1
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Madanian S, Nakarada-Kordic I, Reay S, Chetty T. Patients' perspectives on digital health tools. PEC INNOVATION 2023; 2:100171. [PMID: 37384154 PMCID: PMC10294099 DOI: 10.1016/j.pecinn.2023.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
Objective Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake. Methods A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively. Results Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology. Conclusion Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies. Innovation Participatory design approaches have the potential to support the creation of patient-centred digital health tools.
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Affiliation(s)
- Samaneh Madanian
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), 6 St. Paul Street, AUT WZ Building, Auckland 1010, New Zealand
| | - Ivana Nakarada-Kordic
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
| | - Stephen Reay
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
| | - T'heniel Chetty
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
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2
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LeLaurin JH, Nguyen OT, Thompson LA, Hall J, Bian J, Cho HD, Acharya R, Harle CA, Salloum RG. Disparities in Pediatric Patient Portal Activation and Feature Use. JAMIA Open 2021; 4:ooab086. [PMID: 34604712 PMCID: PMC8480543 DOI: 10.1093/jamiaopen/ooab086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.
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Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Oliver T Nguyen
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jaclyn Hall
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Hee Deok Cho
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ratna Acharya
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
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3
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Moqbel M, Hewitt B, Nah FFH, McLean RM. Sustaining Patient Portal Continuous Use Intention and Enhancing Deep Structure Usage: Cognitive Dissonance Effects of Health Professional Encouragement and Security Concerns. INFORMATION SYSTEMS FRONTIERS : A JOURNAL OF RESEARCH AND INNOVATION 2021; 24:1483-1496. [PMID: 34177359 PMCID: PMC8215097 DOI: 10.1007/s10796-021-10161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Sustaining patient portal use is a major problem for many healthcare organizations and providers. If this problem can be successfully addressed, it could have a positive impact on various stakeholders. Through the lens of cognitive dissonance theory, this study investigates the role of health professional encouragement as well as patients' security concerns in influencing continuous use intention and deep structure usage among users of a patient portal. The analysis of data collected from 177 patients at a major medical center in the Midwestern region of the United States shows that health professional encouragement helps increase the continuous use intention and deep structure usage of the patient portal, while security concerns impede them. Interestingly, health professional encouragement not only has a direct positive influence on continuous use intention and deep structure usage but also lowers the negative impact of security concerns on them. The research model explains a substantial variance in continuous use intention (i.e., 40%) and deep structure usage (i.e., 32%). The paper provides theoretical implications as well as practical implications to healthcare managers and providers to improve patient portal deep structure usage and sustained use for user retention.
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Affiliation(s)
- Murad Moqbel
- Information Systems Department, University of Texas Rio Grande Valley, Edinburg, TX USA
| | - Barbara Hewitt
- Health Information Management Department, Texas State University, San Marcos, TX USA
| | - Fiona Fui-Hoon Nah
- Department of Business and Information Technology, Missouri University of Science and Technology, Rolla, MO USA
| | - Rosann M. McLean
- Department of Health Information Management, University of Kansas Medical Center, Kansas City, KS USA
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4
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Cemballi AG, Karter AJ, Schillinger D, Liu JY, McNamara DS, Brown W, Crossley S, Semere W, Reed M, Allen J, Lyles CR. Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study. J Am Med Inform Assoc 2020; 28:1252-1258. [PMID: 33236117 DOI: 10.1093/jamia/ocaa281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
The substantial expansion of secure messaging (SM) via the patient portal in the last decade suggests that it is becoming a standard of care, but few have examined SM use longitudinally. We examined SM patterns among a diverse cohort of patients with diabetes (N = 19 921) and the providers they exchanged messages with within a large, integrated health system over 10 years (2006-2015), linking patient demographics to SM use. We found a 10-fold increase in messaging volume. There were dramatic increases overall and for patient subgroups, with a majority of patients (including patients with lower income or with self-reported limited health literacy) messaging by 2015. Although more physicians than nurses and other providers messaged throughout the study, the distribution of health professions using SM changed over time. Given this rapid increase in SM, deeper understanding of optimizing the value of patient and provider engagement, while managing workflow and training challenges, is crucial.
