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Fennelly O, Moroney D, Doyle M, Eustace-Cook J, Hughes M. Key interoperability Factors for patient portals and Electronic health Records: A scoping review. Int J Med Inform 2024; 183:105335. [PMID: 38266425 DOI: 10.1016/j.ijmedinf.2023.105335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
AIM To identify the key requirements and challenges to interoperability between patient portals and electronic health records (EHRs). INTRODUCTION Patient portals provide patients with access to their health information directly from EHRs within hospitals, primary care centres and general practices (GPs). Patient portals offer many benefits to patients including improved communication with healthcare providers and care coordination. However, many challenges exist with the integration and automatic and secure sharing of information between EHRs and patient portals. It is critical that countries learn from international experiences to successfully develop interoperable national patient portals. METHODS A scoping review methodology was undertaken. A search strategy using index terms and keywords was applied across four key databases, an additional grey literature search was also run. The identified studies were screened by two reviewers to determine eligibility against defined inclusion criteria. Data were abstracted from the eligible studies and reviewed to identify the key requirements and challenges to interoperability of patient portals with EHRs. RESULTS After screening 3,462 studies, 34 were included across 11 countries. Of the 29 unique patient portals studied, few offered patients access to their entire healthcare record across multiple sites and a number of different functionalities were available. Key interoperability requirements and challenges identified were: Data Sharing Incentives & Supports; Heterogenous Organisations & Information Systems; Data Storage & Management; Available Information & Functionalities; Data Formats & Standards; Identification of Individuals; User Access, Control & Consent; and Security & Privacy. CONCLUSION Seamless exchange of health information across patient portals and EHRs required organisational and individual factors, as well as technical considerations. Interorganisational collaboration and engagement of key stakeholders to determine standards and guidelines for consent and sharing of information, as well as technical standards and security measures were recommended.
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Affiliation(s)
| | | | - Michelle Doyle
- Children's Health Ireland at Temple Street, Dublin, Ireland
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Park YT, Park HA, Lee JM, Choi BK. Hospitals' Adoption of Mobile-Based Personal Health Record Systems and Patients' Characteristics: A Cross-Sectional Study Analyzing National Healthcare Big Data. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231160892. [PMID: 36927267 PMCID: PMC10026127 DOI: 10.1177/00469580231160892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Insufficient information exists on the associations between hospitals' adoption of mobile-based personal health record (mPHR) systems and patients' characteristics. This study explored the associations between patients' characteristics and hospitals' adoption of mPHR systems in Korea. This cross-sectional study used 316 hospitals with 100 or more beds as the unit of analysis. Previously collected data on mPHR adoption from May 1 to June 30, 2020 were analyzed. National health insurance claims data for 2019 were also used to analyze patients' characteristics. The dependent variable was mPHR system adoption (0 vs 1) and the main independent variables were the number of patients, age distribution, and proportions of patients with cancer, diabetes, and hypertension among inpatients and outpatients. The number of inpatients was significantly associated with mPHR adoption (adjusted odds ratio [aOR]: 1.174; 1.117-1.233, P < .001), as was the number of outpatients (aOR: 1.041; 1.028-1.054, P < .001). The proportion of inpatients aged 31 to 60 years to those aged 31 years and older was also associated with hospital mPHR adoption (aOR: 1.053; 1.022-1.085, P = .001). mPHR system adoption was significantly associated with the proportion of inpatients (aOR: 1.089; 1.012-1.172, P = .024) and outpatients (aOR: 1.138; 1.026-1.263, P = .015) with cancer and outpatients (aOR: 1.271; 1.101-1.466, P = .001) with hypertension. Although mPHR systems are useful for the management of chronic diseases such as diabetes and hypertension, the number of patients, younger age distribution, and the proportion of cancer patients were closely associated with hospitals' introduction of mPHR systems.
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Affiliation(s)
- Young-Taek Park
- Health Insurance Review & Assessment Service (HIRA), Wonju, Korea
| | | | - Jae Meen Lee
- Pusan National University Hospital, Pusan, Korea
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Kainiemi E, Vehko T, Kyytsönen M, Hörhammer I, Kujala S, Jormanainen V, Heponiemi T. Factors Associated with Non-use of and Dissatisfaction with the National Patient Portal in Finland in the Era of COVID-19: A Population-based Cross-sectional Survey Study (Preprint). JMIR Med Inform 2022; 10:e37500. [PMID: 35404831 PMCID: PMC9037616 DOI: 10.2196/37500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 12/29/2022] Open
Abstract
Background In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. Objective The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. Methods A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. Results In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. Conclusions Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public’s confidence in the protection of their confidential data.
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Affiliation(s)
- Emma Kainiemi
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuulikki Vehko
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Iiris Hörhammer
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
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Matthews AK, Watson KS, Duangchan C, Steffen A, Winn R. A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers. Front Public Health 2021; 9:762784. [PMID: 34926386 PMCID: PMC8674302 DOI: 10.3389/fpubh.2021.762784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Smoking rates among low-income patients are double those of the general population. Access to health care is an essential social determinant of health. Federally qualified health care centers (FQHC) are government-supported and community-based centers to increase access to health care for non-insured and underinsured patients. However, barriers to implementation impact adherence and sustainability of evidence-based smoking cessation within FQHC settings. To address this implementation barrier, our multi-disciplinary team proposes Mi QUIT CARE (Mile Square QUIT Community-Access-Referral-Expansion) to establish the acceptability, feasibility, and capacity of an FQHC system to deliver an evidence-based and multi-level intervention to increase patient engagement with a state tobacco quitline. Methods: A mixed-method approach, rooted in an implementation science framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), will be used in this hybrid effectiveness-implementation design. We aim to evaluate the efficacy of a novel delivery system (patient portal) for increasing access to smoking cessation treatment. In preparation for a future randomized clinical trial of Mi QUIT CARE, we will conduct the following developmental research: (1) Examine the burden of tobacco among patient populations served by our partner FQHC, (2) Evaluate among FQHC patients and health care providers, knowledge, attitudes, barriers, and facilitators related to smoking cessation and our intervention components, (3) Evaluate the use of tailored communication strategies and patient navigation to increase patient portal uptake among patients, and (4) To test the acceptability, feasibility, and capacity of the partner FQHC to deliver Mi QUIT CARE. Discussion: This study provides a model for developing and implementing smoking and other health promotion interventions for low-income patients delivered via patient health portals. If successful, the intervention has important implications for addressing a critical social determinant of cancer and other tobacco-related morbidities. Trial Registration: U.S. National Institutes of Health Clinical Trials, NCT04827420, https://clinicaltrials.gov/ct2/show/NCT04827420.
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Affiliation(s)
- Alicia K. Matthews
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Karriem S. Watson
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
- School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Cherdsak Duangchan
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Alana Steffen
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Robert Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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Carini E, Villani L, Pezzullo AM, Gentili A, Barbara A, Ricciardi W, Boccia S. The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review. J Med Internet Res 2021; 23:e26189. [PMID: 34494966 PMCID: PMC8459217 DOI: 10.2196/26189] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/24/2021] [Accepted: 05/24/2021] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- Elettra Carini
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Villani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Maria Pezzullo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Gentili
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Barbara
- Hygiene and Public Health Service, ASL Roma 1, Rome, Italy.,Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Women, Children and Public Health Sciences - Public Health Area, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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Ruhi U, Chugh R. Utility, Value, and Benefits of Contemporary Personal Health Records: Integrative Review and Conceptual Synthesis. J Med Internet Res 2021; 23:e26877. [PMID: 33866308 PMCID: PMC8120425 DOI: 10.2196/26877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care. Objective This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and industry levels. Methods Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three research questions were formulated and used as selection criteria in our review of the extant literature relevant to our study. Results We offer a high-level functional utility model of PHR features and functions. We also conceptualize a consumer value framework of PHRs, highlighting the applications of these technologies across various health care delivery activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public health agencies. Conclusions PHR products offer a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers benefit from the tools provided by PHR technologies, their overall value extends across the constituents of the health care delivery chain. Despite advances in technology, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value analysis committees in the health care sector that are commissioned for the appraisal of innovative health information technologies such as PHRs.
