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Midboe AM, Cave S, Shimada SL, Griffin AC, Avoundjian T, Asch SM, Gifford AL, McInnes DK, Troszak LK. Relationship Between Patient Portal Tool Use and Medication Adherence and Viral Load Among Patients Living with HIV. J Gen Intern Med 2024; 39:127-135. [PMID: 38252241 PMCID: PMC10937883 DOI: 10.1007/s11606-023-08474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/10/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Patient portals play an increasingly critical role in engaging patients in their health care. They have the potential to significantly impact the health of those living with chronic diseases, such as HIV, for whom consistent care engagement is both critical and complex. OBJECTIVE The primary aim was to examine the longitudinal relationships between individual portal tool use and health-related outcomes in patients living with HIV. DESIGN Retrospective cohort study using electronic health record data to examine the relationship between patient portal tool use and key HIV-specific, health-related outcomes in patients engaged in care in the Veterans Health Administration (VA) through the application of marginal structural models. PARTICIPANTS A national sample of patients living with HIV (PLWH) active in VA care who were registered to use the VA's patient portal, My HealtheVet (MHV; n = 18,390) between 10/1/2012 and 4/1/2017. MAIN MEASURES The MHV tools examined were prescription refill (including prescription refill of an antiretroviral (ART) medication and any medication), secure messaging, view appointments, and view labs. Primary outcomes were viral load test receipt, viral load suppression, and ART medication adherence (measured as proportion of days covered). KEY RESULTS The use of prescription refill for any medication or for ART was positively associated with ART adherence. Secure messaging was positively associated with ART adherence but not with viral load test receipt or viral load suppression. The use of view appointments was positively associated with ART adherence and viral load test receipt but not viral load suppression. The use of view labs was positively associated with viral load suppression but not ART adherence or viral load test receipt. CONCLUSIONS These findings highlight the valuable role patient portals may play in improving health-related outcomes among PLWH and have implications for patients living with other types of chronic disease.
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Affiliation(s)
- Amanda M Midboe
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.
- Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA.
| | - Shayna Cave
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Ashley C Griffin
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Tigran Avoundjian
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Steven M Asch
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Donald Keith McInnes
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
| | - Lara K Troszak
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
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Mahmoud R, Callahan K, Schell D, Carron S, Chahin S. Direct and Indirect Care of Patients With Multiple Sclerosis: Burden on Providers and Impact of Portal Messages. Int J MS Care 2024; 26:13-16. [PMID: 38213674 PMCID: PMC10779709 DOI: 10.7224/1537-2073.2022-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) indirect patient-care time is often underreported and uncompensated. Data on time spent on indirect and direct care by MS providers is lacking. METHODS A survey was designed to understand the practice patterns among MS providers in the United States, including time spent on direct and indirect patient care, as well as managing electronic medical record portal messages. The National MS Society and the American Academy of Neurology facilitated the distribution of the survey to MS providers. RESULTS Most providers spent at least 1 hour on new and at least 30 minutes on follow-up direct patient care. For indirect patient care, 77% of providers spent more than 1 hour and 57% spent more than 2 hours per day. While some providers have support staff to help with portal messages, many do not have protected time or compensation for portal messages. CONCLUSIONS Multiple sclerosis providers spent a higher-than-average time on direct and indirect patient care tasks, including portal messages, and most lack protected time or compensation for portal messages. These results highlight the potential impact of indirect patient care (notably portal messages) on provider workload and burnout. Better support, protected time and/or compensation for indirect patient care can help ease physician burden and decrease burnout.
