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Gerber DE. Taking It to the States: Adapting Information Blocking Legislation to Oncology. J Clin Oncol 2023; 41:4348-4351. [PMID: 37410962 DOI: 10.1200/jco.23.01108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Oncologists have successfully pushed for new state laws on how we release life-changing test results
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Affiliation(s)
- David E Gerber
- Department of Internal Medicine (Division of Hematology-Oncology) and O'Donnell School of Public Health, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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Bruno B, Steele S, Carbone J, Schneider K, Posk L, Rose SL. Informed or anxious: patient preferences for release of test results of increasing sensitivity on electronic patient portals. HEALTH AND TECHNOLOGY 2022; 12:59-67. [PMID: 35036280 PMCID: PMC8741580 DOI: 10.1007/s12553-021-00628-5] [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: 07/31/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
Worldwide, governments and healthcare systems are moving towards increased transparency to improve care quality, increase patient engagement, and decrease costs. For example, the American 21st Century Cures Act Final Rule requires providers to grant patients access to their electronic medical record. Unfortunately, limited research guides release of test results to online patient portals, especially concerning emotionally sensitive information. To address this gap, we surveyed the largest patient sample published to date. This cross-sectional survey project was conducted by the Market Research & Insights and Office of Patient Experience departments at a large academic medical center. Data were analyzed in SPSS using descriptive statistics and Z-tests. Of 8030 respondents, 74% and 57% accepted first learning their results online for cholesterol and strep throat tests, respectively. Most prefer in-person appointments for more serious tests detecting cancer (54%) and fetal miscarriage (53%). Excluding sexually transmitted disease (STD) testing, there are no clinically significant differences in preference between respondents previously diagnosed with the condition in question and respondents without such experience. When weighing the possibility of a 3-week wait to hear from their provider, most patients want automatic release of cholesterol (94%), strep throat (90%), genetic (68%), and STD (60%) test results, but the majority say it is unacceptable to receive Alzheimer’s (52%), fetal miscarriage (51%), and cancer (59%) test results this way. Electronic results release is acceptable for less serious tests, but not for more consequential tests. Providers should consider patient preferences when developing policies to increase healthcare transparency.
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Affiliation(s)
- Bethany Bruno
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425 USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195 USA
| | - Scott Steele
- Market Research, Cleveland Clinic, Cleveland, OH 44195 USA
| | - Justin Carbone
- Market Research, Cleveland Clinic, Cleveland, OH 44195 USA
| | | | - Lori Posk
- Department of Internal Medicine, Cleveland Clinic, Vero Beach, FL 32960 USA.,Clinic Informatics, Cleveland Clinic, Vero Beach, FL 32960 USA
| | - Susannah L Rose
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195 USA.,Office of Patient Experience, Cleveland Clinic, Cleveland, OH 44195 USA.,Center for Bioethics, Cleveland Clinic, Cleveland, OH 44195 USA
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Salmi L, Mansouri SA, Taylor LP. New federal rule requires open notes: what do clinicians and patients need to know? Insights and suggestions from a neuro-oncologist, a neurosurgeon, and a person living with a brain tumor. Neurooncol Pract 2021; 8:233-235. [PMID: 34055370 DOI: 10.1093/nop/npab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liz Salmi
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - S Alireza Mansouri
- Department of Neurosurgery, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lynne P Taylor
- Departments of Neurology, Neurologic Surgery and Medicine, UW Medicine, Seattle Cancer Care Alliance, Seattle, Washington, USA
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Wolfe L, Chisolm MS, Bohsali F. Clinically Excellent Use of the Electronic Health Record: Review. JMIR Hum Factors 2018; 5:e10426. [PMID: 30291099 PMCID: PMC6231887 DOI: 10.2196/10426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The transition to the electronic health record (EHR) has brought forth a rapid cultural shift in the world of medicine, presenting both new challenges as well as opportunities for improving health care. As clinicians work to adapt to the changes imposed by the EHR, identification of best practices around the clinically excellent use of the EHR is needed. OBJECTIVE Using the domains of clinical excellence previously defined by the Johns Hopkins Miller Coulson Academy of Clinical Excellence, this review aims to identify best practices around the clinically excellent use of the EHR. METHODS The authors searched the PubMed database, using keywords related to clinical excellence domains and the EHR, to capture the English-language, peer-reviewed literature published between January 1, 2000, and August 2, 2016. One author independently reviewed each article and extracted relevant data. RESULTS The search identified 606 titles, with the majority (393/606, 64.9%) in the domain of communication and interpersonal skills. Twenty-eight of the 606 (4.6%) titles were excluded from full-text review, primarily due to lack of availability of the full-text article. The remaining 578 full-text articles reviewed were related to clinical excellence generally (3/578, 0.5%) or the specific domains of communication and interpersonal skills (380/578, 65.7%), diagnostic acumen (31/578, 5.4%), skillful negotiation of the health care system (4/578, 0.7%), scholarly approach to clinical practice (41/578, 7.1%), professionalism and humanism (2/578, 0.4%), knowledge (97/578, 16.8%), and passion for clinical medicine (20/578, 3.5%). CONCLUSIONS Results suggest that as familiarity and expertise are developed, clinicians are leveraging the EHR to provide clinically excellent care. Best practices identified included deliberate physical configuration of the clinical space to involve sharing the screen with patients and limiting EHR use during difficult and emotional topics. Promising horizons for the EHR include the ability to augment participation in pragmatic trials, identify adverse drug effects, correlate genomic data to clinical outcomes, and follow data-driven guidelines. Clinician and patient satisfaction with the EHR has generally improved with time, and hopefully continued clinician, and patient input will lead to a system that satisfies all.