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Affiliation(s)
- Umar Ruhi
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Ritesh Chugh
- School of Engineering & Technology, Central Queensland University, Melbourne, Australia
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Baderol Allam FN, Ab Hamid MR, Buhari SS, Md Noor H. Web-Based Dietary and Physical Activity Intervention Programs for Patients With Hypertension: Scoping Review. J Med Internet Res 2021; 23:e22465. [PMID: 33720036 PMCID: PMC8074856 DOI: 10.2196/22465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/13/2020] [Accepted: 01/16/2021] [Indexed: 01/23/2023] Open
Abstract
Background Hypertension is the root cause of many chronic diseases. Lifestyle changes (ie, dietary alterations and physical activity) are seen to be an important step in the prevention and treatment of hypertension. Educating people through web-based interventional programs could offer an effective solution and help these patients with hypertension in the existing health care scenario. Objective In this study, the researchers conducted a scoping literature review of the web-based dietary changes and physical activity–related intervention programs designed for the patients with hypertension and identified the methodologies, effectiveness, protocols, and theories, which could affect and improve existing clinical activities. Methods This review followed the scoping review methodology to identify and process the peer-reviewed studies published between 2010 and 2020. The literature searches were conducted on the following electronic databases: PubMed, Web of Science, MEDLINE (Medical Literature Analysis and Retrieval System Online), ScienceDirect, Scopus, and Google Scholar. By using relevant search terms, studies were included if they offered information related to the web-based intervention tools, specifically dietary and physical activity intervention for patients with hypertension. Studies written or translated in English language and published within the date range (January 2010 to March 2020) were included. Results Overall, 1441 articles were initially identified. The reviewers included 35 articles after removing duplicates and screening titles. Only 21 articles were assessed for full review, and 15 were kept for analysis. The researchers selected 15 web-based intervention articles published on the topic of hypertension from 7 countries. A few of these 15 web-based tools (4, 27%) included more than 3 functions and provided a lot of important information (such as appointments, health records, or viewable care). Several tools were standalone tools (11, 73%), while most of the tools supported communication intervention–related lifestyle or behavioral changes (13, 87%) and medication adherence (6, 40%). It was found that physicians (9, 60%), allied health professionals (5, 33%), and nurses (5, 33%) were the health care providers who generally used these tools for communicating with their patients. More than half of the above tools (10, 67%) were assessed by different researchers in randomized controlled trials, while 5 tools (33%) were investigated in nonrandomized studies. Conclusions We identified many web-based intervention programs for patients with hypertension from the literature databases. The findings indicate that numerous benefits can be derived after using a web-based dietary and physical activity intervention program for hypertension focusing on lifestyle changes. However, developers need to consider the preferences of the patients with regard to the information or the design features while developing or modifying web-based educational websites. These tools could be used for designing a patient-tailored website intervention program that is based on diet and physical activities for patients with hypertension.
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Affiliation(s)
| | - Mohd Ramadan Ab Hamid
- Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Siti Sabariah Buhari
- Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Harrinni Md Noor
- Faculty of Education, Universiti Teknologi MARA, Puncak Alam, Malaysia
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Beal LL, Kolman JM, Jones SL, Khleif A, Menser T. Quantifying Patient Portal Use: Systematic Review of Utilization Metrics. J Med Internet Res 2021; 23:e23493. [PMID: 33629962 PMCID: PMC7952240 DOI: 10.2196/23493] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/16/2020] [Accepted: 01/31/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Use of patient portals has been associated with positive outcomes in patient engagement and satisfaction. Portal studies have also connected portal use, as well as the nature of users' interactions with portals, and the contents of their generated data to meaningful cost and quality outcomes. Incentive programs in the United States have encouraged uptake of health information technology, including patient portals, by setting standards for meaningful use of such technology. However, despite widespread interest in patient portal use and adoption, studies on patient portals differ in actual metrics used to operationalize and track utilization, leading to unsystematic and incommensurable characterizations of use. No known review has systematically assessed the measurements used to investigate patient portal utilization. OBJECTIVE The objective of this study was to apply systematic review criteria to identify and compare methods for quantifying and reporting patient portal use. METHODS Original studies with quantifiable metrics of portal use published in English between 2014 and the search date of October 17, 2018, were obtained from PubMed using the Medical Subject Heading term "Patient Portals" and related keyword searches. The first search round included full text review of all results to confirm a priori data charting elements of interest and suggest additional categories inductively; this round was supplemented by the retrieval of works cited in systematic reviews (based on title screening of all citations). An additional search round included broader keywords identified during the full-text review of the first round. Second round results were screened at abstract level for inclusion and confirmed by at least two raters. Included studies were analyzed for metrics related to basic use/adoption, frequency of use, duration metrics, intensity of use, and stratification of users into "super user" or high utilizers. Additional categories related to provider (including care team/administrative) use of the portal were identified inductively. Additional analyses included metrics aligned with meaningful use stage 2 (MU-2) categories employed by the US Centers for Medicare and Medicaid Services and the association between the number of portal metrics examined and the number of citations and the journal impact factor. RESULTS Of 315 distinct search results, 87 met the inclusion criteria. Of the a priori metrics, plus provider use, most studies included either three (26 studies, 30%) or four (23 studies, 26%) metrics. Nine studies (10%) only reported the patient use/adoption metric and only one study (1%) reported all six metrics. Of the US-based studies (n=76), 18 (24%) were explicitly motivated by MU-2 compliance; 40 studies (53%) at least mentioned these incentives, but only 6 studies (8%) presented metrics from which compliance rates could be inferred. Finally, the number of metrics examined was not associated with either the number of citations or the publishing journal's impact factor. CONCLUSIONS Portal utilization measures in the research literature can fall below established standards for "meaningful" or they can substantively exceed those standards in the type and number of utilization properties measured. Understanding how patient portal use has been defined and operationalized may encourage more consistent, well-defined, and perhaps more meaningful standards for utilization, informing future portal development.
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Affiliation(s)
- Lauren L Beal
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen L Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Aroub Khleif
- Ambulatory Clinical Systems, Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
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Szilagyi PG, Valderrama R, Vangala S, Albertin C, Okikawa D, Sloyan M, Lopez N, Lerner CF. Pediatric patient portal use in one health system. J Am Med Inform Assoc 2021; 27:444-448. [PMID: 31841146 DOI: 10.1093/jamia/ocz203] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
| | - Rebecca Valderrama
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
| | - David Okikawa
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California, USA
| | - Nathalie Lopez
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
| | - Carlos F Lerner
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
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Lussier MT, Richard C, Binta Diallo F, Boivin N, Hudon C, Boustani É, Witteman H, Jbilou J. I am ready to see you now, Doctor! A mixed-method study of the Let's Discuss Health website implementation in Primary Care. Health Expect 2020; 24:243-256. [PMID: 33285012 PMCID: PMC8077096 DOI: 10.1111/hex.13158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Let's Discuss Health (LDH) is a website that encourages patients to prepare their health‐care encounters by providing communication training, review of topics and questions that are important to them. Objective To describe LDH implementation during primary care (PC) visits for chronic illnesses. Methods Design: Descriptive mixed‐method study. Setting: 6 PC clinics. Participants: 156 patients and 51 health‐care providers (HCP). Intervention: LDH website implementation. Outcome Measures: Perceived quality and usefulness of LDH; perceived quality of HCP‐patient communication; patient activation; LDH integration in routine PC practices and barriers to its use. Results Patients reported a positive perception of the website in that it helped them to adopt an active role in the encounters; recall their visit agenda and reduce encounter‐related stress; feel more confident to ask questions, feel more motivated to prepare their future medical visits and improve their chronic illness management. However, a certain disconnect emerged between HCP and patient perceptions as to the value of LDH in promoting a sense of partnership and collaboration. The main barriers to the use of LDH are HCP lack of interest, limited access to technology, lack of time and language barriers. Conclusion Our findings indicate that it is advantageous for patients to prepare their medical encounters. However, the study needs to be replicated in other medical environments using larger and more diverse samples. Patient and Public Contribution Patient partners were involved in the conduct of this study.
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Affiliation(s)
- Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada.,Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Claude Richard
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Fatoumata Binta Diallo
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Nathalie Boivin
- École réseau de Science infirmière (ÉRSI), University of Moncton, Moncton, NB, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Élie Boustani
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Holly Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Laval, QC, Canada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau Brunswick, Université de Sherbrooke, École de psychologie, University of Moncton, Moncton, NB, Canada
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Lu C, Batista D, Hamouda H, Lemieux V. Consumers' Intentions to Adopt Blockchain-Based Personal Health Records and Data Sharing: Focus Group Study. JMIR Form Res 2020; 4:e21995. [PMID: 33151149 PMCID: PMC7677023 DOI: 10.2196/21995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 10/26/2020] [Indexed: 01/23/2023] Open
Abstract
Background Although researchers are giving increased attention to blockchain-based personal health records (PHRs) and data sharing, the majority of research focuses on technical design. Very little is known about health care consumers’ intentions to adopt the applications. Objective This study aims to explore the intentions and concerns of health care consumers regarding the adoption of blockchain-based personal health records and data sharing. Methods Three focus groups were conducted, in which 26 participants were shown a prototype of a user interface for a self-sovereign blockchain-based PHR system (ie, a system in which the individual owns, has custody of, and controls access to their personal health information) to be used for privacy and secure health data sharing. A microinterlocutor analysis of focus group transcriptions was performed to show a descriptive overview of participant responses. NVivo 12.0 was used to code the categories of the responses. Results Participants did not exhibit a substantial increase in their willingness to become owners of health data and share the data with third parties after the blockchain solution was introduced. Participants were concerned about the risks of losing private keys, the resulting difficulty in accessing care, and the irrevocability of data access on blockchain. They did, however, favor a blockchain-based PHR that incorporates a private key recovery system and offers a health wallet hosted by government or other positively perceived organizations. They were more inclined to share data via blockchain if the third party used the data for collective good and offered participants nonmonetary forms of compensation and if the access could be revoked from the third party. Conclusions Health care consumers were not strongly inclined to adopt blockchain-based PHRs and health data sharing. However, their intentions may increase when the concerns and recommendations demonstrated in this study are considered in application design.