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Affiliation(s)
- Anupama Gunshekar Cemballi
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Andrew J Karter
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - William Brown
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
| | - Scott Crossley
- Department of Applied Linguistics and ESL, Georgia State University, Atlanta, Georgia, USA
| | - Wagahta Semere
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jill Allen
- Kaiser Research Insights and Operations, Kaiser Permanente, Pleasanton, California, USA
| | - Courtney Rees Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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5
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Ivynian SE, Newton PJ, DiGiacomo M. Patient preferences for heart failure education and perceptions of patient–provider communication. Scand J Caring Sci 2020; 34:1094-1101. [DOI: 10.1111/scs.12820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Serra E. Ivynian
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Faculty of Health University of Technology Sydney Ultimo NSW Australia
| | | | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Faculty of Health University of Technology Sydney Ultimo NSW Australia
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Mold F, Hendy J, Lai YL, de Lusignan S. Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Med Inform 2019; 7:e13042. [PMID: 31793888 PMCID: PMC6918214 DOI: 10.2196/13042] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.
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Affiliation(s)
- Freda Mold
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Jane Hendy
- Brunel Business School, Brunel University London, Uxbridge, United Kingdom
| | - Yi-Ling Lai
- Faculty of Business and Law, University of Portsmouth, Portsmouth, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
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7
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McCleary NJ, Greenberg TL, Barysauskas CM, Guerette EJ, Hassan M, Jacobson JO, Schrag D. Oncology Patient Portal Enrollment at a Comprehensive Cancer Center: A Quality Improvement Initiative. J Oncol Pract 2019; 14:e451-e461. [PMID: 30096276 DOI: 10.1200/jop.17.00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Patient portals (PPs) provide patients access to their electronic health record and may facilitate active engagement in their care. Because PP use has not been well studied among patients with cancer, we sought to: understand the willingness of patients with cancer to use the PP, identify barriers to PP use, and improve PP accessibility. MATERIALS AND METHODS As part of an institutional quality improvement initiative, we used a stakeholder-driven approach to examine PP use at the Dana-Farber Cancer Institute (Boston, MA). We conducted a survey across all ambulatory oncology practices as well as staff and patient focus groups in one ambulatory practice. We deployed three interventions to address barriers: staff education, staff-assisted enrollment support, and independent enrollment support. RESULTS In October 2015, 1,019 (87%) of 1,178 eligible patients completed the survey (PP enrolled, 57%; non-PP enrolled, 43%). PP-enrolled patients reported reviewing test results and appointment schedules. Non-PP-enrolled patients cited difficult PP enrollment, lack of computer access, and concern about sharing data electronically as barriers to PP enrollment. Focus groups (staff, n = 20; patient representatives, n = 5) also identified lack of awareness of PP benefits as a barrier. The interventions, deployed from November to December 2015, increased PP enrollment from 47% to 53% by January 2016. CONCLUSION Patients with cancer want to communicate with their team through the PP, but barriers to enrollment impede use. Straightforward system-level interventions may increase enrollment. Further work is necessary to ascertain the degree to which increased PP enrollment leads to greater engagement and better outcomes.
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Affiliation(s)
- Nadine J McCleary
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Teresa L Greenberg
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | | | - Elissa J Guerette
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Malyun Hassan
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Joseph O Jacobson
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Deborah Schrag
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
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8
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Abd-alrazaq AA, Bewick BM, Farragher T, Gardner P. Factors that affect the use of electronic personal health records among patients: A systematic review. Int J Med Inform 2019; 126:164-175. [DOI: 10.1016/j.ijmedinf.2019.03.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/14/2018] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
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Metting E, Schrage AJ, Kocks JW, Sanderman R, van der Molen T. Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study. JMIR Form Res 2018; 2:e22. [PMID: 30684436 PMCID: PMC6334706 DOI: 10.2196/formative.8822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 04/27/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. OBJECTIVE This study aimed to obtain and present an overview of patients' perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. METHODS We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. RESULTS We included 29 patients (16/29, 55% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14%), whereas others used internet >3 times a week (23/29, 79%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals. CONCLUSIONS Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers.