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Affiliation(s)
- Leah Wolfe
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Margaret Smith Chisolm
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Fuad Bohsali
- Department of Medicine, School of Medicine, Duke University, Durham, NC, United States
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Vermeir P, Degroote S, Van Tiggelen H, Vandijck D, Peleman R, Verhaeghe R, Mariman A, Vermeersch H, Vogelaers D. Patient perspectives on electronic health record accessibility and patient participation: a questionnaire survey. Acta Clin Belg 2018; 73:292-297. [PMID: 29431035 DOI: 10.1080/17843286.2018.1436233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives To explore patient perceptions on personal comfort with participation in their own care process and on support of this patient participation through electronic health record (EHR) accessibility. Methods Explorative quantitative questionnaire study in ambulatory patients visiting the departments of General Internal Medicine or Head, Neck and Maxillo-Facial Surgery of a Belgian tertiary referral center. Results Patients were recruited by convenience sampling of 438 out of the total of 1270 patients visiting either one of these departments within a time period of two weeks. Overall response rate was 97.3% (n = 426; 45.3% male; mean age 42.5 ± 15.4 years). Most patients (89.7%) indicated a desire to make healthcare decisions in partnership with their physician. They were in need of transparent and comprehensible health information. The EHR was perceived as a suitable and effective means to inform patients about their health and to increase involvement in care and treatment (77.6%). Furthermore, access to the EHR was perceived to result in a more effective communication transfer between physician and patient (65.5%), increased patient compliance (64.3%), and satisfaction (57.4%). Conclusion Patients indicate a desire for proactive participation in their individual care process. They felt that medical record accessibility could support decision-making and assist in managing and coordinating individual and personalized care choices.
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Affiliation(s)
- Peter Vermeir
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sophie Degroote
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Hanne Van Tiggelen
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dominique Vandijck
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
- Department of Business Economics, Hasselt University, Diepenbeek, Belgium
| | - Renaat Peleman
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Rik Verhaeghe
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - An Mariman
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hubert Vermeersch
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Head, Neck and Maxillo-Facial Surgery, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Krakov A, Kabaha N, Azuri J, Moshe S. Impact of patients' access to medical records in occupational medicine. Occup Med (Lond) 2018; 68:301-306. [PMID: 29669000 DOI: 10.1093/occmed/kqy045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Information technologies offer new ways to engage with patients regarding their health, but no studies have been done in occupational health services (OHS). Aims To examine the advantages and disadvantages of providing written and oral medical information to patients in OHS. Methods In this cross-sectional study, data were retrieved from patients visiting four different OHS during 2014-15 for a fitness for work evaluation. We built a semi-quantitative satisfaction questionnaire, with responses ranging on a Likert scale of 1-5 from very dissatisfied (1) to very satisfied (5). Results There were 287 questionnaires available for analysis. The number of patients who received detailed oral and written information, which included an explanation of their health condition and of the occupational physician's (OP's) decision, was higher in clinics 1 and 3 compared to clinics 2 and 4 (48 and 38% compared to 21 and 31% respectively, P < 0.05). When patients were provided with detailed oral and written information, they declared having a better understanding (4.3 and 4.4 compared to 3.8 respectively, P < 0.001), a higher level of confidence in their OP (4.4 and 4.3 compared to 3.7 and 4 respectively, P < 0.001), a higher level of satisfaction (4.3 and 4.4 compared to 3.8 respectively, P < 0.001) and a higher sense of control and ability to correct the record (1.8 compared to 1.4 respectively, P < 0.01), compared to patients who received partial information. Conclusions We recommend sharing detailed oral and written medical information with patients in OHS.
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Affiliation(s)
- A Krakov
- Maccabi Healthcare Services, Occupational Medicine Department, Holon, Israel
- The Public Health School, Division of Environmental and Occupational Medicine, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - N Kabaha
- The Public Health School, Division of Environmental and Occupational Medicine, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - J Azuri
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Moshe
- Maccabi Healthcare Services, Occupational Medicine Department, Holon, Israel
- The Public Health School, Division of Environmental and Occupational Medicine, Sackler Faculty of Medicine, Tel-Aviv, Israel
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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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Dey P, Ross JS, Ritchie JD, Desai NR, Bhavnani SP, Krumholz HM. Data Sharing and Cardiology: Platforms and Possibilities. J Am Coll Cardiol 2017; 70:3018-3025. [PMID: 29241491 DOI: 10.1016/j.jacc.2017.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
Sharing deidentified patient-level research data presents immense opportunities to all stakeholders involved in cardiology research and practice. Sharing data encourages the use of existing data for knowledge generation to improve practice, while also allowing for validation of disseminated research. In this review, we discuss key initiatives and platforms that have helped to accelerate progress toward greater sharing of data. These efforts are being prompted by government, universities, philanthropic sponsors of research, major industry players, and collaborations among some of these entities. As data sharing becomes a more common expectation, policy changes will be required to encourage and assist data generators with the process of sharing the data they create. Patients also will need access to their own data and to be empowered to share those data with researchers. Although medicine still lags behind other fields in achieving data sharing's full potential, cardiology research has the potential to lead the way.