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Affiliation(s)
- Rola Mahmoud
- From Kansas City Physician Partners, Kansas City, MO (RM)
| | - Katie Callahan
- Marion Bloch Neuroscience Institute (KC, DS), Saint Luke’s Hospital of Kansas City (RM, KC, DS), University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Doug Schell
- Marion Bloch Neuroscience Institute (KC, DS), Saint Luke’s Hospital of Kansas City (RM, KC, DS), University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Suzanne Carron
- Department of Neurology (RM), The John L. Trotter MS Center, Washington University School of Medicine in St. Louis, St. Louis, MO (SC)
| | - Salim Chahin
- the National Multiple Sclerosis Society, St. Louis, MO (SC)
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Siddiqui S, Etingen B, Patrianakos J, Shimada S, Hogan T, Nazi K, Stroupe K, Smith B. Use of the Veterans Health Administration online patient portal among Veterans with spinal cord injuries and disorders. J Spinal Cord Med 2023; 46:917-928. [PMID: 35763563 PMCID: PMC10653767 DOI: 10.1080/10790268.2022.2084967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE Online patient portals like the Veteran Health Administration's (VA) My HealtheVet (MHV) may be particularly useful for Veterans with spinal cord injuries/disorders (SCI/D), many of whom experience barriers to care. The objective of this analysis was to examine MHV use among Veterans with SCI/D. DESIGN Retrospective database analysis. SETTING VA SCI/D System of Care. PARTICIPANTS Veterans with SCI/D who utilize VA care. INTERVENTIONS N/A. OUTCOME MEASURES MHV registration and use of key portal features among Veterans who newly registered for MHV. Veteran characteristics associated with registration and use of portal features using multiple logistic regression. RESULTS 14.6% of Veterans with SCI/D in our sample registered to use MHV. 48.7% used the medication refill feature, 28.7% used the appointment view feature, 25.0% sent or read at least one secure message and 10.8% used the Blue Button feature. Adjusted analyses indicate that having a C5-8 (OR: 1.36, CI95%: 1.06-1.76, P < 0.05) or T1-S5 (OR: 1.41, CI95%: 1.13-1.78, P < 0.01) (vs. C1-C4), having (vs. not having) neurogenic bladder (OR: 1.45, CI95%: 1.18-1.77, P < 0.01), being married (vs. not married) (OR: 2.00, CI95%: 1.67-2.39, P < 0.01), and increased healthcare utilization in the third (OR: 1.71, CI95%: 1.31-2.24, P < 0.01) and fourth (OR: 1.73, CI95%: 1.27-2.34, P < 0.01) quartiles (vs. first quartile) were associated with increased odds of MHV registration. We also identified factors associated with use of key MHV features. CONCLUSIONS Our results suggest that MHV registration and use of key portal features was limited among Veterans with SCI/D. Effort to increase portal use in this population are warranted.
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Affiliation(s)
- Sameer Siddiqui
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, Illinois, USA
| | - Jamie Patrianakos
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, Illinois, USA
| | - Stephanie Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kim Nazi
- Independent Consultant, Albany, New York, USA
| | - Kevin Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, Illinois, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Bridget Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, Illinois, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Petrovskaya O, Karpman A, Schilling J, Singh S, Wegren L, Caine V, Kusi-Appiah E, Geen W. Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review. J Med Internet Res 2023; 25:e43765. [PMID: 37856174 PMCID: PMC10623227 DOI: 10.2196/43765] [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: 10/24/2022] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.
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Affiliation(s)
| | - Albina Karpman
- Faculty of Nursing, MacEwan University, Edmonton, AB, Canada
| | | | - Simran Singh
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Larissa Wegren
- South Health Campus, Women's Health, Calgary, AB, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Willow Geen
- School of Nursing, University of Victoria, Victoria, BC, Canada
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Johnson NL. Towards Understanding Disparities in Using Technology to Access Health Care Information: African American Veterans' Sociocultural Perspectives on Using My Health eVet for Diabetes Management. HEALTH COMMUNICATION 2023; 38:2399-2407. [PMID: 35514118 DOI: 10.1080/10410236.2022.2071392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The digital divide, a racial disparity in computer and internet use, persists among Veterans. This study examined African American Veterans' experiences with and attitudes about using My HealtheVet (MHV), the online patient portal used in the Department of Veterans Affairs (VA) health care system. Semi-structured interviews were conducted with 35 non-Hispanic African American Veterans about preferences for health information, use of web-enabled devices, and experiences with and preferences for using MHV. Twenty-nine men and 6 women, ranging 35 to 73 years old, participated in this study. About 75% (n = 26) had completed some college or more, and about 75% (n = 26) considered their families financially comfortable. Ninety-one percent (n = 32) of participants were aware of MHV, and 78% (n = 25) of those who were aware reported having enrolled for an account. Data revealed participants valued that MHV provided realistic solutions to cumbersome aspects (e.g., phone call hold-times) of receiving care at the VA. However, participants admitted to not using the patient portal at all or to its full potential for two reasons: a) preference for their pre-MHV routine, b) distrust in the institutional, technological, and organizational aspects surrounding MHV. By highlighting the sociocultural aspects of patient portal use, this study provides a meaningful explanation for barriers and facilitators of health information technology adoption, particularly for MHV among African American Veterans, and ways practitioners may influence uptake.
