaction of a Nationwide Patient Portal: Survey Study

Background

Patient portals have been introduced in several countries in the last few decades. Despite worldwide objectives of introducing patient portals, nationwide portals are rare, and studies about their use are limited. Finland is one of the forerunners in developing nationwide health data systems. A nationwide patient portal, My Kanta, for viewing electronic prescriptions and health data has been phased in, starting in 2010.

Objective

The aim of this study was to investigate what functions Finnish pharmacy customers use in My Kanta, their perceptions of the service’s usability, and how satisfied users are with My Kanta overall.

Methods

In spring 2019, questionnaires (N=2866) were distributed from 18 pharmacies of varying size across mainland Finland to adult pharmacy customers purchasing prescription medications for themselves or for their child under 18 years of age. Questions were asked about the use and usability of the patient portal by means of structured and Likert-scale questions. Statistical analyses included frequencies, means, medians, chi-square tests, Fisher exact tests, and Kruskal-Wallis tests.

Results

In total, 994 completed questionnaires of 2866 delivered questionnaires (34.68%) were returned. The most-used My Kanta functions were browsing prescription information (781/802, 97.4%), records of health care visits (772/802, 96.3%), and results of laboratory tests and x-ray examinations (722/804, 89.8%). Most users (558/793, 70.4%) had also requested a prescription renewal using the service. My Kanta was perceived as easy to log into (772/816, 94.6%) and clear to view (709/808, 87.7%). Most users considered the service useful for monitoring their health information (753/813, 92.6%) and felt that it provides a good overall picture of the medications prescribed to them (711/813, 87.5%). The majority of users found the information recorded about them easy to understand (684/800, 85.5%). Of the users, 16.7% (135/807) disagreed with the statement that the information they were looking for was easy to find. Approximately two-thirds (501/814, 61.5%) of users did not know whether it is easy to view in which pharmacies and health care units their prescription information has been viewed, and over one-third (306/805, 38.0%) did not know whether it is easy to view in which health care units their health information has been processed. Approximately one-fifth of participants (181/805, 22.5%) feared that unauthorized persons might view their information and that their electronically saved prescription and health information might disappear (180/810, 22.2%). In addition, 16.1% (129/799) expressed interest in receiving guidance on My Kanta use. The vast majority of users (719/804, 89.4%) were satisfied with the service overall.

Conclusions

Pharmacy customers were satisfied with the nationwide patient portal. It was mostly used for browsing e-prescriptions and medical records. Overall, the usability of the service was good. However, users need to be better informed about data privacy and security issues, and guidance on using the portal needs to be improved.

Patient Portals: Useful for Whom and for What? A Cross-Sectional Analysis of National Survey Data

BACKGROUND

Patients who use patient portals may be more engaged and empowered in their care; however, differences in who accesses patient portals remain. The characteristics of who uses patient portals more frequently and who perceives them as useful may also differ, as well as which functions people use.

OBJECTIVE

We assessed the characteristics of patient portal users to examine who uses them more frequently and who perceives them as useful. In addition, we wanted to see if those who use them more frequently or perceive them to be more useful use different functions or more functions of patient portals.

METHODS

Pooled cross-sectional data from 2017 to 2018 Health Information National Trends Survey (HINTS) were used. Ordinal regression models were developed to assess frequency of use and perceived usefulness by demographics, and multivariable logistic regression models were used to examine the association between the use of 10 patient portal functions and frequency of use and perceived usefulness of patient portals.

RESULTS

The odds of using patient portals more frequently were higher among those with Bachelor's degrees, incomes between $35,000 and $75,000, and those with two or more chronic conditions. Respondents with three or more chronic conditions had higher odds of rating patient portals as useful. Those who used their patient portal 10 or more times in the past year had higher odds of using all functions except for viewing test results compared with those who used their patient portal one to two times per year. Those who rated patient portals as "very useful" had higher odds of using seven of the functions compared with those who rated them "not very"/"not at all useful."