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Affiliation(s)
- Chang Lu
- Blockchain@UBC, University of British Columbia, Vancouver, BC, Canada
| | - Danielle Batista
- School of Information, University of British Columbia, Vancouver, BC, Canada
| | - Hoda Hamouda
- School of Information, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Lemieux
- School of Information, University of British Columbia, Vancouver, BC, Canada
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12
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Yousef CC, Thomas A, Alenazi AO, Elgadi S, Abu Esba LC, AlAzmi A, Alhameed AF, Hattan A, Almekhloof S, AlShammary MA, Alanezi NA, Alhamdan HS, Eldegeir M, Abulezz R, Khoshhal S, Masala CG, Ahmed O. Adoption of a Personal Health Record in the Digital Age: Cross-Sectional Study. J Med Internet Res 2020; 22:e22913. [PMID: 32998854 PMCID: PMC7657719 DOI: 10.2196/22913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND As health care organizations strive to improve health care access, quality, and costs, they have implemented patient-facing eHealth technologies such as personal health records to better engage patients in the management of their health. In the Kingdom of Saudi Arabia, eHealth is also growing in accordance with Vision 2030 and its National Transformation Program framework, creating a roadmap for increased quality and efficiency of the health care system and supporting the goal of patient-centered care. OBJECTIVE The aim of this study was to investigate the adoption of the personal health record of the Ministry of National Guard Health Affairs (MNGHA Care). METHODS A cross-sectional survey was conducted in adults visiting outpatient clinics in hospitals at the Ministry of National Guard Health Affairs hospitals in Riyadh, Jeddah, Dammam, Madinah, and Al Ahsa, and primary health care clinics in Riyadh and Qassim. The main outcome measure was self-reported use of MNGHA Care. RESULTS In the sample of 546 adult patients, 383 (70.1%) reported being users of MNGHA Care. MNGHA Care users were more likely to be younger (P<.001), high school or university educated (P<.001), employed (P<.001), have a chronic condition (P=.046), use the internet to search for health-related information (P<.001), and use health apps on their mobile phones (P<.001). CONCLUSIONS The results of this study show that there is substantial interest for the use of MNGHA Care personal health record with 70% of participants self-reporting use. To confirm these findings, objective data from the portal usage logs are needed. Maximizing the potential of MNGHA Care supports patient engagement and is aligned with the national eHealth initiative to encourage the use of technology for high-quality, accessible patient-centered care. Future research should include health care provider perspectives, incorporate objective data, employ a mixed-methods approach, and use a theoretical framework.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abin Thomas
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed O Alenazi
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sumaya Elgadi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Laila Carolina Abu Esba
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Aeshah AlAzmi
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Abrar Fahad Alhameed
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Ahmed Hattan
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Saleh Almekhloof
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Mohammed A AlShammary
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Primary Health Care, Prince Bader Housing Clinic, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Nazzal Abdullah Alanezi
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Qassim Primary Health Care Center, Ministry of National Guard-Health Affairs, Qassim, Saudi Arabia
| | - Hani Solaiman Alhamdan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Manal Eldegeir
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
| | - Rayf Abulezz
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Sahal Khoshhal
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Clara Glynis Masala
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Nursing, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
| | - Omaima Ahmed
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Hematology/Oncology/BMT, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
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13
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Wijesundara JG, Ito Fukunaga M, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM, Cutrona SL. Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial. J Med Internet Res 2020; 22:e16373. [PMID: 32975529 PMCID: PMC7547389 DOI: 10.2196/16373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023] Open
Abstract
Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277
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Affiliation(s)
- Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jessica Ogarek
- Center for Gerontology and Healthcare Research, Brown University, Providence, MA, United States
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lloyd Fisher
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | | | | | - Lawrence Garber
- Meyers Primary Care Institute, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Health Services Research & Development, Center of Innovation, Edith Nourse Rogers Memorial Hospital, Veterans Health Administration, Bedford, MA, United States
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14
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Lyles CR, Nelson EC, Frampton S, Dykes PC, Cemballi AG, Sarkar U. Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices. Ann Intern Med 2020; 172:S123-S129. [PMID: 32479176 PMCID: PMC7800164 DOI: 10.7326/m19-0876] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.
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Affiliation(s)
- Courtney R Lyles
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Eugene C Nelson
- Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (E.C.N.)
| | | | - Patricia C Dykes
- Center for Patient Safety, Research, and Practice, Brigham and Women's Hospital, Boston, Massachusetts (P.C.D.)
| | - Anupama G Cemballi
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Urmimala Sarkar
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
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15
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Converging perspectives of providers and student users on extending a patient portal into a university-based mental health service: A qualitative study. Internet Interv 2020; 19:100304. [PMID: 31993336 PMCID: PMC6976866 DOI: 10.1016/j.invent.2020.100304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient portals have the potential to increase access to mental health services. However, a lack of research is available to guide practices on extending patient portals into mental health services. This study explored stakeholder (student service users' and health providers') expectations and perceptions of extending patient portals into a New Zealand university-based mental health service. MATERIALS AND METHODS This qualitative study explored the perspectives of 17 students and staff members at a university-based health and counselling service on an Internet-based patient portal through a software demonstration, two focus groups and 13 interviews. Data were analyzed thematically. RESULTS Staff and students perceived the patient portal as useful, easy to use and expected it to help make mental health care more accessible. Staff were most concerned with the portal's ability to support their triage processes and that it might enable students to 'counselor hop' (see multiple counselors). Staff recommended extension into services that do not require triage. Most students expected the portal to enhance patient-counselor contact and rapport, through continuity of care. Students were concerned with appointment waiting times, the stigmatization of poor mental health and their capacity to seek help. They considered the portal might assist with this. Students recommended extension into all services, including urgent appointments. After viewing findings from initial student and staff groups, staff concluded that extending a patient portal into their counseling services should be prioritized. CONCLUSION This research suggests that there is value in extending patient portals into mental health care, especially into low-risk services. Future research should explore opportunities to support triage and appointment-making processes for mental health services, via patient portals.
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16
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg P, van den Berg M, Schellevis FG, Groenewegen PP. Patients' perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries. BMC Health Serv Res 2019; 19:1018. [PMID: 31888614 PMCID: PMC6937702 DOI: 10.1186/s12913-019-4848-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients' perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients. METHODS We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients' perceptions of communication at the interface between primary and secondary care. RESULTS In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients' perceptions of information shared by GPs with medical specialists, and the patients' perceptions of the GPs' awareness of the results of treatment by medical specialists. Patients whose GPs stated that they 'seldom or never' send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they 'seldom or never' receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care. CONCLUSION Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Michael van den Berg
- Department of Public Health, Amsterdam Public Health Research Institute, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Sociology, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands. .,Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands.