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Affiliation(s)
- Pranammya Dey
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Joseph S Ross
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jessica D Ritchie
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Sanjeev P Bhavnani
- Division of Cardiology, Scripps Clinic and Research Foundation, San Diego, California
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
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10
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Lee CI, Langlotz CP, Elmore JG. Implications of Direct Patient Online Access to Radiology Reports Through Patient Web Portals. J Am Coll Radiol 2017; 13:1608-1614. [PMID: 27888949 DOI: 10.1016/j.jacr.2016.09.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
In an era of increasing health information transparency and informed decision making, more patients are being provided with direct online access to their medical records, including radiology reports, via web-based portals. Although radiologists' narrative reports have previously been the purview of referring physicians, patients are now reading these on their own. Many potential benefits may result from patients reviewing their radiology reports, including improvements in patients' own understanding of their health, promotion of shared decision making and patient-physician communication, and, ultimately, improvements in patient outcomes. However, there may also be negative consequences, including confusion and anxiety among patients and longer patient-physician interactions. The rapid adoption of this new technology has led to major questions regarding ethics and professionalism for radiologists, including the following: Who is the intended audience of radiology reports? How should content be presented or worded? How will open access influence radiologists' relationships with patients and referring physicians? What legal ramifications may arise from increased patient access? The authors describe the current practices and research findings associated with patient online access to medical records, including radiology reports, and discuss several implications of this growing trend for the radiology profession.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Curtis P Langlotz
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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Vermeir P, Degroote S, Vandijck D, Van Tiggelen H, Peleman R, Verhaeghe R, Mariman A, Vogelaers D. The patient perspective on the effects of medical record accessibility: a systematic review. Acta Clin Belg 2017; 72:186-194. [PMID: 28056665 DOI: 10.1080/17843286.2016.1275375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. OBJECTIVES To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. METHODS Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality. RESULTS Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility. CONCLUSION From the patient perspective medical record accessibility contributes to co-management of personal health care.
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Affiliation(s)
- Peter Vermeir
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Sophie Degroote
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dominique Vandijck
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of Patient Safety, Health Economics & Healthcare Innovation, Hasselt University, Agoralaan (building D), 3590 Diepenbeek, Belgium
| | - Hanne Van Tiggelen
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Renaat Peleman
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Rik Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - An Mariman
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dirk Vogelaers
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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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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Laccetti AL, Chen B, Cai J, Gates S, Xie Y, Lee SJC, Gerber DE. Increase in Cancer Center Staff Effort Related to Electronic Patient Portal Use. J Oncol Pract 2016; 12:e981-e990. [PMID: 27601511 DOI: 10.1200/jop.2016.011817] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Electronic portals provide patients with real-time access to personal health records. Use of this technology by individuals with cancer is particularly intensive. We therefore examined patterns of use of electronic portals by clinic staff at a National Cancer Institute-designated comprehensive cancer center. METHODS We identified and characterized cancer center providers and clinic staff who performed electronic activities related to MyChart, the institution's personal health records portal, from 2009 to 2014. Total MyChart actions and messages received were quantified and characterized according to type, timing, and staff category. RESULTS Two hundred eighty-nine employees were included in our analysis: 85 nurses (29%), 79 ancillary staff (27%), 49 clerical/managerial staff (17%), 47 physicians (16%), and 29 advanced practice providers (10%). These individuals performed 740,613 MyChart actions and received 117,799 messages. Seventy-seven percent of actions were performed by nurses, 11% by ancillary staff, 6% by advanced practice providers, 5% by physicians, and 1% by clerical/managerial staff. From 2011 to 2014, staff MyChart activity increased approximately 10-fold. On average, 6.3 staff MyChart actions were performed per patient-initiated message. In 2014, nurses performed an average of 3,838 MyChart actions and received an average of 589 messages, compared with 591 actions and 87 messages in 2011 ( P < .001). Sixteen percent of all actions occurred outside clinic hours. CONCLUSION Cancer center employee effort related to an electronic patient portal has increased markedly over time, particularly among nursing staff. Because further uptake of this technology is expected, it is critical to consider potential effects on clinical resources, employee and patient satisfaction, and patient safety.