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Affiliation(s)
- Esther Metting
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Aaltje Jantine Schrage
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Janwillem Wh Kocks
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Robbert Sanderman
- GZW-Health Psychology-GZW-General, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Thys van der Molen
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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10
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Bush RA, Barlow H, Pérez A, Vazquez B, Mack J, Connelly CD. Internet Access Influences Community Clinic Portal Use. Health Equity 2018; 2:161-166. [PMID: 30283863 PMCID: PMC6110185 DOI: 10.1089/heq.2018.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To assess whether individuals attending a community clinic had the necessary Internet access and experience to use the patient portal, while examining covariates of education, income, and self-perception of health with past and anticipated portal use. Methods: Adults attending an urban, community primary care clinic were invited to participate in a brief survey assessing current Internet access and use, past portal use, and anticipated future portal use. Survey responses were analyzed using descriptive and multivariate statistics. Results: One hundred fifteen participants ranging in age from 18 to 84 years (mean 42.1, standard deviation 17.1) completed the survey; 6 (5%) in Spanish. Thirty-five (30%) self-identified as Latino; 12 (10%) as Asian; and 20 (17%) as other. Almost 80% reported their health as good or better. Although 38% reported some college and 47% reported being college graduates, 60% reported household incomes were <$50,000. Most (87%) used the Internet for >1 year. Fewer than half (42%) had past portal use, with significant differences associated with weekly Internet use (Fisher's exact=9.59; p=0.02) and smart phone access (Fisher's exact=6.15; p=0.02). Computer Internet access was significantly associated with income (Fisher's exact=16.91; p<0.001). Logistic regression identified that computer Internet access was a significant predictor (odds ratio 9.9 (95% confidence interval: 1.7–58.8) of future portal use, controlling for smart phone use, health status, gender, and age. Conclusions: Among this highly educated but lower economic sample, computer Internet access and smart phone access were associated with past portal use and anticipated future use.
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Affiliation(s)
- Ruth A Bush
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
| | - Halsey Barlow
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
| | - Alexa Pérez
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
| | - Bianca Vazquez
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
| | - Jonathan Mack
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
| | - Cynthia D Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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11
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Spooner KK, Salemi JL, Salihu HM, Zoorob RJ. eHealth patient-provider communication in the United States: interest, inequalities, and predictors. J Am Med Inform Assoc 2018; 24:e18-e27. [PMID: 27497797 DOI: 10.1093/jamia/ocw087] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/30/2016] [Indexed: 11/13/2022] Open
Abstract
Objective Health-related Internet use and eHealth technologies, including online patient-provider communication (PPC), are continually being integrated into health care environments. This study aimed to describe sociodemographic and health- and Internet-related correlates that influence adult patients' interest in and electronic exchange of medical information with health care providers in the United States. Methods Nationally representative cross-sectional data from the 2014 Health Information National Trends Survey ( N = 3677) were analyzed. Descriptive statistics and multivariable regression analyses were performed to examine associations between patient-level characteristics and online PPC behavior and interests. Results Most respondents were Internet users (82.8%), and 61.5% of information seekers designated the Internet as their first source for health information. Younger respondents (<50 years), Hispanics, those from higher-income households, and those perceiving access to personal health information as important were more likely to be interested in online PPC. Despite varying levels of patient interest, 68.5% had no online PPC in the last year. However, Internet users (odds ratio, OR = 2.87, 95% CI, 1.35-6.08), college graduates (OR = 2.92, 95% CI, 1.42-5.99), and those with frequent provider visits (OR = 1.94, 95% CI, 1.02-3.71) had a higher likelihood of online PPC via email or fax, while Hispanics and those from higher-income households were 2-3 times more likely to communicate via text messaging or phone/mobile apps. Conclusion Patients' interest in and display of online PPC-related behaviors vary by age, race/ethnicity, education, income, Internet access/behaviors, and information type. These findings can inform efforts aimed at improving the use and adoption of eHealth technologies, which may contribute to a reduction in communication inequalities and health care disparities.