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Aslani N, Ahmadi M, Samadbeik M. A systematic review of the attributes of electronic personal health Records for Patients with multiple sclerosis. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00387-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Evaluating the implementation of a personal health record for chronic primary and secondary care: a mixed methods approach. BMC Med Inform Decis Mak 2019; 19:241. [PMID: 31775734 PMCID: PMC6882368 DOI: 10.1186/s12911-019-0969-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/06/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Personal health records (PHRs) provide the opportunity for self-management support, enhancing communication between patients and caregivers, and maintaining and/or improving the quality of chronic disease management. Their implementation is a multi-level and complex process, requiring a holistic approach that takes into account the technology, its users and the context of implementation. The aim of this research is to evaluate the fidelity of a PHR in chronic care (the degree to which it was implemented as intended) in order to explain the found effects. METHODS A convergent parallel mixed methods design was used, where qualitative and quantitative data were collected in parallel, analyzed separately, and finally merged. Log data of 536 users were used to gain insight into the actual long-term use of the PHR (the dose). Focus group meetings among caregivers (n = 13) were conducted to assess program differentiation (or intended use). Interviews with caregivers (n = 28) and usability tests with potential end-users (n = 13) of the PHR were used to understand the responsiveness and the differences and similarities between the intended and actual use of the PHR. RESULTS The results of the focus groups showed that services for coaching are strongly associated with monitoring health values and education. However, the PHR was not used that way during the study period. In the interviews, caregivers indicated that they were ignorant on how to deploy the PHR in current working routines. Therefore, they find it difficult to motivate their patients in using the PHR. Participants in the usability study indicate that they would value a PHR in the future, given that the usability will be improved and that the caregivers will use it in daily practice as well. CONCLUSIONS In this study, actual use of the PHRs by patients was influenced by the responsiveness of caregivers. This responsiveness is likely to be strongly influenced by the perceived support when defining the differentiation and delivery of the PHR. A mixed-methods approach to understand intervention fidelity was of added value in providing explanations for the found effects that could not be revealed by solely focusing on the effectiveness of the technology in an experimental trial.
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19
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Duvall M, North F, Leasure W, Pecina J. Patient portal message characteristics and reported thoughts of self-harm and suicide: A retrospective cohort study. J Telemed Telecare 2019; 27:501-508. [PMID: 31726902 DOI: 10.1177/1357633x19887262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION As use of electronic portal communication with healthcare teams increases, processes that effectively recognize messages that contain critical information are needed. This study aims to evaluate whether certain language and other characteristics of patient portal messages are associated with expressions of self-harm and suicidal ideation. METHODS Using patient portal messages sent between 1 January 2013 and 30 June 2017, we searched for words and letter combinations 'suicid' (to identify words suicide and suicidal), 'depress' (for depression, depressed, depressing), 'harm himself' (or 'herself 'or 'myself'), 'hurt himself' ('herself' or 'myself'), 'kill', 'shoot', 'cutting', 'knife', 'gun', 'overdose', 'over dose' and 'jump'. RESULTS Of 831,009 messages, 11,174 messages contained one or more search terms. We manually reviewed 7,736 messages for content expressing self-harm or suicidality. Of the reviewed messages, 3.2% indicated thoughts of self-harm or suicide and 2.2% of messages suggested active suicidality. Of those expressing any thoughts of self-harm or suicide, 13.4% mentioned a specific plan, 20% were passively suicidal. Messages indicating thoughts of self-harm and suicide were more common in patients who were unmarried, non-white and younger than 18 years. Factors significantly associated with thoughts of self-harm were messages addressed to psychiatry or containing the letter combinations 'suicide', 'die', 'depress' and 'harm/hurt my/her/himself'. DISCUSSION Certain letter combinations and patient portal message characteristics may be associated with expressions of self-harm and suicide. These factors should be considered as we develop systems of effectively screening patient portal messages for critical clinical information.
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Affiliation(s)
- Michelle Duvall
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Frederick North
- Department of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - William Leasure
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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20
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Secure Messaging with Physicians by Proxies for Patients with Diabetes: Findings from the ECLIPPSE Study. J Gen Intern Med 2019; 34:2490-2496. [PMID: 31428986 PMCID: PMC6848304 DOI: 10.1007/s11606-019-05259-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Little is known about patients who have caregiver proxies communicate with healthcare providers via portal secure messaging (SM). Since proxy portal use is often informal (e.g., sharing patient accounts), novel methods are needed to estimate the prevalence of proxy-authored SMs. OBJECTIVE (1) Develop an algorithm to identify proxy-authored SMs, (2) apply this algorithm to estimate predicted proxy SM (PPSM) prevalence among patients with diabetes, and (3) explore patient characteristics associated with having PPSMs. DESIGN Retrospective cohort study. PARTICIPANTS We examined 9856 patients from Diabetes Study of Northern California (DISTANCE) who sent ≥ 1 English-language SM to their primary care physician between July 1, 2006, and Dec. 31, 2015. MAIN MEASURES Using computational linguistics, we developed ProxyID, an algorithm that identifies phrases frequently found in registered proxy SMs. ProxyID was validated against blinded expert categorization of proxy status among an SM sample, then applied to identify PPSM prevalence across patients. We examined patients' sociodemographic and clinical characteristics according to PPSM penetrance, "none" (0%), "low" (≥ 0-50%), and "high" (≥ 50-100%). KEY RESULTS Only 2.3% of patients had ≥ 1 registered proxy-authored SM. ProxyID demonstrated moderate agreement with expert classification (Κ = 0.58); 45.7% of patients had PPSMs (40.2% low and 5.5% high). Patients with high percent PPSMs were older than those with low percent and no PPSMs (66.5 vs 57.4 vs 56.2 years, p < 0.001) had higher rates of limited English proficiency (16.1% vs 3.2% vs 3.5%, p < 0.05), lower self-reported health literacy (3.83 vs 4.43 vs 4.44, p < 0.001), and more comorbidities (Charlson index 3.78 vs 2.35 vs 2.18, p < 0.001). CONCLUSIONS Among patients with diabetes, informal proxy SM use is more common than registered use and prevalent among socially and medically vulnerable patients. Future research should explore whether proxy portal use improves patient and/or caregiver outcomes and consider policies that integrate caregivers in portal communication.
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Edmonds S, Lou Y, Robinson B, Cram P, Roblin DW, Wright NC, Saag K, Wolinsky FD. Characteristics of older adults using patient web portals to view their DXA results. BMC Med Inform Decis Mak 2019; 19:187. [PMID: 31533717 PMCID: PMC6751667 DOI: 10.1186/s12911-019-0904-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Sharing test results with patients via patient web portals is a new trend in healthcare. No research has been done examining patient web portal use with bone density test results. The objective of our study was to identify patient characteristics associated with the use of patient web portals to view their bone density test results. Methods A secondary analysis of data from a pragmatic randomized controlled trial of 7749 participants ≥50 years old that had presented for a dual energy X-ray absorptiometry (DXA) bone density test. Patients were interviewed at enrollment and 12 weeks later. Multivariable logistic regression identified patient characteristics that differentiated those who used the web portal from those who did not. Results Our sample included 4669 patients at the two (University of Iowa [UI], and Kaiser Permanente of Georgia [KPGA]) clinical sites that had patient web portals. Of these patients, 3399 (72.8%) reported knowing their test results 12 weeks post-DXA, with 649 (13.9%) reporting that they viewed their DXA results using the web portal. Web portal users were more likely to be from UI than KPGA, and were younger, more educated, had higher health literacy, had osteopenia, and had the same sex as their referring physician (all p < 0.05). Conclusion Only 19.1% of the 3399 patients who knew their DXA results used the available patient web portals to find out about them. Web portal users differed from non-users on several characteristics. This suggests that simply making patient web portals available for use may not be sufficient to appreciably enhance patient awareness of their test results. Based on these findings, a better understanding of the reasons why older, less educated, and less activated patients do not access their test results through patient web portals is needed.
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Affiliation(s)
- Stephanie Edmonds
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, 200 Newton Rd. 5231 WL, Iowa City, IA, 52242, USA. .,CADRE, Iowa City VA Health System, Iowa City, IA, USA.
| | - Yiyue Lou
- College of Public Health, Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Brandi Robinson
- Kaiser Permanente, Center for Clinical and Outcomes Research, Atlanta, GA, USA
| | - Peter Cram
- College of Medicine, Department of Internal Medicine, University of Toronto, Toronto, Canada.,University of Toronto Health Network, Toronto, Canada
| | | | - Nicole C Wright
- School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, UK
| | - Kenneth Saag
- School of Medicine, Department of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, UK
| | - Fredric D Wolinsky
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, 200 Newton Rd. 5231 WL, Iowa City, IA, 52242, USA.,College of Public Health, Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA.,College of Nursing, University of Iowa, Iowa City, IA, USA
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Hochheimer CJ, Sabo RT, Perera RA, Mukhopadhyay N, Krist AH. Identifying Attrition Phases in Survey Data: Applicability and Assessment Study. J Med Internet Res 2019; 21:e12811. [PMID: 31444875 PMCID: PMC6729115 DOI: 10.2196/12811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although Web-based questionnaires are an efficient, increasingly popular mode of data collection, their utility is often challenged by high participant dropout. Researchers can gain insight into potential causes of high participant dropout by analyzing the dropout patterns. OBJECTIVE This study proposed the application of and assessed the use of user-specified and existing hypothesis testing methods in a novel setting-survey dropout data-to identify phases of higher or lower survey dropout. METHODS First, we proposed the application of user-specified thresholds to identify abrupt differences in the dropout rate. Second, we proposed the application of 2 existing hypothesis testing methods to detect significant differences in participant dropout. We assessed these methods through a simulation study and through application to a case study, featuring a questionnaire addressing decision-making surrounding cancer screening. RESULTS The user-specified method set to a low threshold performed best at accurately detecting phases of high attrition in both the simulation study and test case application, although all proposed methods were too sensitive. CONCLUSIONS The user-specified method set to a low threshold correctly identified the attrition phases. Hypothesis testing methods, although sensitive at times, were unable to accurately identify the attrition phases. These results strengthen the case for further development of and research surrounding the science of attrition.