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Affiliation(s)
- Nicole L Johnson
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System
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Scheckel B, Schmidt K, Stock S, Redaèlli M. Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability. J Med Internet Res 2023; 25:e38447. [PMID: 37624629 PMCID: PMC10492174 DOI: 10.2196/38447] [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: 04/02/2022] [Revised: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features. OBJECTIVE This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability. METHODS We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design. RESULTS After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support. CONCLUSIONS The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
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Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katharina Schmidt
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Fix GM, Haltom TM, Cogan AM, Shimada SL, Davila JA. Understanding Patients' Preferences and Experiences During an Electronic Health Record Transition. J Gen Intern Med 2023:10.1007/s11606-023-08338-6. [PMID: 37580637 DOI: 10.1007/s11606-023-08338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The Department of Veterans Affairs (VA) has embarked on the largest system-wide electronic health record (EHR) transition in history. To date, most research on EHR-to-EHR transitions has focused on employee and system transition-related needs, with limited focus on how patients experience transitions. OBJECTIVE (1) Understand patients' preferences for information and support prior to an EHR transition, and (2) examine actual patient experiences that occurred at facilities that implemented a new EHR. DESIGN We used a two-step approach. We had discussions with geographically diverse patient advisory groups. Discussions informed semi-structured, qualitative interviews with patients. PARTICIPANTS Patients affected by the EHR transition. MAIN MEASURES We met with four patient advisory groups at sites that had not transitioned their EHR. Interviews were conducted with patients who received care at one of two facilities that recently transitioned to the new EHR. KEY RESULTS Patient advisors identified key areas important to patients during an EHR transition. 1) Use a range of communication strategies to reach diverse populations, especially older, rural patients. 2) Information about the EHR transition should be clear and reinforce trustworthiness. 3) Patients will need guidance using the new patient portal. From the patient interviews, we learned if and how these key areas mapped onto patients' experiences. Patients at the sites that had transitioned learned about the new EHR through a variety of modalities, including letters and banners on the patient portal. However, their experiences varied in terms of information quality, leading to frustrations during and between healthcare encounters. Patient portal issues exacerbated frustrations. These raised concerns about the accuracy and security of the overall EHR. CONCLUSIONS Maintaining clear communication across patients, local leadership, and providers throughout an EHR transition is essential for successful implementation. Patient-facing communications can set expectations, and help patients receive adequate support, particularly related to the patient portal.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Rd., Bedford, MA, USA.
- Chobanian & Avedisian School of Medicine, Boston University, 72 E Concord St, Boston, MA, USA.
- Boston University School of Public Health, 715 Albany St., Boston, MA, USA.