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Affiliation(s)
- Kiara K Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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12
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Ramsey A, Lanzo E, Huston-Paterson H, Tomaszewski K, Trent M. Increasing Patient Portal Usage: Preliminary Outcomes From the MyChart Genius Project. J Adolesc Health 2018; 62:29-35. [PMID: 29169768 PMCID: PMC5963535 DOI: 10.1016/j.jadohealth.2017.08.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the feasibility, acceptability, and preliminary effectiveness of dedicating staff ("MyChart Geniuses") to assist adolescents with patient portal sign-up; to examine patient satisfaction with MyChart Genius services; and to determine patient preferences for future communications related to health issues. METHODS Adolescent patients (13-25 years old) in an urban, academic, primary care clinic were approached by MyChart Genius staff to assist with enrolling in MyChart and downloading the MyChart mobile App. Patients were also invited to partake in a brief, online survey assessing their technology use and access, as well as their preferences surrounding communication with their health-care providers. Survey responses were analyzed using SPSS Statistics (SPSS Inc., Chicago, IL). RESULTS Ninety-six patients were approached, 84 (87.5%) of whom enrolled in MyChart. Sixty-four adolescents agreed to answer survey questions. Respondents were primarily African-American patients (87%), with a mean age of 18.7 years. The majority (79%) of participants were either satisfied or very satisfied with the Genius program. The respondents reported high access to and use of basic technology, and a high perceived need for an electronic health record App. Preferences for future communications with health-care providers revealed population subsets, indicating an area to further individualize interventions. CONCLUSIONS This is one of the first studies to examine a strategy to increase patient portal uptake and usage among minority, urban adolescents (a group with demonstrated preferences on communications with health-care providers). The presence of specially trained MyChart Genius staff is a feasible, effective, and patient-satisfactory method of engaging with this group of adolescents.
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Affiliation(s)
- Alexandra Ramsey
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erin Lanzo
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hattie Huston-Paterson
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kathy Tomaszewski
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Trent
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
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13
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An analysis of patient portal utilization: what can we learn about online patient behavior by examining portal click data? Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2015.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Torrens E, Walker SM. Demographic characteristics of Australian health consumers who were early registrants for opt-in personally controlled electronic health records. HEALTH INF MANAG J 2017; 46:127-133. [DOI: 10.1177/1833358317699341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Differential uptake of, or access to, personal electronic health records (PEHRs) has the potential to impact on health disparities among certain social groups. In 2012, the Australian Government introduced the Personally Controlled Electronic Health Record (PCEHR), an opt-in system operated by the then National E-Health Transition Authority (NEHTA). In July 2016, the My Health Record (MyHR), an opt-out model, operated by the Australian Digital Health Agency replaced the PCEHR, providing additional support for consumers. Objective: This research was carried out between 2012 and 2015, covering the opt-in PCEHR phase. The aim of the study was to explore demographic characteristics of Australian health consumers who were first to register for a PEHR, and to identify the age and gender populations less likely to register for a PEHR in the opt-in format. The study aimed to provide early data on registrants and potential methods to encourage individuals to register for a PEHR. Method: A cross-sectional study investigated differences in registrations for PEHRs from 2012 to 2015 by age and sex. Results: Results revealed that males were less likely to register than females, and adolescents of both sexes were the least likely to register when compared with any other age group. Similarly, middle-aged males had among the lowest reported registrations, as did older females. Conclusion: While e-health has the potential to improve health outcomes and PEHRs the potential to empower consumers to better manage their health and improve their access health services, evidence from this study suggested that some population groups that experience health inequalities (e.g. older people) were underrepresented among registrants for PEHRs. As income, ethnicity and education are major drivers for health disparities in Australia, future research should focus on uptake and use of PEHRs (now the MyHR) from the perspective of these variables.