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Affiliation(s)
- Camille J Hochheimer
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Nitai Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
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Ploeg J, Valaitis RK, Cleghorn L, Yous ML, Gaber J, Agarwal G, Kastner M, Mangin D, Oliver D, Parascandalo F, Risdon C, Dolovich L. Perceptions of older adults in Ontario, Canada on the implementation and impact of a primary care programme, Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY): a descriptive qualitative study. BMJ Open 2019; 9:e026257. [PMID: 31201187 PMCID: PMC6575818 DOI: 10.1136/bmjopen-2018-026257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The aim of the study was to explore the perceptions of older adults on the implementation and impact of Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY), a multicomponent primary care programme that seeks to improve care coordination for individuals through health-related goal-setting supported by trained lay volunteers who are an extension of an interprofessional team, and the use of technology to support communication among the team. DESIGN This study used a qualitative descriptive design. SETTING The setting for this study was two primary care practice sites located in a large urban area in Ontario, Canada. PARTICIPANTS The sample consisted of community-dwelling older adults aged 70 years and older. Participants were recruited from a convenience sample obtained from 360 clients who participated in the 12-month Health TAPESTRY randomised controlled trial. METHODS Semistructured interviews were conducted with 32 older adults either face-to-face or by telephone. Interviews were transcribed verbatim. Data were analysed using a constant comparative approach to develop themes. RESULTS Older adults' perceptions about the Health TAPESTRY programme included (1) the lack of a clear purpose and understanding of how information was shared among providers, (2) mixed positive and negative perceptions of goal-setting and provider follow-up after inhome visits by volunteers, (3) positive impacts such as satisfaction with the primary care team, and (4) the potential for the programme to become a regular programme and applied to other communities and groups. CONCLUSIONS Older adults living in the community may benefit from greater primary care support provided through enhanced team-based approaches. Programmes such as Health TAPESTRY facilitate opportunities for older adults to work with primary care providers to meet their self-identified needs. By exploring perceptions of clients, primary care programmes can be further refined and expanded for various populations.
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Affiliation(s)
- Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Laura Cleghorn
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Fiona Parascandalo
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University/McMaster Innovation Park, Hamilton, Ontario, Canada
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Ratliff-Schaub K, Valleru J. Increasing Patient Portal Activation in a Pediatric Subspecialty Clinic. Pediatr Qual Saf 2018; 2:e049. [PMID: 30229185 PMCID: PMC6132890 DOI: 10.1097/pq9.0000000000000049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Online patient portals are not widely used, despite their advantages for efficient communication, especially for patients with chronic conditions. A hospital-based group practice of Developmental-Behavioral Pediatricians initiated this quality improvement (QI) project with a goal to increase the percentage of patients with an active MyChart (Epic Systems Corporation’s patient portal) account and ultimately improve efficiency of communication between families and clinical staff. Methods: Using QI methodology, we identified staff commitment, workflow issues, and family awareness as gaps and implemented progressive Plan, Do, Study, Act cycles aimed at developing standard processes for activating families on MyChart. We tracked our project measures with statistical process control methodology and sustained our progress with improving awareness and regular feedback. Results: Patient portal activations increased from 1.8% to 30% in a 6-month time period. Highly successful interventions included development and implementation of a standard process for activation, staff education to ensure comfort and commitment, having families opt out instead of opt in, and completed activation of accounts before families leaving clinic. Conclusions: Patient portal activation can be significantly increased through systematic application of QI methodology to address staff training and workflow in a busy subspecialty clinic. Engagement of operations staff and completion of the activation process while the family is still in clinic seemed to be effective in getting families activated in MyChart. It is possible to improve patient portal activation with minimal impact to workflow.
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25
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Hoogenbosch B, Postma J, de Man-van Ginkel JM, Tiemessen NA, van Delden JJ, van Os-Medendorp H. Use and the Users of a Patient Portal: Cross-Sectional Study. J Med Internet Res 2018; 20:e262. [PMID: 30224334 PMCID: PMC6231740 DOI: 10.2196/jmir.9418] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/05/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022] Open
Abstract
Background Patient portals offer patients access to their medical information and tools to communicate with health care providers. It has been shown that patient portals have the potential to positively impact health outcomes and efficiency of health care. It is therefore important that health care organizations identify the patients who use or do not use the patient portal and explore the reasons in either case. The Unified Theory of Acceptance and Use of Technology (UTAUT) is a frequently used theory for explaining the use of information technology. It consists of the following constructs: performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention to use. Objective This study aimed to explore the prevalence of patient portal use and the characteristics of patients who use or do not use a patient portal. The main constructs of UTAUT, together with demographics and disease- and care-related characteristics, have been measured to explore the predictive factors of portal use. Methods A cross-sectional study was conducted in the outpatient departments for adult patients of a university hospital in the Netherlands. Following outcomes were included: self-reported portal use, characteristics of users such as demographics, disease- and care-related data, eHealth literacy (modified score), and scores of UTAUT constructs. Descriptive analyses and univariate and multivariate logistic regression were also conducted. Results In the analysis, 439 adult patients were included. Furthermore, 32.1% (141/439) identified as being a user of the patient portal; 31.2% (137/439) indicated as nonusers, but being aware of the existence of the portal; and 36.6% (161/439) as being nonusers not aware of the existence of the portal. In the entire study population, the factors of being chronically ill (odds ratio, OR 1.62, 95% CI 1.04-2.52) and eHealth literacy (modified score; OR 1.12, 95% CI 1.07-1.18) best predicted portal use. In users and nonusers who were aware of the portal, UTAUT constructs were added to the multivariate logistic regression, with chronically ill and modified eHealth literacy sum score. Effort expectancy (OR 13.02, 95% CI 5.68-29.87) and performance expectancy (OR 2.84, 95% CI 1.65-4.90) are shown to significantly influence portal use in this group. Conclusions Approximately one-third of the patients of a university hospital self-reported using the patient portal; most expressed satisfaction. At first sight, being chronically ill and higher scores on the modified eHealth literacy scale explained portal use. Adding UTAUT constructs to the model revealed that effort expectancy (ease of use and knowledge and skills related to portal use) and performance expectancy (perceived usefulness) influenced portal use. Interventions to improve awareness of the portal and eHealth literacy skills of patients and further integration of the patient portal in usual face-to-face care are needed to increase use and potential subsequent patient benefits.
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Affiliation(s)
- Bas Hoogenbosch
- Department of Information Technology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Jeroen Postma
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | - Nicole Am Tiemessen
- Department of Information Technology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johannes Jm van Delden
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
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Affiliation(s)
- Richard G. Abramson
- From the Department of Radiology and Radiological Science, Vanderbilt University School of Medicine, 1161 21st Ave South, CCC-1121 MCN, Nashville, TN 37232-2675
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Shah SD, Liebovitz D. It Takes Two to Tango: Engaging Patients and Providers With Portals. PM R 2018; 9:S85-S97. [PMID: 28527507 DOI: 10.1016/j.pmrj.2017.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/20/2022]
Abstract
Patient portals are designed to be tools to more fully engage patients in their health care and help enable them to better manage their own health information. As the U.S. health care system rapidly adopted electronic health records (EHRs) over the past decade, many with linked patient portals, enthusiasm and expectations for this new technology as a means to engage and empower patients grew. Most patient portals have a set of core features designed to facilitate health care transactions, information tracking, and communication with care team members. The evidence supporting the anticipated benefits of patient portals on patient outcomes, however, remains mixed and incomplete. Moreover, a paradox exists in that, despite a high consumer interest in patient portals, widespread adoption remains relatively low. Potential reasons include the need for greater provider endorsement, examination and adaptation of clinical workflows, and the recognition of patient engagement as a reciprocal process.