| | - Trenton M Haltom
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Houston, Houston, TX, USA
- Department of Medicine-Health Services Research, Baylor College of Medicine, One Baylor Plaza Houston, Houston, TX, USA
| | - Alison M Cogan
- Center for the Study of Health Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 Alcazar St, Los Angeles, CA, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Rd., Bedford, MA, USA
- Boston University School of Public Health, 715 Albany St., Boston, MA, USA
- UMass Chan Medical School, 55 N Lake Ave, Worcester, MA, USA
| | - Jessica A Davila
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Houston, Houston, TX, USA
- Department of Medicine-Health Services Research, Baylor College of Medicine, One Baylor Plaza Houston, Houston, TX, USA
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Son EH, Nahm ES. Adult Patients' Experiences of Using a Patient Portal With a Focus on Perceived Benefits and Difficulties, and Perceptions on Privacy and Security: Qualitative Descriptive Study. JMIR Hum Factors 2023; 10:e46044. [PMID: 37490316 PMCID: PMC10411420 DOI: 10.2196/46044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Patient portals can facilitate patient engagement in care management. Driven by national efforts over the past decade, patient portals are being implemented by hospitals and clinics nationwide. Continuous evaluation of patient portals and reflection of feedback from end users across care settings are needed to make patient portals more user-centered after the implementation. OBJECTIVE The aim of this study was to investigate the lived experience of using a patient portal in adult patients recruited from a variety of care settings, focusing on their perceived benefits and difficulties of using the patient portal, and trust and concerns about privacy and security. METHODS This qualitative descriptive study was part of a cross-sectional digital survey research to examine the comprehensive experience of using a patient portal in adult patients recruited from 20 care settings from hospitals and clinics of a large integrated health care system in the mid-Atlantic area of the United States. Those who had used a patient portal offered by the health care system in the past 12 months were eligible to participate in the survey. Data collected from 734 patients were subjected to descriptive statistics and content analysis. RESULTS The majority of the participants were female and non-Hispanic White with a mean age of 53.1 (SD 15.34) years. Content analysis of 1589 qualitative comments identified 22 themes across 4 topics: beneficial aspects (6 themes) and difficulties (7 themes) in using the patient portal; trust (5 themes) and concerns (4 themes) about privacy and security of the patient portal. Most of the participants perceived the patient portal functions as beneficial for communicating with health care teams and monitoring health status and care activities. At the same time, about a quarter of them shared difficulties they experienced while using those functions, including not getting eMessage responses timely and difficulty finding information in the portal. Protected log-in process and trust in health care providers were the most mentioned reasons for trusting privacy and security of the patient portal. The most mentioned reason for concerns about privacy and security was the risk of data breaches such as hacking attacks and identity theft. CONCLUSIONS This study provides an empirical understanding of the lived experience of using a patient portal in adult patient users across care settings with a focus on the beneficial aspects and difficulties in using the patient portal, and trust and concerns about privacy and security. Our study findings can serve as a valuable reference for health care institutions and software companies to implement more user-centered, secure, and private patient portals. Future studies may consider targeting other patient portal programs and patients with infrequent or nonuse of patient portals.
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Affiliation(s)
- Elisa H Son
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Eun-Shim Nahm
- Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, United States
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Chen Y, Liu X, Gao L, Zhu M, Shia BC, Chen M, Ye L, Qin L. Using the H2O Automatic Machine Learning Algorithms to Identify Predictors of Web-Based Medical Record Nonuse Among Patients in a Data-Rich Environment: Mixed Methods Study. JMIR Med Inform 2023; 11:e41576. [PMID: 37335616 DOI: 10.2196/41576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/26/2022] [Accepted: 04/08/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND With the advent of electronic storage of medical records and the internet, patients can access web-based medical records. This has facilitated doctor-patient communication and built trust between them. However, many patients avoid using web-based medical records despite their greater availability and readability. OBJECTIVE On the basis of demographic and individual behavioral characteristics, this study explores the predictors of web-based medical record nonuse among patients. METHODS Data were collected from the National Cancer Institute 2019 to 2020 Health Information National Trends Survey. First, based on the data-rich environment, the chi-square test (categorical variables) and 2-tailed t tests (continuous variables) were performed on the response variables and the variables in the questionnaire. According to the test results, the variables were initially screened, and those that passed the test were selected for subsequent analysis. Second, participants were excluded from the study if any of the initially screened variables were missing. Third, the