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Affiliation(s)
- Emma Torrens
- School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Sue M Walker
- School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
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White H, Gillgrass L, Wood A, Peckham DG. Requirements and access needs of patients with chronic disease to their hospital electronic health record: results of a cross-sectional questionnaire survey. BMJ Open 2016; 6:e012257. [PMID: 27742623 PMCID: PMC5073570 DOI: 10.1136/bmjopen-2016-012257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To identify patient's views on the functionality required for personalised access to the secondary care electronic health record (EHR) and their priorities for development. DESIGN Quantitative analysis of a cross-sectional self-complete survey of patient views on required EHR functionality from a secondary care EHR, including a patient ranking of functionality. SETTING Secondary care patients attending a regional cystic fibrosis unit in the north of England. PARTICIPANTS 201 adults (106 (52.7%) males), median age 29 years (range 17-58 years), entered and completed the study. Inclusion criteria are as follows: a confirmed diagnosis of cystic fibrosis, aged 16 years and over, at the time of clinical stability. OUTCOME MEASURES Quantitative responses within 4 themes; (1) value placed on aspects of the EHR; (2) access requirements to functions of the EHR; (3) views on information sent to the EHR and (4) patient feedback entered into the EHR. A ranked score for 15 functions of the EHR was obtained. RESULTS Highest ratings (% reporting item as very important/important) were reported for access to clinical measures (lung function (94%), C reactive protein (84%), sputum microbiology (81%) and blood results (80%)), medication changes (82%) and lists (83%) and sending repeat prescription (83%) and treatment requests (80%), while sending symptom diaries was less so (62%). Email contact with clinicians was the most valuable communication element of the EHR (84% very important/important). Of 15 features of the EHR (1=most desirable to 15=least desirable), patients identified 'clinical measures' (2.62 (CI 2.07 to 3.06)), and 'access to medication lists' (4.91 (CI 4.47 to 5.44)), as highest priority for development and the ability to comment on errors/omissions (11.0 (CI 10.6 to 11.5)) or experience of care (11.8 (CI 11.4 to 12.2)) as lowest. CONCLUSIONS Patients want extensive personal access to their hospital EHR, placing high importance on the viewing of practical clinical measures and medication management. These influence routine day-to-day care and are priorities for development.
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Affiliation(s)
- H White
- School of Clinical and Applied Science, Leeds Beckett University, Leeds, West Yorkshire, UK
| | - L Gillgrass
- Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds, West Yorkshire, UK
| | - A Wood
- Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds, West Yorkshire, UK
| | - D G Peckham
- Respiratory Medicine/School of Medicine, St James's University Hospital/University of Leeds, Leeds, West Yorkshire, UK
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Mold F, de Lusignan S. Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice. J Pers Med 2015; 5:452-69. [PMID: 26690225 PMCID: PMC4695865 DOI: 10.3390/jpm5040452] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/25/2022] Open
Abstract
Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.
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Affiliation(s)
- Freda Mold
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7TE, UK.
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford GU2 7XH, UK.
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Irizarry T, DeVito Dabbs A, Curran CR. Patient Portals and Patient Engagement: A State of the Science Review. J Med Internet Res 2015; 17:e148. [PMID: 26104044 PMCID: PMC4526960 DOI: 10.2196/jmir.4255] [Citation(s) in RCA: 418] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/10/2015] [Accepted: 04/03/2015] [Indexed: 12/30/2022] Open
Abstract
Background Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. Objective The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. Methods We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms “patient portal” OR “personal health record” OR “electronic personal health record”. Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. Results We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. Conclusions Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient’s ability to engage through and with the patient portal. Future directions of research should focus on identifying specific populations and contextual considerations that would benefit most from a greater degree of patient engagement through a patient portal. Ultimately, adoption by patients and endorsement by providers will come when existing patient portal features align with patients’ and providers’ information needs and functionality.