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Affiliation(s)
- Sachin D Shah
- Departments of Medicine and Pediatrics, University of Chicago, 5841 S. Maryland Ave, MC 3051, Chicago, IL 60637(∗).
| | - David Liebovitz
- Department of Medicine, University of Chicago, Chicago, IL(†)
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Coughlin SS, Stewart JL, Young L, Heboyan V, De Leo G. Health literacy and patient web portals. Int J Med Inform 2018; 113:43-48. [PMID: 29602432 DOI: 10.1016/j.ijmedinf.2018.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES There is limited evidence about the association between health literacy and use of patient web portals in patients with chronic illnesses. The objective of this review was to learn more about health literacy and use of patient web portals. METHODS Bibliographic searches were conducted in PubMed and CINAHL using relevant MeSH search terms and Boolean algebra commands. RESULTS Qualitative studies and studies with a cross-sectional, cohort, or pre-/post-test design have shown that persons with limited health literacy are less likely to use patient web portals, although there is inconsistency in the association across studies. CONCLUSIONS The conflicting findings may be partially due to racial and ethnic differences in health literacy or level of comfort in sharing private health information using mobile technologies. Several opportunities exist to improve the usability and acceptability of web portals for patients with limited health literacy including enhancements in the design of the portals, patient and provider education and training, and engagement of proxies such as caregivers and close family members.
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States; Research Service, Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, United States.
| | - Jessica L Stewart
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Lufei Young
- College of Nursing, Augusta University, Augusta, GA, United States
| | - Vahé Heboyan
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Gianluca De Leo
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
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Woolf SH, Krist AH, Lafata JE, Jones RM, Lehman RR, Hochheimer CJ, Sabo RT, Frosch DL, Zikmund-Fisher BJ, Longo DR. Engaging Patients in Decisions About Cancer Screening: Exploring the Decision Journey Through the Use of a Patient Portal. Am J Prev Med 2018; 54:237-247. [PMID: 29241715 PMCID: PMC7144024 DOI: 10.1016/j.amepre.2017.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/03/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Engaging patients to make informed choices is paramount but difficult in busy practices. This study sought to engage patients outside the clinical setting to better understand how they approach cancer screening decisions, including their primary concerns and their preferences for finalizing their decision. METHODS Twelve primary care practices offering patients an online personal health record invited eligible patients to complete a 17-item online interactive module. Among 11,458 registered users, invitations to complete the module were sent to adults aged 50-74 years who were overdue for colorectal cancer screening and to women aged 40-49 years and men aged 55-69 who had not undergone a recent mammogram or prostate-specific antigen test, respectively. RESULTS The module was started by 2,355 patients and completed by 903 patients. Most respondents (76.8%) knew they were eligible for screening. Preferred next steps were talking to the clinician (76.6%), reading/research (28.6%), and consulting trusted friends/family (16.4%). Priority topics included how much screening improves life expectancy, comparative test performance, and the prevalence/health risks of the cancer. Leading fears were getting cancer/delayed detection (79.2%), abnormal results (40.5%), and testing complications (39.1%), the last referring to false test results, medical complications, or unnecessary treatments. Men eligible for prostate-specific antigen screening were more likely than women eligible for mammography to express concerns about testing complications and to prioritize weighing pros and cons over gut feelings (p<0.05). CONCLUSIONS Although this sample was predisposed to screening, most patients wanted help in finalizing their decision. Many wanted to weigh the pros and cons and expressed fears of potential harms from screening. Understanding how patients approach decisions may help design more effective engagement strategies.
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Affiliation(s)
- Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer Elston Lafata
- Department of Health Behavior and Policy, Lineberger Comprehensive Cancer Center and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania
| | | | - Camille J Hochheimer
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Daniel R Longo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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Clinician-Stakeholders' Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results. J Genet Couns 2017; 27:349-357. [PMID: 29159545 DOI: 10.1007/s10897-017-0179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record's patient portal may increase the efficiency of returning results and could activate patient follow-up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow-up and providing resources to notify at-risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.
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Increasing Health Portal Utilization in Cardiac Ambulatory Patients: A Pilot Project. Comput Inform Nurs 2017; 35:512-519. [PMID: 28541965 DOI: 10.1097/cin.0000000000000361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Increasing health portal participation actively engages patients in their care and improves outcomes. The primary aim for this project was to increase patient health portal utilization. Nurses used a tablet-based demo to teach patients how to navigate the health portal. Assigning health videos to the portal was a tactic used to increase utilization. Each patient participant was surveyed about health portal utilization at initial nurse navigator appointment, day of procedure, and 30 days after discharge. Seventy-three percent (n = 14) of the 19 selected patients received the intervention; 36% (n = 4) of patients reported using a health portal feature; meaningful use metric preintervention increased from 12% to 16% after the intervention; 16% and 18% of patients viewed assigned videos in their health portal prior to procedure and after hospital discharge. Patients need a reason to access their health portal. Education alone is not enough to motivate patient portal use. Further research is needed to specify what tactics are required to motivate patients to use their health portals.
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Glaser E, Richard C, Lussier MT. The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:2062-2070. [PMID: 28535926 DOI: 10.1016/j.pec.2017.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 05/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Examine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care. METHODS Three arm single-blind RCT in community primary care (PC) practices. PC practitioners (n=18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia. INTERVENTIONS (1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care. OUTCOME Proportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for. RESULTS Patients (n=322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00-2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up. CONCLUSIONS Training patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients. PRACTICE IMPLICATIONS Web communication interventions are an effective tool that can be used in primary care.
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Affiliation(s)
- Emma Glaser
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Faculty of Medicine, Université de Montréal, Canada.
| | - Claude Richard
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada
| | - Marie-Thérèse Lussier
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Canada
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Abstract
OBJECTIVE To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales. METHODS Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review. RESULTS One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6-27.7) and 18.8 (95% CI, 1.9-35.7) percentage points, respectively. CONCLUSION A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.
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Katkin JP, Kressly SJ, Edwards AR, Perrin JM, Kraft CA, Richerson JE, Tieder JS, Wall L, Alexander JJ, Flanagan PJ, Hudak ML, Quinonez RA, Shenkin BN, Smith TK. Guiding Principles for Team-Based Pediatric Care. Pediatrics 2017; 140:peds.2017-1489. [PMID: 28739656 DOI: 10.1542/peds.2017-1489] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics (AAP) recognizes that children's unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child's life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family.
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Affiliation(s)
- Julie P. Katkin
- Pediatric Pulmonary Medicine Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | - James M. Perrin
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Colleen A. Kraft
- Health Network by Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Joel S. Tieder
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington; and
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Demiris G, Kneale L. Informatics Systems and Tools to Facilitate Patient-centered Care Coordination. Yearb Med Inform 2017; 10:15-21. [PMID: 26293847 DOI: 10.15265/iy-2015-003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is a growing international focus on patient- centered care. A model designed to facilitate this type of care in the primary care setting is the patient-centered medical home. This model of care strives to be patient-focused, comprehensive, team-based, coordinated, accessible, and focused on quality and safety of care. OBJECTIVE The objective of this paper is to identify the current status and future trends of patient-centered care and the role of informatics systems and tools in facilitating this model of care. METHODS In this paper we review recent scientific literature of the past four years to identify trends and state of current evidence when it comes to patient-centered care overall, and more specifically medical homes. RESULTS There are several studies that indicate growth and development in seven informatics areas within patient-centered care, namely clinical decision support, registries, team care, care transitions, personal health records, telehealth, and measurement. In some cases we are still lacking large randomized clinical trials and the evidence base is not always solid, but findings strongly indicate the potential of informatics to support patient-centered care. CONCLUSION Current evidence indicates that advancements have been made in implementing and evaluating patient-centered care models. Technical, legal, and practical challenges still remain. Further examination of the impact of patient-centered informatics tools and systems on clinical outcomes is needed.