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Affiliation(s)
| | - Beibei Chen
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jennifer Cai
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Samantha Gates
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Yang Xie
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - David E Gerber
- University of Texas Southwestern Medical Center, Dallas, TX
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14
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Ford EW, Hesse BW, Huerta TR. Personal Health Record Use in the United States: Forecasting Future Adoption Levels. J Med Internet Res 2016; 18:e73. [PMID: 27030105 PMCID: PMC4830902 DOI: 10.2196/jmir.4973] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/11/2015] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
Background Personal health records (PHRs) offer a tremendous opportunity to generate consumer support in pursing the triple aim of reducing costs, increasing access, and improving care quality. Moreover, surveys in the United States indicate that consumers want Web-based access to their medical records. However, concerns that consumers’ low health information literacy levels and physicians’ resistance to sharing notes will limit PHRs’ utility to a relatively small portion of the population have reduced both the product innovation and policy imperatives. Objective The purpose of our study was 3-fold: first, to report on US consumers’ current level of PHR activity; second, to describe the roles of imitation and innovation influence factors in determining PHR adoption rates; and third, to forecast future PHR diffusion uptake among US consumers under 3 scenarios. Methods We used secondary data from the Health Information National Trends Survey (HINTS) of US citizens for the survey years 2008, 2011, and 2013. Applying technology diffusion theory and Bass modeling, we evaluated 3 future PHR adoption scenarios by varying the introduction dates. Results All models displayed the characteristic diffusion S-curve indicating that the PHR technology is likely to achieve significant market penetration ahead of meaningful use goals. The best-performing model indicates that PHR adoption will exceed 75% by 2020. Therefore, the meaningful use program targets for PHR adoption are below the rates likely to occur without an intervention. Conclusions The promise of improved care quality and cost savings through better consumer engagement prompted the US Institute of Medicine to call for universal PHR adoption in 1999. The PHR products available as of 2014 are likely to meet and exceed meaningful use stage 3 targets before 2020 without any incentive. Therefore, more ambitious uptake and functionality availability should be incorporated into future goals.
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Affiliation(s)
- Eric W Ford
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States.
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15
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Esch T, Mejilla R, Anselmo M, Podtschaske B, Delbanco T, Walker J. Engaging patients through open notes: an evaluation using mixed methods. BMJ Open 2016; 6:e010034. [PMID: 26826154 PMCID: PMC4735137 DOI: 10.1136/bmjopen-2015-010034] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES (A) To gain insights into the experiences of patients invited to view their doctors' visit notes, with a focus on those who review multiple notes; (B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes. DESIGN Mixed methods qualitative study: analyses of survey data, including content analysis of free-text answers, and quantitative-descriptive measures combined with semistructured individual interviews, patient activation measures, and member checks. SETTING Greater Boston, USA. PARTICIPANTS Patients cared for by primary care physicians (PCPs) at the Beth Israel Deaconess Medical Center who had electronic access to their PCP visit notes. Among those submitting surveys, 576 free-text answers were identified and analysed (414 from female patients, 162 from male patients; 23-88 years). In addition, 13 patients (9 female, 4 male; 58-87 years) were interviewed. RESULTS Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits. CONCLUSIONS As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physician's office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient activation and engagement in important ways.
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Affiliation(s)
- Tobias Esch
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Roanne Mejilla
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Melissa Anselmo
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Beatrice Podtschaske
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Tom Delbanco
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jan Walker
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Rigby M, Georgiou A, Hyppönen H, Ammenwerth E, de Keizer N, Magrabi F, Scott P. Patient Portals as a Means of Information and Communication Technology Support to Patient- Centric Care Coordination - the Missing Evidence and the Challenges of Evaluation. A joint contribution of IMIA WG EVAL and EFMI WG EVAL. Yearb Med Inform 2015; 10:148-59. [PMID: 26123909 PMCID: PMC4587055 DOI: 10.15265/iy-2015-007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To review the potential contribution of Information and Communication Technology (ICT) to enable patient-centric and coordinated care, and in particular to explore the role of patient portals as a developing ICT tool, to assess the available evidence, and to describe the evaluation challenges. METHODS Reviews of IMIA, EFMI, and other initiatives, together with literature reviews. RESULTS We present the progression from care coordination to care integration, and from patient-centric to person-centric approaches. We describe the different roles of ICT as an enabler of the effective presentation of information as and when needed. We focus on the patient's role as a co-producer of health as well as the focus and purpose of care. We discuss the need for changing organisational processes as well as the current mixed evidence regarding patient portals as a logical tool, and the reasons for this dichotomy, together with the evaluation principles supported by theoretical frameworks so as to yield robust evidence. CONCLUSIONS There is expressed commitment to coordinated care and to putting the patient in the centre. However to achieve this, new interactive patient portals will be needed to enable peer communication by all stakeholders including patients and professionals. Few portals capable of this exist to date. The evaluation of these portals as enablers of system change, rather than as simple windows into electronic records, is at an early stage and novel evaluation approaches are needed.
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Affiliation(s)
- M Rigby
- Emeritus Professor Michael Rigby, Lavender Hill, 6 Carrighill Lower, Calverstown, Kilcullen, Co. Kildare, Ireland, Tel: +353 45 485858, E-mail:
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Martin DB. “Write It Down Like You Told Me”: Transparent Records and My Oncology Practice. J Oncol Pract 2015; 11:285-6. [DOI: 10.1200/jop.2014.003095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The author concludes that providing all the information a patient can choose to use in an accessible format facilitates better communication and collaboration between patients and their providers.