data obtained were modeled using 5 machine learning algorithms, namely, logistic regression, automatic generalized linear model, automatic random forest, automatic deep neural network, and automatic gradient boosting machine, to identify and investigate factors affecting web-based medical record nonuse. The aforementioned automatic machine learning algorithms were based on the R interface (R Foundation for Statistical Computing) of the H2O (H2O.ai) scalable machine learning platform. Finally, 5-fold cross-validation was adopted for 80% of the data set, which was used as the training data to determine hyperparameters of 5 algorithms, and 20% of the data set was used as the test data for model comparison. RESULTS Among the 9072 respondents, 5409 (59.62%) had no experience using web-based medical records. Using the 5 algorithms, 29 variables were identified as crucial predictors of nonuse of web-based medical records. These 29 variables comprised 6 (21%) sociodemographic variables (age, BMI, race, marital status, education, and income) and 23 (79%) variables related to individual lifestyles and behavioral habits (such as electronic and internet use, individuals' health status and their level of health concern, etc). H2O's automatic machine learning methods have a high model accuracy. On the basis of the performance of the validation data set, the optimal model was the automatic random forest with the highest area under the curve in the validation set (88.52%) and the test set (82.87%). CONCLUSIONS When monitoring web-based medical record use trends, research should focus on social factors such as age, education, BMI, and marital status, as well as personal lifestyle and behavioral habits, including smoking, use of electronic devices and the internet, patients' personal health status, and their level of health concern. The use of electronic medical records can be targeted to specific patient groups, allowing more people to benefit from their usefulness.
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Affiliation(s)
- Yang Chen
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Xuejiao Liu
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Lei Gao
- School of Law, University of International Business and Economics, Beijing, China
| | - Miao Zhu
- School of Statistics, Huaqiao University, Xiamen, China
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Linglong Ye
- School of Public Affairs, Xiamen University, Xiamen, China
| | - Lei Qin
- School of Statistics, University of International Business and Economics, Beijing, China
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
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Zaidi M, Amante DJ, Anderson E, Ito Fukunaga M, Faro JM, Frisard C, Sadasivam RS, Lemon SC. Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study. JMIR Cancer 2022; 8:e34745. [PMID: 35943789 PMCID: PMC9399875 DOI: 10.2196/34745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied. OBJECTIVE The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients' self-efficacy in health information-seeking. METHODS We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5-derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information-seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods. RESULTS A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information-seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use. CONCLUSIONS Increased frequency of patient portal use was associated with higher PCC, and an individual's health information-seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.
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Affiliation(s)
- Maryum Zaidi
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Ekaterina Anderson
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Jamie M Faro
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
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11
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Raps SJ, Chen D, Bakken S, Caban J, Engler MB. Baseline eHealth Behaviors of Service Members: A Retrospective, Cross-Sectional Analysis of Patient Portal Use Before the Pandemic. Mil Med 2022; 188:usac168. [PMID: 35766515 PMCID: PMC9384380 DOI: 10.1093/milmed/usac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/26/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The use of electronic health (eHealth) tools has the potential to support the overall health, wellness, fitness status, and ability to deploy worldwide of active duty service members (SMs). Additionally, the Coronavirus Disease 2019 pandemic forced healthcare organizations to quickly convert to virtual care settings to decrease face-to-face interactions and increase access to healthcare using technology. The shift to virtual care and the push to increase use of eHealth tools heightened the need to understand how military members interact with eHealth tools. Little is known about the factors that influence SMs use of eHealth tools and if having a health condition increases or decreases use. To evaluate these factors, we completed a cross-sectional, retrospective analysis on a sample of 198,388 active duty SMs aged 18 to 68 years. MATERIALS AND METHODS We used two Military Health System (MHS) data sources-Tricare Online (TOL) Patient Portal 2018 audit logs and outpatient electronic health record data. Using eHealth behaviors identified in the audit logs, we evaluated and compared individual characteristics (i.e., "gender", "age", "race", and "marital status"), environmental factors (i.e., "rank", "military branch", and "geographic location"), and six available health conditions (i.e., congenital health defects, amputation, anxiety, sleep, traumatic brain injury, and depression). Since moderate usage of eHealth tools is linked to improved health