CONCLUSION

It is important to continue to assess usefulness, frequency of use, and overall patient portal function use to identify opportunities to increase patient engagement with patient portals.

An Internet-Based Intervention for Cardiovascular Disease Management Integrated With Primary Care Electronic Health Records: Mixed Methods Evaluation of Implementation Fidelity and User Engagement

Background

Growing evidence supports the benefits of eHealth interventions to increase patient engagement and improve outcomes for a range of conditions. However, ineffective program delivery and usage attrition limit exposure to these interventions and may reduce their effectiveness.

Objective

This study aims to evaluate the delivery fidelity of an eHealth intervention, describe use patterns, compare outcomes between low and high users, and identify mediating factors on intervention delivery and receipt.

Methods

This is a mixed methods study of an internet-based intervention being evaluated for effectiveness in a randomized controlled trial (RCT). The intervention comprised medication and cardiovascular disease (CVD) risk data uploaded from the primary care electronic health record (EHR); interactive, personalized CVD risk score estimation; goal setting and self-monitoring; an interactive social forum; and optional receipt of heart health messages. Fidelity was assessed over 12 months. Trial outcomes were compared between low and high users. Data sources included program delivery records, web log data, trial data, and thematic analysis of communication records.

Results

Most participants in the intervention group (451/486, 93%) had an initial training session conducted by telephone (413/447, 92.4% of participants trained), with a mean duration of 44 minutes (range 10-90 minutes). Staff conducted 98.45% (1776/1804) of the expected follow-ups, mostly by telephone or email. Of the 451 participants who commenced log-ins, 46.8% (211) were categorized as low users (defined as at least one log-in in 3 or fewer months of follow-up), 40.4% (182) were categorized as high users (at least one log-in in more than 3 months of follow-up), and 12.8% (58) were nonadopters (no log-ins after their training session). The mean log-in frequency was 3-4 per month in ongoing users. There was no significant difference between the groups in the primary trial outcome of adherence to guideline-recommended medications (P=.44). In unadjusted analyses, high users had significantly greater eHealth literacy scores (P=.003) and were more likely to meet recommended weekly targets for fruit (P=.03) and fish (P=.004) servings; however, the adjusted findings were not significant. Interactive screen use was highest for goal tracking and lowest for the chat forum. Screens with EHR-derived data held only an early interest for most users. Fidelity measures (reach, content, dose delivered, and dose received) were influenced by the facilitation strategies used by staff, invisible qualities of staff-participant communication, and participants’ responsiveness to intervention attributes.

Conclusions

A multifeature internet-based intervention was delivered with high fidelity to the RCT protocol and was regularly used by 40.4% (182/451) of users over 12 months. Higher log-in frequency as an indicator of greater intervention exposure was not associated with statistically significant improvements in eHealth literacy scores, lifestyle changes, or clinical outcomes. Attributes of the intervention and individualized support influenced initial and ongoing use.

Technological and informational frames: explaining age-related variation in the use of patient accessible electronic health records as technology and information

Purpose

Data from a national patient survey (N = 1,155) of the Swedish PAEHR “Journalen” users were analysed, and an extended version of the theory of technological frames was developed to explain the variation in the technological and informational framing of information technologies found in the data.

Design/methodology/approach

Patient Accessible Electronic Health Records (PAEHRs) are implemented globally to address challenges with an ageing population. However, firstly, little is known about age-related variation in PAEHR use, and secondly, user perceptions of the PAEHR technology and the health record information and how the technology and information–related perceptions are linked to each other. The purpose of this study is to investigate these two under-studied aspects of PAEHRs and propose a framework based on the theory of technological frames to support studying the second aspect, i.e. the interplay of information and technology–related perceptions.

Findings

The results suggest that younger respondents were more likely to be interested in PAEHR contents for general interest. However, they did not value online access to the information as high as older ones. Older respondents were instead inclined to use medical records information to understand their health condition, prepare for visits, become involved in their own healthcare and think that technology has a much potential. Moreover, the oldest respondents were more likely to consider the information in PAEHRs useful and aimed for them but to experience the technology as inherently difficult to use.