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Lyratzopoulos G, Vedsted P, Singh H. Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation. Br J Cancer 2015; 112 Suppl 1:S84-91. [PMID: 25734393 PMCID: PMC4385981 DOI: 10.1038/bjc.2015.47] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The diagnosis of cancer is a complex, multi-step process. In this paper, we highlight factors involved in missed opportunities to diagnose cancer more promptly in symptomatic patients and discuss responsible mechanisms and potential strategies to shorten intervals from presentation to diagnosis. Missed opportunities are instances in which post-hoc judgement indicates that alternative decisions or actions could have led to more timely diagnosis. They can occur in any of the three phases of the diagnostic process (initial diagnostic assessment; diagnostic test performance and interpretation; and diagnostic follow-up and coordination) and can involve patient, doctor/care team, and health-care system factors, often in combination. In this perspective article, we consider epidemiological 'signals' suggestive of missed opportunities and draw on evidence from retrospective case reviews of cancer patient cohorts to summarise factors that contribute to missed opportunities. Multi-disciplinary research targeting such factors is important to shorten diagnostic intervals post presentation. Insights from the fields of organisational and cognitive psychology, human factors science and informatics can be extremely valuable in this emerging research agenda. We provide a conceptual foundation for the development of future interventions to minimise the occurrence of missed opportunities in cancer diagnosis, enriching current approaches that chiefly focus on clinical decision support or on widening access to investigations.
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Affiliation(s)
- G Lyratzopoulos
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
- Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - P Vedsted
- Department of Public Health, Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, DK-Bartholins Allé, 8000 Aarhus, Denmark
| | - H Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston TX 77030, US
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19
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Wright A, Feblowitz J, Maloney FL, Henkin S, Ramelson H, Feltman J, Bates DW. Increasing patient engagement: patients' responses to viewing problem lists online. Appl Clin Inform 2014; 5:930-42. [PMID: 25589908 DOI: 10.4338/aci-2014-07-ra-0057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/01/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To characterize the opinions, emotions, and actions taken by patients who viewed their electronic problem list via an online personal health record (PHR). MATERIALS AND METHODS An online survey of patients who viewed their problem lists, as maintained by their healthcare provider, in a web-based PHR linked to an electronic health record for the first time. RESULTS A total 3,649 patients completed the survey, yielding a response rate of 42.1%. Patient attitudes towards the problem list function were positive overall, with 90.4% rating it at least somewhat useful and 86.7% reporting they would probably or definitely use it again. Nearly half (45.6%) of patients identified at least one major or minor problem missing from their list. After viewing the list, 56.1% of patients reported taking at least one action in response, with 32.4% of patients reporting that they researched a condition on the Internet, 18.3% reported that they contacted their healthcare provider and 16.7% reported changing or planning to change a health behavior (patients could report multiple actions). 64.7% of patients reported feeling at least somewhat happy while viewing their problem list, though others reported feeling sad (30.4%), worried (35.7%) or scared (23.8%) (patients could report multiple emotions). A smaller number of patients reported feeling angry (16.6%) or ashamed (14.3%). Patients who experienced an emotional response were more likely to take action. CONCLUSION Overall, patients found the ability to view their problem lists very useful and took action in response to the information. However, some had negative emotions. More research is needed into optimal strategies for supporting patients receiving this information.
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Affiliation(s)
- A Wright
- Division of General Internal Medicine, Brigham & Women's Hospital , Boston, MA ; Partners HealthCare , Boston, MA ; Harvard Medical School , Boston, MA
| | - J Feblowitz
- Division of General Internal Medicine, Brigham & Women's Hospital , Boston, MA ; Partners HealthCare , Boston, MA ; Harvard Medical School , Boston, MA
| | | | - S Henkin
- Division of General Internal Medicine, Brigham & Women's Hospital , Boston, MA ; Partners HealthCare , Boston, MA
| | - H Ramelson
- Division of General Internal Medicine, Brigham & Women's Hospital , Boston, MA ; Partners HealthCare , Boston, MA ; Harvard Medical School , Boston, MA
| | | | - D W Bates
- Division of General Internal Medicine, Brigham & Women's Hospital , Boston, MA ; Partners HealthCare , Boston, MA ; Harvard Medical School , Boston, MA ; Harvard School of Public Health , Boston, MA
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20
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Jackson SL, Mejilla R, Darer JD, Oster NV, Ralston JD, Leveille SG, Walker J, Delbanco T, Elmore JG. Patients who share transparent visit notes with others: characteristics, risks, and benefits. J Med Internet Res 2014; 16:e247. [PMID: 25405911 PMCID: PMC4260006 DOI: 10.2196/jmir.3363] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/14/2014] [Accepted: 09/02/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Inviting patients to read their primary care visit notes may improve communication and help them engage more actively in their health care. Little is known about how patients will use the opportunity to share their visit notes with family members or caregivers, or what the benefits might be. OBJECTIVE Our goal was to evaluate the characteristics of patients who reported sharing their visit notes during the course of the study, including their views on associated benefits and risks. METHODS The OpenNotes study invited patients to access their primary care providers' visit notes in Massachusetts, Pennsylvania, and Washington. Pre- and post-intervention surveys assessed patient demographics, standardized measures of patient-doctor communication, sharing of visit notes with others during the study, and specific health behaviors reflecting the potential benefits and risks of offering patients easy access to their visit notes. RESULTS More than half (55.43%, 2503/4516) of the participants who reported viewing at least one visit note would like the option of letting family members or friends have their own Web access to their visit notes, and 21.70% (980/4516) reported sharing their visit notes with someone during the study year. Men, and those retired or unable to work, were significantly more likely to share visit notes, and those sharing were neither more nor less concerned about their privacy than were non-sharers. Compared to participants who did not share clinic notes, those who shared were more likely to report taking better care of themselves and taking their medications as prescribed, after adjustment for age, gender, employment status, and study site. CONCLUSIONS One in five OpenNotes patients shared a visit note with someone, and those sharing Web access to their visit notes reported better adherence to self-care and medications. As health information technology systems increase patients' ability to access their medical records, facilitating access to caregivers may improve perceived health behaviors and outcomes.