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Affiliation(s)
- Taya Irizarry
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States.
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Clark SJ, Costello LE, Gebremariam A, Dombkowski KJ. A national survey of parent perspectives on use of patient portals for their children's health care. Appl Clin Inform 2015; 6:110-9. [PMID: 25848417 DOI: 10.4338/aci-2014-10-ra-0098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/15/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess parents' current utilization and future willingness to use patient portals to interact with their child's health care provider. METHODS A cross-sectional survey of a nationally representative sample of US parents was conducted using an established online panel. Bivariate analyses assessed associations between current utilization and future willingness to use patient portals, parental concerns, and demographic variables. RESULTS Among the 1,420 parent respondents, 40% did not know whether their child's health practice offers the option of setting up a patient portal for their child. Of the 21% of parents who reported being offered the option of setting up a patient portal for their child, 59% had done so. Among parents who had the option but chose not to set up a patient portal for their child, lack of time and low perceived need were the main reasons cited. Current use and likelihood of future use was highest for viewing lab results and immunization records. The most common concern about patient portals was the security of the child portal system. CONCLUSIONS Current use of patient portals by parents is low. Only about half of parents currently using or likely to use a portal perceive value in using portals for certain tasks, which suggests that providers will need to continue traditional communication mechanisms to reach their entire patient population.
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Affiliation(s)
- S J Clark
- Child Health Evaluation and Research Unit, University of Michigan
| | - L E Costello
- Child Health Evaluation and Research Unit, University of Michigan
| | - A Gebremariam
- Child Health Evaluation and Research Unit, University of Michigan
| | - K J Dombkowski
- Child Health Evaluation and Research Unit, University of Michigan
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de Lusignan S, Mold F, Sheikh A, Majeed A, Wyatt JC, Quinn T, Cavill M, Gronlund TA, Franco C, Chauhan U, Blakey H, Kataria N, Barker F, Ellis B, Koczan P, Arvanitis TN, McCarthy M, Jones S, Rafi I. Patients' online access to their electronic health records and linked online services: a systematic interpretative review. BMJ Open 2014; 4:e006021. [PMID: 25200561 PMCID: PMC4158217 DOI: 10.1136/bmjopen-2014-006021] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/11/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. SETTING Primary care. PARTICIPANTS A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. RESULTS No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. CONCLUSIONS Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091.
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Affiliation(s)
- Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Freda Mold
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | - Azeem Majeed
- Department of Primary Care & Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Jeremy C Wyatt
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Quinn
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mary Cavill
- The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK
| | | | | | - Umesh Chauhan
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Neha Kataria
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Fiona Barker
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Beverley Ellis
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | | | - Mary McCarthy
- Belvidere Medical Practice, Shrewsbury, Shropshire, UK
| | - Simon Jones
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Imran Rafi
- The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK
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Krist AH, Woolf SH, Bello GA, Sabo RT, Longo DR, Kashiri P, Etz RS, Loomis J, Rothemich SF, Peele JE, Cohn J. Engaging primary care patients to use a patient-centered personal health record. Ann Fam Med 2014; 12:418-26. [PMID: 25354405 PMCID: PMC4157978 DOI: 10.1370/afm.1691] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia Fairfax Family Practice Residency, Fairfax, Virginia
| | - Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
| | - Ghalib A Bello
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T Sabo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel R Longo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Paulette Kashiri
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca S Etz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - John Loomis
- Fairfax Family Practice Residency, Fairfax, Virginia
| | - Stephen F Rothemich
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - J Eric Peele
- RTI International, Research Triangle Park, North Carolina
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Neuner J, Fedders M, Caravella M, Bradford L, Schapira M. Meaningful use and the patient portal: patient enrollment, use, and satisfaction with patient portals at a later-adopting center. Am J Med Qual 2014; 30:105-13. [PMID: 24563085 DOI: 10.1177/1062860614523488] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many physicians are adopting patient portals in response to governmental incentives for meaningful use (MU), but the stage 2 requirements for portal use may be particularly challenging for newer electronic health record (EHR) users. This study examined enrollment, use based on MU requirements, and satisfaction in a recently adopting fee-for-service multispecialty system. Between 2010 and 2012, overall portal enrollment increased from 13.2% to 23.1% but varied substantially by physician specialty. In 2013, more than 97% of physicians would have met requirements for a stage 2 MU utilization measure requiring that patients download personal health information, but only 38% of all physicians (87% of primary care physicians [PCPs] and 37% of other specialists) would have met e-mail requirements. Satisfaction with the portal overall and with portal-based e-mails was high. These results suggest that later-adopting PCPs can succeed in providing satisfactory record and e-mail access but specialists may find reaching e-mail thresholds more difficult.