outcomes, adherence, communication, and increased consumer satisfaction, a logistic regression model was developed to find the factors most associated with moderate (3-11 logins per year) use of the portal. RESULTS Electronic health use increased by SMs with underlying health conditions or if they were managing family member health. Most SMs who used the TOL Patient Portal were of ages 25-34 years, White, and married. The mean age is 32.53 for males and 29.98 for females. Over half of the TOL Patient Portal SM users utilized the portal one to two times. Most SMs used the TOL Patient Portal in Virginia, Texas, California, Florida, North Carolina, Georgia, and Maryland. The highest use was during the months of March to May. Frequent patient portal actions include searching for appointments, viewing health information, viewing medical encounters, and refilling medications. Although SMs with congenital health defects, anxiety, sleep issues, and depression have higher patient portal use rates, SMs with depression have a negative association with using the patient portal at a "moderate" rate. Viewing family member health information and searching for appointments were strongly associated with patient portal moderate use. CONCLUSIONS Our findings support top military initiatives to improve the overall health, wellness, and readiness of SMs while decreasing the MHS's overall cost of care while providing a foundation to compare "pre" and "post" pandemic eHealth behaviors. It is essential to note that SMs are more likely to use a patient portal to seek information or manage family member health. This key factor identifies the significance of family health promotion and readiness in the active duty SM's life. The long-term goal of our study is to build the foundation for delivering tailored health information and eHealth tools to promote health and readiness-centric patient engagement.
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Affiliation(s)
- Stephanie J Raps
- Science and Technology, 59th Medical Group, Lackland, TX 78236, USA
| | - Dechang Chen
- School of Medicine, Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY 10032, USA
| | - Jesus Caban
- Clinical & Research Informatics, National Intrepid Center of Excellence, Bethesda, MD 20814, USA
| | - Mary B Engler
- Graduate School of Nursing, Ph.D in Nursing Science Program, Uniformed Services University, Bethesda, MD 20814, USA
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12
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Robinson SA, Netherton D, Zocchi M, Purington C, Ash AS, Shimada SL. Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis. JMIR Diabetes 2021; 6:e32320. [PMID: 34807834 PMCID: PMC8663667 DOI: 10.2196/32320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. OBJECTIVE This study explored whether rural patients' self-management and glycemic control was associated with the use of SM. METHODS This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients' rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. RESULTS The sample was 51% (n=229) rural and 49% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95% CI -1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01). CONCLUSIONS More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control.
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Affiliation(s)
- Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Dane Netherton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Mark Zocchi
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Carolyn Purington
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Arlene S Ash
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephanie L Shimada
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
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13
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Zocchi MS, Robinson SA, Ash AS, Vimalananda VG, Wolfe HL, Hogan TP, Connolly SL, Stewart MT, Am L, Netherton D, Shimada SL. Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration. J Am Med Inform Assoc 2021; 28:2176-2183. [PMID: 34339500 DOI: 10.1093/jamia/ocab115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study sought to investigate whether consistent use of the Veterans Health Administration's My HealtheVet (MHV) online patient portal is associated with improvement in diabetes-related physiological measures among new portal users. MATERIALS AND METHODS We conducted a retrospective cohort study of new portal users with type 2 diabetes that registered for MHV between 2012 and 2016. We used random-effect linear regression models to examine associations between months of portal use in a year (consistency) and annual means of the physiological measures (hemoglobin A1c [HbA1c], low-density lipoproteins [LDLs], and blood pressure [BP]) in the first 3 years of portal use. RESULTS For patients with uncontrolled HbA1c, LDL, or BP at baseline, more months of portal use in a year was associated with greater improvement. Compared with 1 month of use, using the portal 12 months in a year was associated with annual declines in HbA1c of -0.41% (95% confidence interval [CI], -0.46% to -0.36%) and in LDL of -6.25 (95% CI, -7.15 to -5.36) mg/dL. Twelve months of portal use was associated with minimal improvements in BP: systolic BP of -1.01 (95% CI, -1.33 to -0.68) mm Hg and diastolic BP of -0.67 (95% CI, -0.85 to -0.49) mm Hg. All associations were smaller or not present for patients in control of these measures at baseline. CONCLUSIONS We found consistent use of the patient portal among new portal users to be associated with modest improvements in mean HbA1c and LDL for patients at increased risk at baseline. For patients with type 2 diabetes, self-management supported by online patient portals may help control HbA1c, LDL, and BP.