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Affiliation(s)
- Sara L Jackson
- University of Washington, Division of General Internal Medicine, Seattle, WA, United States.
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21
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Nazi KM, Turvey CL, Klein DM, Hogan TP, Woods SS. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes. J Am Med Inform Assoc 2014; 22:380-9. [PMID: 25352570 DOI: 10.1136/amiajnl-2014-003144] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. METHODS A web-based survey of VA patient portal users from June 22 to September 15, 2013. RESULTS 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). CONCLUSIONS Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication.
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Affiliation(s)
- Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Informatics &Analytics, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA
| | - Carolyn L Turvey
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dawn M Klein
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), A VA HSR&D Center of Innovation, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, eHealth Quality Enhancement Research Initiative, Bedford, Massachusetts, USA Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Susan S Woods
- VA Maine Healthcare System, Togus, Maine, USA Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
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Gerber DE, Laccetti AL, Chen B, Yan J, Cai J, Gates S, Xie Y, Lee SJC. Predictors and intensity of online access to electronic medical records among patients with cancer. J Oncol Pract 2014; 10:e307-12. [PMID: 25006222 PMCID: PMC4161732 DOI: 10.1200/jop.2013.001347] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Electronic portals are secure Web-based servers that provide patients with real-time access to their personal health record (PHR). These applications are now widely used at cancer centers nationwide, but their impact has not been well studied. This study set out to determine predictors and patterns of use of a Web-based portal for accessing PHRs and communicating with health providers among patients with cancer. METHODS Retrospective analysis of enrollment in and use of MyChart, a PHR portal for the Epic electronic medical record system, among patients seen at a National Cancer Institute-designated cancer center. Predictors of MyChart use were analyzed through univariable and multivariable regression models. RESULTS A total of 6,495 patients enrolled in MyChart from 2007 to 2012. The median number of log-ins over this period was 57 (interquartile range 17-137). The most common portal actions were viewing test results (37%), viewing and responding to clinic messages (29%), and sending medical advice requests (6.4%). Increased portal use was significantly associated with younger age, white race, and an upper aerodigestive malignancy diagnosis. Thirty-seven percent of all log-ins and 31% of all medical advice requests occurred outside clinic hours. Over the study period, the average number of patient log-ins per year more than doubled. CONCLUSIONS Among patients with cancer, PHR portal use is frequent and increasing. Younger patients, white patients, and patients with upper aerodigestive malignancies exhibit the heaviest portal use. Understanding the implications of this new technology will be central to the delivery of safe and effective care.
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Affiliation(s)
- David E Gerber
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Beibei Chen
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jingsheng Yan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jennifer Cai
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Samantha Gates
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Yang Xie
- University of Texas Southwestern Medical Center, Dallas, TX
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Hogan TP, Nazi KM, Luger TM, Amante DJ, Smith BM, Barker A, Shimada SL, Volkman JE, Garvin L, Simon SR, Houston TK. Technology-assisted patient access to clinical information: an evaluation framework for blue button. JMIR Res Protoc 2014; 3:e18. [PMID: 24675395 PMCID: PMC4004159 DOI: 10.2196/resprot.3290] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/14/2014] [Indexed: 11/22/2022] Open
Abstract
Background Patient access to clinical information represents a means to improve the transparency and delivery of health care as well as interactions between patients and health care providers. We examine the movement toward augmenting patient access to clinical information using technology. Our analysis focuses on “Blue Button,” a tool that many health care organizations are implementing as part of their Web-based patient portals. Objective We present a framework for evaluating the effects that technology-assisted access to clinical information may have on stakeholder experiences, processes of care, and health outcomes. Methods A case study of the United States Department of Veterans Affairs' (VA) efforts to make increasing amounts of clinical information available to patients through Blue Button. Drawing on established collaborative relationships with researchers, clinicians, and operational partners who are engaged in the VA’s ongoing implementation and evaluation efforts related to Blue Button, we assessed existing evidence and organizational practices through key informant interviews, review of documents and other available materials, and an environmental scan of published literature and the websites of other health care organizations. Results Technology-assisted access to clinical information represents a significant advance for VA patients and marks a significant change for the VA as an organization. Evaluations of Blue Button should (1) consider both processes of care and outcomes, (2) clearly define constructs of focus, (3) examine influencing factors related to the patient population and clinical context, and (4) identify potential unintended consequences. Conclusions The proposed framework can serve as a roadmap to guide subsequent research and evaluation of technology-assisted patient access to clinical information. To that end, we offer a series of related recommendations.