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Affiliation(s)
- G Demiris
- George Demiris PhD, FACMI, University of Washington, BNHS Box 357266, Seattle, WA, 98195, USA, Tel: +1 206 221 3866, Fax: +1 206 543 4771, E-mail:
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Assadi V, Hassanein K. Consumer Adoption of Personal Health Record Systems: A Self-Determination Theory Perspective. J Med Internet Res 2017; 19:e270. [PMID: 28751301 PMCID: PMC5553007 DOI: 10.2196/jmir.7721] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/02/2017] [Accepted: 06/19/2017] [Indexed: 01/07/2023] Open
Abstract
Background Personal Health Records (PHR) systems provide individuals with access and control over their health information and consequently can support individuals in becoming active participants, rather than passive recipients, in their own care process. In spite of numerous benefits suggested for consumers’ utilizing PHR systems, research has shown that such systems are not yet widely adopted or well known to consumers. Bearing in mind the potential benefits of PHRs to consumers and their potential interest in these systems—and that similar to any other type of information system, adoption is a prerequisite for realizing the potential benefits of PHR systems—research is needed to understand how to enhance the adoption rates for PHR systems. Objective This research seeks to understand how individuals’ intentions to adopt PHR systems are affected by their self-determination in managing their own health—the extent of their ability to take an active role in managing their own health. As such, this research aims to develop and empirically validate a theoretical model that explains PHR systems adoption by the general public through the integration of theories from the information systems and psychology literatures. Methods This research employs a cross-sectional survey method targeted at the Canadian general public without any prior experience in using PHR systems. A partial least squares approach to structural equation modeling was used to validate the proposed research model of this study (N=159). Results Individuals with higher levels of ability to manage their own health (self-determination) are more likely to adopt PHR systems since they have more positive perceptions regarding the use of such systems. Further, such self-determination is fueled by autonomy support from consumers’ physicians as well as the consumers’ personality trait of autonomy orientation. Conclusions This study advances our theoretical understanding of PHR systems adoption. It also contributes to practice by providing insightful implications for designing, promoting, and facilitating the use of PHR systems among consumers.
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Affiliation(s)
- Vahid Assadi
- McMaster Digital Transformation Research Centre, DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Khaled Hassanein
- McMaster Digital Transformation Research Centre, DeGroote School of Business, McMaster University, Hamilton, ON, Canada
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Sieck CJ, Hefner JL, Schnierle J, Florian H, Agarwal A, Rundell K, McAlearney AS. The Rules of Engagement: Perspectives on Secure Messaging From Experienced Ambulatory Patient Portal Users. JMIR Med Inform 2017; 5:e13. [PMID: 28676467 PMCID: PMC5516097 DOI: 10.2196/medinform.7516] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/28/2017] [Accepted: 04/14/2017] [Indexed: 11/23/2022] Open
Abstract
Background Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic’s MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician’s time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the “rules of engagement” at portal sign-up, either in the office or through an online tutorial. Conclusions As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing “rules of engagement” for communication via patient portals.
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Affiliation(s)
- Cynthia J Sieck
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jeanette Schnierle
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Hannah Florian
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Aradhna Agarwal
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kristen Rundell
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States.,The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, United States
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Greenberg AJ, Falisi AL, Finney Rutten LJ, Chou WYS, Patel V, Moser RP, Hesse BW. Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis. J Med Internet Res 2017; 19:e188. [PMID: 28576755 PMCID: PMC5473948 DOI: 10.2196/jmir.7417] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/24/2017] [Accepted: 04/29/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC. OBJECTIVE The aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public's use of ePHRs varies across subpopulations, including those with MCC. METHODS This study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models. RESULTS Those with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03). CONCLUSIONS We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC.
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Affiliation(s)
| | - Angela L Falisi
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | | | - Wen-Ying Sylvia Chou
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Vaishali Patel
- Office of the National Coordinator, US Department of Health and Human Services, Washington, DC, United States
| | - Richard P Moser
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Bradford W Hesse
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
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Krist AH, Woolf SH, Hochheimer C, Sabo RT, Kashiri P, Jones RM, Lafata JE, Etz RS, Tu SP. Harnessing Information Technology to Inform Patients Facing Routine Decisions: Cancer Screening as a Test Case. Ann Fam Med 2017; 15:217-224. [PMID: 28483886 PMCID: PMC5422082 DOI: 10.1370/afm.2063] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/22/2016] [Accepted: 12/31/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. METHODS Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. RESULTS In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). CONCLUSIONS Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia .,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia.,Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
| | - Camille Hochheimer
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.,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
| | - Paulette Kashiri
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Resa M Jones
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina.,Institute for Healthcare Quality Improvement, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca S Etz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Shin-Ping Tu
- School of Public Health, University of Washington, Seattle, Washington
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Ose D, Baudendistel I, Pohlmann S, Winkler EC, Kunz A, Szecsenyi J. Persönliche Patientenakten im Internet. Ein narrativer Review zu Einstellungen, Erwartungen, Nutzung und Effekten. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 122:9-21. [DOI: 10.1016/j.zefq.2017.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2017] [Accepted: 04/07/2017] [Indexed: 12/20/2022]
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Coughlin SS, Prochaska JJ, Williams LB, Besenyi GM, Heboyan V, Goggans DS, Yoo W, De Leo G. Patient web portals, disease management, and primary prevention. Risk Manag Healthc Policy 2017; 10:33-40. [PMID: 28435342 PMCID: PMC5391175 DOI: 10.2147/rmhp.s130431] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Efforts aimed at health care reform and continued advances in information technologies have prompted interest among providers and researchers in patient web portals. Patient web portals are password-protected online websites that offer the patients 24-hour access to personal health information from anywhere with an Internet connection. METHODS This article, which is based upon bibliographic searches in PubMed, reviews important developments in web portals for primary and secondary disease prevention, including patient web portals tethered to electronic medical records, disease-specific portals, health disparities, and health-related community web portals. RESULTS Although findings have not been uniformly positive, several studies of the effectiveness of health care system patient portals in chronic disease management have shown promising results with regard to patient outcomes. Patient web portals have also shown promising results in increasing adherence with screening recommendations. Racial and ethnic minorities, younger persons, and patients who are less educated or have lower health literacy have been found to be less likely to use patient portals. CONCLUSION Additional studies are needed of the utility and effectiveness of different elements of web portals for different patient populations. This should include additional diseases and health topics such as smoking cessation and weight management.
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
| | - Judith J Prochaska
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA
| | - Lovoria B Williams
- Department of Biobehavioral Nursing, College of Nursing, Augusta University
| | - Gina M Besenyi
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
| | - Vahé Heboyan
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
| | | | - Wonsuk Yoo
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA
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Randhawa GS, Ahern DK, Hesse BW. Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care. HEALTH POLICY AND TECHNOLOGY 2017; 6:67-71. [PMID: 28948138 PMCID: PMC5609681 DOI: 10.1016/j.hlpt.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system. This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients. We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.
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Affiliation(s)
- Gurvaneet S Randhawa
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, 3E442, Bethesda, MD 20892-9761, United States
| | - David K Ahern
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
- Program in Behavioral Informatics and eHealth, Brigham & Women's Hospital, United States
| | - Bradford W Hesse
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
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Gerber DE, Beg MS, Duncan T, Gill M, Lee SJC. Oncology Nursing Perceptions of Patient Electronic Portal Use: A Qualitative Analysis. Oncol Nurs Forum 2017; 44:165-170. [PMID: 28222081 PMCID: PMC7066859 DOI: 10.1188/17.onf.165-170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify nursing staff reactions to and perceptions of electronic portal use in a cancer setting.
. RESEARCH APPROACH Qualitative.
. SETTING Outpatient clinic at the Harold C. Simmons Comprehensive Cancer Center of the University of Texas Southwestern Medical Center in Dallas.
. PARTICIPANTS 13 nurses with a range of credentials and experience, representing infusion, medical oncology, and bone marrow transplantation clinics.
. METHODOLOGIC APPROACH Two focus groups were conducted. Theoretical thematic content analysis of data was performed.
. FINDINGS Key themes that emerged for consideration of electronic portals included work volume and flow, patient expectations and safety, variation in use of communication technologies, and education and management.
. INTERPRETATION The current study provides insight into the implications of electronic portals by identifying nursing staff reactions to this technology. These reactions are predominantly related to the impact on clinical workload and patient safety and expectations.
. IMPLICATIONS FOR NURSING As clinical cancer facilities incorporate electronic portal technology into their operations, attention to the impact on staff workload, division of labor, patient safety, and patient expectations should be considered.
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Affiliation(s)
- David E. Gerber
- Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - M. Shaalan Beg
- Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tobi Duncan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mary Gill
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Simon J. Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Clinical Sciences. University of Texas Southwestern Medical Center, Dallas, Texas
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DeVoe J, Angier H, Hoopes M, Gold R. A new role for primary care teams in the United States after "Obamacare:" Track and improve health insurance coverage rates. Fam Med Community Health 2016; 4:63-67. [PMID: 28966926 DOI: 10.15212/fmch.2016.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Maintaining continuous health insurance coverage is important. With recent expansions in access to coverage in the United States after "Obamacare," primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients. We describe efforts to longitudinally track health insurance rates using data from the electronic health record (EHR) of a primary care network and to use these data to support practice-based insurance outreach and assistance. Although we highlight a few examples from one network, we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care. By partnering with researchers through practice-based research networks and other similar collaboratives, primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care.