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Affiliation(s)
- Mark S Zocchi
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arlene S Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hill L Wolfe
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen T Stewart
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Linda Am
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Dane Netherton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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14
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Glöggler M, Ammenwerth E. Improvement and Evaluation of the TOPCOP Taxonomy of Patient Portals: Taxonomy-Evaluation-Delphi Approach (TED). J Med Internet Res 2021; 23:e30701. [PMID: 34403354 PMCID: PMC8527386 DOI: 10.2196/30701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patient portals have been introduced in many countries over the last 10 years, but many health information managers still feel they have too little knowledge of patient portals. A taxonomy can help them to better compare and select portals. This has led us to develop the TOPCOP taxonomy for classifying and comparing patient portals. However, the taxonomy has not been evaluated by users. Objective This study aimed to evaluate the taxonomy’s usefulness to support health information managers in comparing, classifying, defining a requirement profile for, and selecting patient portals and to improve the taxonomy where needed. Methods We used a modified Delphi approach. We sampled a heterogeneous panel of 13 health information managers from 3 countries using the criterion sampling strategy. We conducted 4 anonymous survey rounds with qualitative and quantitative questions. In round 1, the panelists assessed the appropriateness of each dimension, and we collected new ideas to improve the dimensions. In rounds 2 and 3, the panelists iteratively evaluated the taxonomy that was revised based on round 1. In round 4, the panelists assessed the need for a taxonomy and the appropriateness of patient engagement as a distinguishing concept. Then, they compared 2 real portals with the final taxonomy and evaluated its usefulness for comparing portals, creating an initial requirement profile, and selecting patient portals. To determine group consensus, we applied the RAND/UCLA Appropriateness Method. Results The final taxonomy consists of 25 dimensions with 65 characteristics. Five new dimensions were added to the original taxonomy, with 8 characteristics added to already existing dimensions. Group consensus was achieved on the need for such a taxonomy to compare portals, on patient engagement as an appropriate distinguishing concept, and on the comprehensibility of the taxonomy’s form. Further, consensus was achieved on the taxonomy’s usefulness for classifying and comparing portals, assisting users in better understanding portals, creating a requirement profile, and selecting portals. This allowed us to test the usefulness of the final taxonomy with the intended users. Conclusions The TOPCOP taxonomy aims to support health information managers in comparing and selecting patient portals. By providing a standardized terminology to describe various aspects of patient portals independent of clinical setting or country, the taxonomy will also be useful for advancing research and evaluation of patient portals.
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Affiliation(s)
- Michael Glöggler
- Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, AT
| | - Elske Ammenwerth
- Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, AT
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15
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Clarke MA, Fruhling AL, Lyden EL, Tarrell AE, Bernard TL, Windle JR. The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers. JMIR Hum Factors 2021; 8:e19191. [PMID: 34309574 PMCID: PMC8367119 DOI: 10.2196/19191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/17/2020] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption. Objective The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR. Methods A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE). Results There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006). Conclusions In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients’ use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients’ preferences and abilities when developing effective user-friendly health information technologies.