Research limitations/implications

The sample excludes non-users and is not a representative sample of the population of Sweden. However, although the data contain an unknown bias, there are no specific reasons to believe that it would differently affect the survey's age groups.

Practical implications

Age should be taken into account as a key factor that influences perceptions of the usefulness of PAEHRs. It is also crucial to consider separately patients' views of PAEHRs as a technology and of the information contained in the EHR when developing and evaluating existing and future systems and information provision for patients.

Social implications

This study contributes to bridging the gap between information behaviour and systems design research by showing how the theory of technological frames complemented with parallel informational frames to provide a potentially powerful framework for elucidating distinct conceptualisations of (information) technologies and the information they mediate. The empirical findings show how information and information technology needs relating to PAEHRs vary according to age. In contrast to the assumptions in much of the earlier work, they need to be addressed separately.

Originality/value

Few earlier studies focus on (1) age-related variation in PAEHR use and (2) user perceptions of the PAEHR technology and the health record information and how the technology and information–related perceptions are linked to each other.

The Causal Relationship Between Portal Usage and Self-Efficacious Health Information-Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data

Background

Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients’ health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals.

Objective

The aim of this study was to examine the causal relationship between the usage of patient portals and patients’ self-efficacy toward obtaining health information and performing self-care.

Methods

This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients’ confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method.

Results

We showed that frequently using patient portals improves patients’ confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients’ confidence in exercising self-care.

Conclusions

The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies.

Preferred Functions of Personal Health Records in Rural Primary Health Clinics in Canada: Health Care Team Perspectives

BACKGROUND

Personal health records (PHR) provide opportunities for improved patient engagement, collection of patient-generated data, and overcome health-system inefficiencies. While PHR use is increasing, uptake in rural populations is lower than in urban areas.

OBJECTIVES

The study aimed to identify priorities for PHR functionality and gain insights into meaning, value, and use of patient-generated data for rural primary care providers.

METHODS

We performed PHR preimplementation focus groups with rural providers and their health care teams from five primary care clinics in a sparsely populated mountainous region of British Columbia, Canada to obtain their understanding of PHR functionality, needs, and perceived challenges.

RESULTS

Eight general practitioners (GP), five medical office assistants, two nurse practitioners (NP), and two registered nurses (14 females and 3 males) participated in focus groups held at their respective clinics. Providers (GPs, NPs, and RNs) had been practicing for a median of 9.5 (range = 1-38) years and had used an electronic medical record for 7.0 (1-20) years. Participants expressed interest in incorporating functionality around two-way communication and appointment scheduling, previsit data gathering, patient and provider data sharing, virtual care including visits using videoconferencing tools, and postvisit sharing of educational materials. Three further themes emerged from the focus groups: (1) the context in which the providers' practice matters, (2) the need for providing patients and providers with choice (e.g., which data to share, who gets to initiate/respond in communications, and processes around virtual care visits), and (3) perceived risks of system use (e.g., increased complexity for older patients and workload barriers for the health care team).

CONCLUSION

Rural primary care teams perceived PHR opportunities for increased patient engagement and access to patient-generated data, while worries about changes in workflow were the biggest perceived risk. Recommendations for PHR adoption in a rural primary health network include setting provider-patient expectations about response times, ability to share notes selectively, and automatically augmented note-taking from virtual-care visits.

Pediatric patient portal use in one health system

OBJECTIVE

The study sought to assess, for children in one large health system, (1) characteristics of active users of the patient portal (≥1 use in prior 12 months), (2) portal use by adolescents, and (3) variations in pediatric patient portal use.

MATERIALS AND METHODS

We analyzed data from the electronic health record regarding pediatric portal use during 2017-2018 across a health system (39 871 pediatric patients).