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Affiliation(s)
| | | | | | - Rachel Gold
- Kaiser Permanente Center for Health Research Northwest Region, Portland, OR, USA
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Fix GM, Hogan TP, Amante DJ, McInnes DK, Nazi KM, Simon SR. Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives. J Med Internet Res 2016; 18:e308. [PMID: 27876686 PMCID: PMC5141333 DOI: 10.2196/jmir.6488] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/23/2016] [Accepted: 10/29/2016] [Indexed: 11/30/2022] Open
Abstract
Background Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. Objective We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. Methods Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system. Results We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal. Conclusions Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Kim M Nazi
- Veterans Health Administration, Veterans and Consumers Health Informatics Office, Office of Connected Care, US Department of Veterans Affairs, Washington, DC, United States
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, United States
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Hochheimer CJ, Sabo RT, Krist AH, Day T, Cyrus J, Woolf SH. Methods for Evaluating Respondent Attrition in Web-Based Surveys. J Med Internet Res 2016; 18:e301. [PMID: 27876687 PMCID: PMC5141338 DOI: 10.2196/jmir.6342] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/12/2016] [Accepted: 10/07/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic surveys are convenient, cost effective, and increasingly popular tools for collecting information. While the online platform allows researchers to recruit and enroll more participants, there is an increased risk of participant dropout in Web-based research. Often, these dropout trends are simply reported, adjusted for, or ignored altogether. OBJECTIVE To propose a conceptual framework that analyzes respondent attrition and demonstrates the utility of these methods with existing survey data. METHODS First, we suggest visualization of attrition trends using bar charts and survival curves. Next, we propose a generalized linear mixed model (GLMM) to detect or confirm significant attrition points. Finally, we suggest applications of existing statistical methods to investigate the effect of internal survey characteristics and patient characteristics on dropout. In order to apply this framework, we conducted a case study; a seventeen-item Informed Decision-Making (IDM) module addressing how and why patients make decisions about cancer screening. RESULTS Using the framework, we were able to find significant attrition points at Questions 4, 6, 7, and 9, and were also able to identify participant responses and characteristics associated with dropout at these points and overall. CONCLUSIONS When these methods were applied to survey data, significant attrition trends were revealed, both visually and empirically, that can inspire researchers to investigate the factors associated with survey dropout, address whether survey completion is associated with health outcomes, and compare attrition patterns between groups. The framework can be used to extract information beyond simple responses, can be useful during survey development, and can help determine the external validity of survey results.
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Affiliation(s)
- Camille J Hochheimer
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Teresa Day
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - John Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, Richmond, VA, United States
| | - Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
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Ruiz JG, Andrade AD, Hogue C, Karanam C, Akkineni S, Cevallos D, Anam R, Sharit J. The Association of Graph Literacy With Use of and Skills Using an Online Personal Health Record in Outpatient Veterans. JOURNAL OF HEALTH COMMUNICATION 2016; 21:83-90. [PMID: 27668834 DOI: 10.1080/10810730.2016.1193915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Personal health records (PHRs) are intended to increase patients' access to and ownership over their health care information for self-management purposes. The purpose of this study was to determine the association of graph literacy with adoption of an online PHR and, among adopters with self-reported skills, the frequency of use and intent to return to use the PHR . We conducted a cross-sectional survey of veterans receiving outpatient care. We measured health literacy, numeracy, graph literacy, and Internet and PHR adoption and use. We compared subgroups of veterans using analyses of covariance. We used hierarchical logistic regression models to estimate the effects of the literacy variables on PHR use. A total of 600 veterans (age = 22-94) participated in the survey. After we adjusted for known covariates, we found that adopters of a PHR were more likely to demonstrate higher health and graph literacy than nonadopters. Among PHR adopters, self-reported frequent and skillful users were more likely to have higher graph literacy than lower frequency and less skillful users. Adopters with higher intentions to return to use the PHR were more likely to show lower graph literacy than those less likely to return to use the PHR. Inadequate graph literacy was associated with lower adoption of a PHR and, among users, with lower self-reported frequent use and skills . As PHR use becomes more widespread, stakeholders will need to consider patients' levels of graph literacy when implementing PHRs.
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Affiliation(s)
- Jorge G Ruiz
- a Laboratory of E-learning and Multimedia Research , Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC , Miami , Florida , USA
- b University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Allen D Andrade
- c Icahn School of Medicine at Mount Sinai , New York , New York , USA
- d Bronx New York Harbor GRECC , New York , New York , USA
| | - Christie Hogue
- a Laboratory of E-learning and Multimedia Research , Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC , Miami , Florida , USA
| | - Chandana Karanam
- a Laboratory of E-learning and Multimedia Research , Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC , Miami , Florida , USA
| | - Sisir Akkineni
- a Laboratory of E-learning and Multimedia Research , Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC , Miami , Florida , USA
| | - David Cevallos
- a Laboratory of E-learning and Multimedia Research , Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC , Miami , Florida , USA
| | - Ramanakumar Anam
- a Laboratory of E-learning and Multimedia Research , Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC , Miami , Florida , USA
| | - Joseph Sharit
- a Laboratory of E-learning and Multimedia Research , Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC , Miami , Florida , USA
- b University of Miami Miller School of Medicine , Miami , Florida , USA
- e University of Miami College of Engineering , Miami , Florida , USA
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Oramasionwu CU, Vitko ML, Johnson TL, Sage AJ, Chung AE, Bailey SC. Assessing the Quality and Suitability of Multimedia Resources to Assist Patients With Patient Portal Use. Am J Med Qual 2016; 32:453-455. [PMID: 27577935 DOI: 10.1177/1062860616667212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Adam J Sage
- 1 The University of North Carolina at Chapel Hill, NC
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Fiks AG, DuRivage N, Mayne SL, Finch S, Ross ME, Giacomini K, Suh A, McCarn B, Brandt E, Karavite D, Staton EW, Shone LP, McGoldrick V, Noonan K, Miller D, Lehmann CU, Pace WD, Grundmeier RW. Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study. J Med Internet Res 2016; 18:e172. [PMID: 27357835 PMCID: PMC4945817 DOI: 10.2196/jmir.5610] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 12/25/2022] Open
Abstract
Background Patient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established. Objective We evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success. Methods We conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework. Results We invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success. Conclusions Although use was associated with higher treatment engagement, our results suggest that achieving widespread portal adoption is unlikely in the short term. Implementation efforts should include workflow redesign and prioritize enrollment of symptomatic children. ClinicalTrial Clinicaltrials.gov NCT01966068; https://clinicaltrials.gov/ct2/show/NCT01966068 (Archived by WebCite at http://www.webcitation.org/6i9iSQkm3)
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Affiliation(s)
- Alexander G Fiks
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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Griffin A, Skinner A, Thornhill J, Weinberger M. Patient Portals: Who uses them? What features do they use? And do they reduce hospital readmissions? Appl Clin Inform 2016; 7:489-501. [PMID: 27437056 DOI: 10.4338/aci-2016-01-ra-0003] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient portals have demonstrated numerous benefits including improved patient-provider communication, patient satisfaction with care, and patient engagement. Recent literature has begun to illustrate how patients use selected portal features and an association between portal usage and improved clinical outcomes. OBJECTIVES This study sought to: (1) identify patient characteristics associated with the use of a patient portal; (2) determine the frequency with which common patient portal features are used; and (3) examine whether the level of patient portal use (non-users, light users, active users) is associated with 30-day hospital readmission. METHODS My UNC Chart is the patient portal for the UNC Health Care System. We identified adults discharged from three UNC Health Care hospitals with acute myocardial infarction, congestive heart failure, or pneumonia and classified them as active, light, or non-users of My UNC Chart. Multivariable analyses were conducted to compare across user groups; logistic regression was used to predict whether patient portal use was associated with 30-day readmission. RESULTS Of 2,975 eligible patients, 83.4% were non-users; 8.6% were light users; and 8.0% were active users of My UNC Chart. The messaging feature was used most often. For patients who were active users, the odds of being readmitted within 30 days was 66% greater than patients who were non-users (p<0.05). There was no difference in 30-day readmission between non-users and light users. CONCLUSIONS The vast majority of patients who were given an access code for My UNC Chart did not use it within 30 days of discharge. Of those who used the portal, active users had a higher odds of being readmitted within 30 days. Health care systems should consider strategies to: (1) increase overall use of patient portals and (2) target patients with the highest comorbidity scores to reduce hospital readmissions.
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Affiliation(s)
- Ashley Griffin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , 135 Dauer Drive, Chapel Hill, NC 27599
| | - Asheley Skinner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , 135 Dauer Drive, Chapel Hill, NC 27599
| | - Jonathan Thornhill
- Learning and Diffusion Group, Center for Medicare and Medicaid Innovation , 7500 Security Boulevard, Baltimore, MD 21244
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599; Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham NC 27705
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