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Affiliation(s)
- Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), eHealth Quality Enhancement Research Initiative (QUERI), National eHealth QUERI Coordinating Center, Bedford, MA, United States.
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Edmonds SW, Solimeo SL, Lu X, Roblin DW, Saag KG, Cram P. Developing a bone mineral density test result letter to send to patients: a mixed-methods study. Patient Prefer Adherence 2014; 8:827-41. [PMID: 24940049 PMCID: PMC4051798 DOI: 10.2147/ppa.s60106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To use a mixed-methods approach to develop a letter that can be used to notify patients of their bone mineral density (BMD) results by mail that may activate patients in their bone-related health care. PATIENTS AND METHODS A multidisciplinary team developed three versions of a letter for reporting BMD results to patients. Trained interviewers presented these letters in a random order to a convenience sample of adults, aged 50 years and older, at two different health care systems. We conducted structured interviews to examine the respondents' preferences and comprehension among the various letters. RESULTS A total of 142 participants completed the interview. A majority of the participants were female (64.1%) and white (76.1%). A plurality of the participants identified a specific version of the three letters as both their preferred version (45.2%; P<0.001) and as the easiest to understand (44.6%; P<0.01). A majority of participants preferred that the letters include specific next steps for improving their bone health. CONCLUSION Using a mixed-methods approach, we were able to develop and optimize a printed letter for communicating a complex test result (BMD) to patients. Our results may offer guidance to clinicians, administrators, and researchers who are looking for guidance on how to communicate complex health information to patients in writing.
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Affiliation(s)
- Stephanie W Edmonds
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
- College of Nursing, University of Iowa, Iowa City, IA, USA
- Correspondence: Stephanie W Edmonds, University of Iowa, 200 Hawkins Drive, Internal Medicine, C44-G GH, Iowa City, IA 52242, USA, Tel +1 319 356 1761, Fax +1 319 356 1229, Email
| | - Samantha L Solimeo
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Xin Lu
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Douglas W Roblin
- Kaiser Permanente of Atlanta, Atlanta, GA, USA
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Kenneth G Saag
- Department of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Cram
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
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Hung M, Conrad J, Hon SD, Cheng C, Franklin JD, Tang P. Uncovering patterns of technology use in consumer health informatics. WILEY INTERDISCIPLINARY REVIEWS. COMPUTATIONAL STATISTICS 2013; 5:432-447. [PMID: 24904713 PMCID: PMC4041299 DOI: 10.1002/wics.1276] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Internet usage and accessibility has grown at a staggering rate, influencing technology use for healthcare purposes. The amount of health information technology (Health IT) available through the Internet is immeasurable and growing daily. Health IT is now seen as a fundamental aspect of patient care as it stimulates patient engagement and encourages personal health management. It is increasingly important to understand consumer health IT patterns including who is using specific technologies, how technologies are accessed, factors associated with use, and perceived benefits. To fully uncover consumer patterns it is imperative to recognize common barriers and which groups they disproportionately affect. Finally, exploring future demand and predictions will expose significant opportunities for health IT. The most frequently used health information technologies by consumers are gathering information online, mobile health (mHealth) technologies, and personal health records (PHRs). Gathering health information online is the favored pathway for healthcare consumers as it is used by more consumers and more frequently than any other technology. In regard to mHealth technologies, minority Americans, compared with White Americans utilize social media, mobile Internet, and mobile applications more frequently. Consumers believe PHRs are the most beneficial health IT. PHR usage is increasing rapidly due to PHR integration with provider health systems and health insurance plans. Key issues that have to be explicitly addressed in health IT are privacy and security concerns, health literacy, unawareness, and usability. Privacy and security concerns are rated the number one reason for the slow rate of health IT adoption.