RESULTS

Altogether, 63.5% of pediatric patients were active portal users. Children (proxies) who were boys, privately insured, white, and spoke English were more likely to be active users. Common uses involved messaging with physicians, medications, allergies, letters, and laboratory results. By 15 years of age, >50% of adolescents used the portal by themselves (without a proxy). Pediatric portal use varied widely across practices.

DISCUSSION

Pediatric or adolescent portal use is quite high, but large variations exist.

CONCLUSION

Use of the portal for pediatric care may reflect varying pediatric patient engagement.

Patient Portal Functionalities and Uptake: Systematic Review Protocol

Background

Patient portals are digital health tools adopted by health care organizations. The portals are generally connected to the electronic health record of the health care organization and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments, or message the health care provider. Patient portals may be beneficial for both patients and the health care system. Patient portals can widely differ from one context to another due to the differences in the portal functionalities and capabilities and it is anticipated that outcomes associated with the functionalities also differ. Current systematic reviews report outcomes associated with patient portal uptake but do not explicitly specify the patient portal functionalities.

Objective

The aim of this systematic review is to synthesize the evidence on health and health care quality outcomes associated with patient portal use among adult (18 years or older) patients. The review research questions are as follows: What kind of health outcomes do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? and What kind of health care quality outcomes, including health care utilization outcomes, do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)?

Methods

The systematic review will be conducted by searching the MEDLINE, EMBASE, and Scopus databases for relevant literature. The review inclusion criteria will be studies about adult patients (18 years or older), studies only about tethered patient portals, and studies with or without a comparator. We will report patient portal–associated health and health care quality outcomes based on the patient portal functionalities. All quantitative primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials and the National Heart, Lung, and Blood Institute’s quality assessment tools. Data will be synthesized using narrative synthesis and will be reported according to the patient portal functionalities, country, disease, and health care system model.

Results

Searches will be conducted in September 2019, and the review is anticipated to be completed by the end of June 2020.

Conclusions

This systematic review will provide an overview of health and health care quality outcomes associated with patient portal use among adult patients, providing detailed information about the functionalities of the portals and their associations with the outcomes. The review could potentially help patient portal evaluation studies by providing insights into outcomes associated with the different functionalities of patient portals.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141131

International Registered Report Identifier (IRRID)

PRR1-10.2196/14975

Analysis of Employee Patient Portal Use and Electronic Health Record Access at an Academic Medical Center

BACKGROUND

Patient portals provide patients and their caregivers online access to limited health results. Health care employees with electronic health record (EHR) access may be able to view their health information not available in the patient portal by looking in the EHR.

OBJECTIVE

In this study, we examine how employees use the patient portal when they also have access to the tethered EHR.

METHODS

We obtained patient portal and EHR usage logs corresponding to all employees who viewed their health data at our institution between January 1, 2013 and November 1, 2017. We formed three cohorts based on the systems that employees used to view their health data: employees who used the patient portal only, employees who viewed health data in the EHR only, and employees who used both systems. We compared system accesses and usage patterns for each employee cohort.

RESULTS

During the study period, 35,172 employees accessed the EHR as part of patients' treatment and 28,631 employees accessed their health data: 25,193 of them used the patient portal and 13,318 accessed their clinical data in EHR. All employees who accessed their records in the EHR viewed their clinical notes at least once. Among EHR accesses, clinical note accesses comprised more than 42% of all EHR accesses. Provider messaging and appointment scheduling were the most commonly used functions in the patient portal. Employees who had access to their health data in both systems were more likely to engage with providers through portal messages.

CONCLUSION

Employees at a large medical center accessed clinical notes in the EHR to obtain information about their health. Employees also viewed other health data not readily available in the patient portal.

Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development

BACKGROUND

Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients' use of an outpatient portal to examine how patients engage with the tool.

OBJECTIVE

This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool.

METHODS

Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame.

RESULTS

Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function.

CONCLUSIONS

In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.