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Affiliation(s)
| | - Megan Fedders
- Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI
| | - Mary Caravella
- University of Connecticut School of Business, Storrs, CT
| | | | - Marilyn Schapira
- Perleman School of Medicine, University of Pennsylvania and the Center for Health Equity Research Program (CHERP) at Philadelphia VA Medical Center, Philadelphia, PA
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Kerns JW, Krist AH, Longo DR, Kuzel AJ, Woolf SH. How patients want to engage with their personal health record: a qualitative study. BMJ Open 2013; 3:e002931. [PMID: 23901027 PMCID: PMC3731712 DOI: 10.1136/bmjopen-2013-002931] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/10/2013] [Accepted: 06/18/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess factors related to use and non-use of a sophisticated interactive preventive health record (IPHR) designed to promote uptake of 18 recommended clinical preventive services; little is known about how patients want to use or be engaged by such advanced information tools. DESIGN Descriptive and interpretive qualitative analysis of transcripts and field notes from focus groups of the IPHR users and of patients who were invited but did not use the IPHR (non-users). Grounded theory techniques were then applied via an editing approach for key emergent themes. SETTING Primary care patients in eight practices of the Virginia Ambulatory Care Outcomes Research Network (ACORN). PARTICIPANTS Three focus groups involved a total of 14 IPHR users and two groups of non-users totalled 14 participants. OUTCOMES/RESULTS For themes identified (relevance, trust and functionality) participants indicated that endorsement and use of the IPHR by their personal clinician was vital. In particular, participants' comments linked the IPHR use to: (1) integrating the IPHR into current care, (2) promoting effective patient-clinician encounters and communication and (3) their confidence in the accuracy, security and privacy of the information. CONCLUSIONS In addition to patients' stated desires for advanced functionality and information accuracy and privacy, successful adoption of the IPHRs by primary care patients depends on such technology's relevance, and on its promotion via integration with primary care practices' processes and the patient-clinician relationship. Accordingly, models of technological success and adoption, when applied to primary care, may need to include the patient-clinician relationship and practice workflow. These findings are important for healthcare providers, the information technology industry and policymakers who share an interest in encouraging patients to use personal health records. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT00589173.
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Schiller JH, Christner JG, Stansfield RB, Watnick CS, Mullan PB. What parents want from emails with their pediatrician: implications for teaching communication skills. PATIENT EDUCATION AND COUNSELING 2013; 92:61-66. [PMID: 23510794 DOI: 10.1016/j.pec.2013.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 02/07/2013] [Accepted: 02/23/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Physician-patient email communication is increasing but trainees receive no education on this communication medium. Research eliciting patient preferences about email communication could inform training. Investigators elicited parents' perspectives on physician-parent email communication and compared parent and faculty assessments of medical students' emails. METHODS This mixed methods study explored physician-parent email communication in 5 parent focus groups using qualitative analyses to identify themes. Differences between faculty and parent assessment scores for students' email responses were calculated using univariate general linear modeling. RESULTS Themes that emerged were: (1) Building the Relationship, (2) Clarity of Communication and (3) Expectations. Parents criticized student's statements as condescending. The sum of assessment scores by parents and faculty were moderately correlated (r(44)=.407, P<.01), but parents gave students lower scores on "acknowledges validity/expresses empathy" (P=.01) and higher scores on "provides next steps" (P<.01) and "identifies issues" (P<.01). CONCLUSION Parents place value on students' abilities to communicate clearly and convey respect and empathy in email. Parent and faculty perspectives on email communication are similar but not the same. PRACTICE IMPLICATIONS Differences between parental and faculty assessments of medical students' emails supports the need for the involvement of patients and families in email communication curriculum development.