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Affiliation(s)
- Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Jillian Conrad
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Shirley D. Hon
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Christine Cheng
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Philip Tang
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Narcisse MR, Kippenbrock TA, Odell E, Buron B. Advanced Practice Nurses' Meaningful use of electronic health records. Appl Nurs Res 2013; 26:127-32. [DOI: 10.1016/j.apnr.2013.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 12/12/2012] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
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Zulman DM, Piette JD, Jenchura EC, Asch SM, Rosland AM. Facilitating out-of-home caregiving through health information technology: survey of informal caregivers' current practices, interests, and perceived barriers. J Med Internet Res 2013; 15:e123. [PMID: 23841987 PMCID: PMC3713893 DOI: 10.2196/jmir.2472] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 03/24/2013] [Accepted: 05/04/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many patients with chronic conditions are supported by out-of-home informal caregivers-family members, friends, and other individuals who provide care and support without pay-who, if armed with effective consumer health information technology, could inexpensively facilitate their care. OBJECTIVE We sought to understand caregivers' use of, interest in, and perceived barriers to health information technology for out-of-home caregiving. METHODS We conducted 2 sequential Web-based surveys with a national sample of individuals who provide out-of-home caregiving to an adult family member or friend with a chronic illness. We queried respondents about their use of health information technology for out-of-home caregiving and used multivariable regression to investigate caregiver and care-recipient characteristics associated with caregivers' technology use for caregiving. RESULTS Among 316 out-of-home caregiver respondents, 34.5% (109/316) reported using health information technology for caregiving activities. The likelihood of a caregiver using technology increased significantly with intensity of caregiving (as measured by number of out-of-home caregiving activities). Compared with very low intensity caregivers, the adjusted odds ratio (OR) of technology use was 1.88 (95% CI 1.01-3.50) for low intensity caregivers, 2.39 (95% CI 1.11-5.15) for moderate intensity caregivers, and 3.70 (95% CI 1.62-8.45) for high intensity caregivers. Over 70% (149/207) of technology nonusers reported interest in using technology in the future to support caregiving. The most commonly cited barriers to technology use for caregiving were health system privacy rules that restrict access to care-recipients' health information and lack of familiarity with programs or websites that facilitate out-of-home caregiving. CONCLUSIONS Health information technology use for out-of-home caregiving is common, especially among individuals who provide more intense caregiving. Health care systems can address the mismatch between caregivers' interest in and use of technology by modifying privacy policies that impede information exchange.
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Affiliation(s)
- Donna M Zulman
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, United States.
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Naming right: gnostic nomenclature vs useful names. Am J Med 2013; 126:654-6. [PMID: 23688664 DOI: 10.1016/j.amjmed.2013.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/24/2022]
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Ricciardi L, Mostashari F, Murphy J, Daniel JG, Siminerio EP. A National Action Plan To Support Consumer Engagement Via E-Health. Health Aff (Millwood) 2013; 32:376-84. [DOI: 10.1377/hlthaff.2012.1216] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lygeia Ricciardi
- Lygeia Ricciardi is the director of the Office of Consumer eHealth in the Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services, in Washington, D.C
| | - Farzad Mostashari
- Farzad Mostashari is the national coordinator for health information technology at the ONC
| | - Judy Murphy
- Judy Murphy is deputy national coordinator for programs and policy at the ONC
| | - Jodi G. Daniel
- Jodi G. Daniel is the director of the Office of Policy and Planning in the ONC
| | - Erin P. Siminerio
- Erin P. Siminerio (
) is a policy analyst in the Office of Consumer eHealth in the ONC
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Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, Feldman HJ, Mejilla R, Ngo L, Ralston JD, Ross SE, Trivedi N, Vodicka E, Leveille SG. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157:461-70. [PMID: 23027317 PMCID: PMC3908866 DOI: 10.7326/0003-4819-157-7-201210020-00002] [Citation(s) in RCA: 449] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors' office notes. OBJECTIVE To evaluate the effect on doctors and patients of facilitating patient access to visit notes over secure Internet portals. DESIGN Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided patients with electronic links to their doctors' notes. SETTING Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Washington. PARTICIPANTS 105 PCPs and 13,564 of their patients who had at least 1 completed note available during the intervention period. MEASUREMENTS Portal use and electronic messaging by patients and surveys focusing on participants' perceptions of behaviors, benefits, and negative consequences. RESULTS 11,155 [corrected] of 13,564 patients with visit notes available opened at least 1 note (84% at BIDMC, 82% [corrected] at GHS, and 47% at HMC). Of 5219 [corrected] patients who opened at least 1 note and completed a postintervention survey, 77% to 59% [corrected] across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense; and 20% to 42% reported sharing notes with others. The volume of electronic messages from patients did not change. After the intervention, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%), with practice size having little effect; 3% to 36% of doctors reported changing documentation content; and 0% to 21% reported taking more time writing notes. Looking ahead, 59% to 62% of patients believed that they should be able to add comments to a doctor's note. One out of 3 patients believed that they should be able to approve the notes' contents, but 85% to 96% of doctors did not agree. At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop. LIMITATIONS Only 3 geographic areas were represented, and most participants were experienced in using portals. Doctors volunteering to participate and patients using portals and completing surveys may tend to offer favorable feedback, and the response rate of the patient surveys (41%) may further limit generalizability. CONCLUSION Patients accessed visit notes frequently, a large majority reported clinically relevant benefits and minimal concerns, and virtually all patients wanted the practice to continue. With doctors experiencing no more than a modest effect on their work lives, open notes seem worthy of widespread adoption. PRIMARY FUNDING SOURCE The Robert Wood Johnson Foundation, the Drane Family Fund, the Richard and Florence Koplow Charitable Foundation, and the National Cancer Institute.
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Affiliation(s)
- Tom Delbanco
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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