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Affiliation(s)
- Martina A Clarke
- School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska Omaha, Omaha, NE, United States.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ann L Fruhling
- School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska Omaha, Omaha, NE, United States
| | - Elizabeth L Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alvin E Tarrell
- School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska Omaha, Omaha, NE, United States
| | - Tamara L Bernard
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - John R Windle
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
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16
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Association between Patient Portal use and Office Visits. J Med Syst 2021; 45:74. [PMID: 34097149 DOI: 10.1007/s10916-021-01749-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Extant research on the relationship between portal use and office visits is mixed. Some researchers have stated that there is no correlation between the two events, others have found a positive correlation, and still others have found a negative correlation between portal use and office visits. Through the use of system-generated data from two different portal systems, we demonstrate the correlation between portal visits and office visits. We also demonstrate how this correlation differs between two institutions and across three demographic attributes. We performed a retrospective bivariate correlation analysis between portal visits and office visits. The correlation analysis was followed by an application of Fisher's z transformation of the correlation coefficients to determine significant differences in correlation across ethnicity, gender, and age. We found a positive and statistically significant correlation between portal visits and office visits among both hospital patients (n = 2,594, r = .239, p < .000) and university health service patients (n = 1,233, r = .596, p < .000). This correlation varies significantly across the dimensions of ethnicity, gender, and age. Our findings support the importance of portal use in the care continuum. Future research should aim to better understand the nuance of personal characteristics on the relationship between portal visits and office visits. Knowing these nuances can assist practitioners with further promoting patient self-engagement through portal use.
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17
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Heisey‐Grove D, Rathert C, McClelland LE, Jackson K, DeShazo J. Classification of patient- and clinician-generated secure messages using a theory-based taxonomy. Health Sci Rep 2021; 4:e295. [PMID: 34084944 PMCID: PMC8142627 DOI: 10.1002/hsr2.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND As secure electronic message exchange increases between patients and clinicians, we must explore and understand how patients and clinicians use those messages to communicate between clinical visits. OBJECTIVE To present the application of a taxonomy developed specifically to code secure message content in a way that allows for identification of patient and clinician communication functions demonstrated to be associated with patients' intermediate and health outcomes. METHOD We randomly sampled 1031 patients who sent and received 18 309 messages and coded those messages with codes from our taxonomy. We present the prevalence of each taxon (ie, code) within the sample. RESULTS The most common taxon among initial patient-generated messages were Information seeking (29.09%), followed by Scheduling requests (27.91%), and Prescription requests (23.09%). Over half of subsequent patient-generated messages included responses to clinic staffs' questions (58.31%). Six in 10 clinic staff responses included some form of Information sharing with process-based responses being most common (32.81%). A third of all clinician-generated messages (36.28%) included acknowledgement or some level of fulfilment of a patient's task-oriented request. Clinic staff sought information from patients in 20.54% of their messages. CONCLUSION This taxonomy is the first step toward examining whether secure messaging communication can be associated with patients' health outcomes. Knowing which content is positively associated with outcomes can support training of, and targeted responses from, clinicians with the goal of generating message content designed to improve outcomes. PATIENT CONTRIBUTION This study is based on analyses of patient-initiated secure message threads.
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Affiliation(s)
- Dawn Heisey‐Grove
- Promoting Health and Disease Prevention Department, Public Health Division, The Health FFRDCThe MITRE CorporationMcLeanVirginia
| | - Cheryl Rathert
- Health Administration DepartmentCollege of Health Professions, Virginia Commonwealth UniversityRichmondVirginia
| | - Laura E McClelland
- Department of Health Management and PolicySaint Louis UniversitySt. LouisMissouri
| | - Kevin Jackson
- Allied Health DepartmentNorfolk State UniversityNorfolkVirginia
| | - Jonathan DeShazo
- Department of Health Management and PolicySaint Louis UniversitySt. LouisMissouri
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18
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Park J, Liang M, Alpert JM, Brown RF, Zhong X. The Causal Relationship Between Portal Usage and Self-Efficacious Health Information-Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data. J Med Internet Res 2021; 23:e17782. [PMID: 33502334 PMCID: PMC7875689 DOI: 10.2196/17782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/25/2020] [Accepted: 12/21/2020] [Indexed: 01/26/2023] Open
Abstract
Background Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients’ health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals. Objective The aim of this study was to examine the causal relationship between the usage of patient portals and patients’ self-efficacy toward obtaining health information and performing self-care. Methods This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients’ confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method. Results We showed that frequently using patient portals improves patients’ confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients’ confidence in exercising self-care. Conclusions The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies.
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Affiliation(s)
- Jaeyoung Park
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, United States
| | - Muxuan Liang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Xiang Zhong
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, United States
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