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Affiliation(s)
- Jocelyn H Schiller
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109-4280, USA.
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Moore DR, Feurer ID, Zavala EY, Shaffer D, Karp S, Hoy H, Moore DE. A web-based application for initial screening of living kidney donors: development, implementation and evaluation. Am J Transplant 2013; 13:450-7. [PMID: 23205926 DOI: 10.1111/j.1600-6143.2012.04340.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/19/2012] [Accepted: 10/08/2012] [Indexed: 01/25/2023]
Abstract
Most centers utilize phone or written surveys to screen candidates who self-refer to be living kidney donors. To increase efficiency and reduce resource utilization, we developed a web-based application to screen kidney donor candidates. The aim of this study was to evaluate the use of this web-based application. Method and time of referral were tabulated and descriptive statistics summarized demographic characteristics. Time series analyses evaluated use over time. Between January 1, 2011 and March 31, 2012, 1200 candidates self-referred to be living kidney donors at our center. Eight hundred one candidates (67%) completed the web-based survey and 399 (33%) completed a phone survey. Thirty-nine percent of donors accessed the application on nights and weekends. Postimplementation of the web-based application, there was a statistically significant increase (p < 0.001) in the number of self-referrals via the web-based application as opposed to telephone contact. Also, there was a significant increase (p = 0.025) in the total number of self-referrals post-implementation from 61 to 116 per month. An interactive web-based application is an effective strategy for the initial screening of donor candidates. The web-based application increased the ability to interface with donors, process them efficiently and ultimately increased donor self-referral at our center.
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Affiliation(s)
- D R Moore
- Department of Surgery and Vanderbilt Transplant Center; Vanderbilt Center for Surgical Quality and Outcomes Research.
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LaVela SL, Schectman G, Gering J, Locatelli SM, Gawron A, Weaver FM. Understanding health care communication preferences of veteran primary care users. PATIENT EDUCATION AND COUNSELING 2012; 88:420-426. [PMID: 22766452 DOI: 10.1016/j.pec.2012.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/18/2012] [Accepted: 06/08/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess veterans' health communication preferences (in-person, telephone, or electronic) for primary care needs and the impact of computer use on preferences. METHODS Structured patient interviews (n=448). Bivariate analyses examined preferences for primary care by 'infrequent' vs. 'regular' computer users. RESULTS Only 54% were regular computer users, nearly all of whom had ever used the internet. 'Telephone' was preferred for 6 of 10 reasons (general medical questions, medication questions and refills, preventive care reminders, scheduling, and test results); although telephone was preferred by markedly fewer regular computer users. 'In-person' was preferred for new/ongoing conditions/symptoms, treatment instructions, and next care steps; these preferences were unaffected by computer use frequency. Among regular computer users, 1/3 preferred 'electronic' for preventive reminders (37%), test results (34%), and refills (32%). CONCLUSION For most primary care needs, telephone communication was preferred, although by a greater proportion of infrequent vs. regular computer users. In-person communication was preferred for reasons that may require an exam or visual instructions. About 1/3 of regular computer users prefer electronic communication for routine needs, e.g., preventive reminders, test results, and refills. PRACTICE IMPLICATIONS These findings can be used to plan patient-centered care that is aligned with veterans' preferred health communication methods.
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Affiliation(s)
- Sherri L LaVela
- Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA.
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