1
|
Zhang X, Kang K, Yan C, Feng Y, Vandekar S, Yu D, Rosenbloom ST, Samuels J, Srivastava G, Williams B, Albaugh VL, English WJ, Flynn CR, Chen Y. Enhanced Patient Portal Engagement Associated with Improved Weight Loss Outcomes in Post-Bariatric Surgery Patients. medRxiv 2024:2024.01.20.24301550. [PMID: 38293039 PMCID: PMC10827275 DOI: 10.1101/2024.01.20.24301550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Bariatric surgery is an effective intervention for obesity, but it requires comprehensive postoperative self-management to achieve optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post-bariatric surgery weight loss remains unclear. Objective This study investigated the association between patient portal engagement and postoperative body mass index (BMI) reduction among bariatric surgery patients. Methods This retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at Vanderbilt University Medical Center (VUMC) between January 2018 and March 2021. Using generalized estimating equations, we estimated the association between active days of postoperative patient portal use and the reduction of BMI percentage (%BMI) at 3, 6, and 12 months post-surgery. Covariates included duration since surgery, the patient's age at the time of surgery, gender, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage. Results The study included 1,415 patients, mostly female (80.9%), with diverse racial and ethnic backgrounds. 805 (56.9%) patients underwent RYGB and 610 (43.1%) underwent SG. By one-year post-surgery, the mean (SD) %BMI reduction was 31.1% (8.3%), and the mean (SD) number of patient portal active days was 61.0 (41.2). A significantly positive association was observed between patient portal engagement and %BMI reduction, with variations revealed over time. Each 10-day increment of active portal use was associated with a 0.57% ([95% CI: 0.42- 0.72], P < .001) and 0.35% ([95% CI: 0.22- 0.49], P < .001) %BMI reduction at 3 and 6 months postoperatively. The association was not statistically significant at 12 months postoperatively (β=-0.07, [95% CI: -0.24- 0.09], P = .54). Various portal functions, including messaging, visits, my record, medical tools, billing, resources, and others, were positively associated with %BMI reduction at 3- and 6-months follow-ups. Conclusions Greater patient portal engagement, which may represent stronger adherence to postoperative instructions, better self-management of health, and enhanced communication with care teams, was associated with improved postoperative weight loss. Future investigations are needed to identify important portal features that contribute to the long-term success of weight loss management.
Collapse
Affiliation(s)
- Xinmeng Zhang
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | - Kaidi Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Chao Yan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Yubo Feng
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jason Samuels
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Gitanjali Srivastava
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
- Division of Diabetes, Endocrinology & Metabolism, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brandon Williams
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vance L. Albaugh
- Metamor Institute, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Wayne J. English
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles R. Flynn
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - You Chen
- Department of Computer Science, Vanderbilt University, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
2
|
Gleason KT, Wu MMJ, Wec A, Powell DS, Zhang T, Gamper MJ, Green AR, Nothelle S, Amjad H, Wolff JL. Use of the patient portal among older adults with diagnosed dementia and their care partners. Alzheimers Dement 2023; 19:5663-5671. [PMID: 37354066 PMCID: PMC10808947 DOI: 10.1002/alz.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Care partners are at the forefront of dementia care, yet little is known about patient portal use in the context of dementia diagnosis. METHODS We conducted an observational cohort study of date/time-stamped patient portal use for a 5-year period (October 3, 2017-October 2, 2022) at an academic health system. The cohort consisted of 3170 patients ages 65+ with diagnosed dementia with 2+ visits within 24 months. Message authorship was determined by manual review of 970 threads involving 3065 messages for 279 patients. RESULTS Most (71.20%) older adults with diagnosed dementia were registered portal users but far fewer (10.41%) had a registered care partner with shared access. Care partners authored most (612/970, 63.09%) message threads, overwhelmingly using patient identity credentials (271/279, 97.13%). DISCUSSION The patient portal is used by persons with dementia and their care partners. Organizational efforts that facilitate shared access may benefit the support of persons with dementia and their care partners. Highlights Patient portal registration and use has been increasing among persons with diagnosed dementia. Two thirds of secure messages from portal accounts of patients with diagnosed dementia were identified as being authored by care partners, primarily using patient login credentials. Care partners who accessed the patient portal using their own identity credentials through shared access demonstrate similar levels of activity to patients without dementia. Organizational initiatives should recognize and support the needs of persons with dementia and their care partners by encouraging awareness, registration, and use of proper identity credentials, including shared, or proxy, portal access.
Collapse
Affiliation(s)
- Kelly T. Gleason
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Mingche M. J. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aleksandra Wec
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle S. Powell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talan Zhang
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ariel R. Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Mai F, Ko DG, Shan Z, Zhang D. The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study. J Med Internet Res 2023; 25:e44981. [PMID: 37384810 PMCID: PMC10414031 DOI: 10.2196/44981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. OBJECTIVE We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19-induced digital acceleration? Does the effect differ across racial lines? METHODS We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). RESULTS Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=-.158; P<.001; RE, β=-.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=-.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=-.004; P<.001; RE, β=-.004; P<.001; FE, β=-.003; P=.001). CONCLUSIONS Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.
Collapse
Affiliation(s)
- Feng Mai
- School of Business, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Dong-Gil Ko
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, United States
| | - Zhe Shan
- Department of Information Systems and Analytics, Miami University, Oxford, OH, United States
| | - Dawei Zhang
- Department of Decision and Technology Analytics, Lehigh University, Bethlehem, PA, United States
| |
Collapse
|
5
|
Abstract
This cohort study assesses the level of engagement with an electronic health management system among patients with recently diagnosed dementia and their caregivers.
Collapse
Affiliation(s)
| | - Mingche M. J. Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aleksandra Wec
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Talan Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L. Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
6
|
Mavragani A, Schoonman GG, Maat B, Habibović M, Krahmer E, Pauws S. Patients Managing Their Medical Data in Personal Electronic Health Records: Scoping Review. J Med Internet Res 2022; 24:e37783. [PMID: 36574275 PMCID: PMC9832357 DOI: 10.2196/37783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/31/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients' medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR. OBJECTIVE This scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients' health and health care services. METHODS We searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query. RESULTS Of the 182 eligible papers, 37 (20%) provided sufficient information about patients' data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients' passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction. CONCLUSIONS The findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.
Collapse
Affiliation(s)
| | - Guus G Schoonman
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Barbara Maat
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Remote Patient Management & Connected Care, Philips Research, Eindhoven, Netherlands
| |
Collapse
|
7
|
Spratt SE, Ravneberg D, Derstine B, Granger BB. Feasibility of Electronic Health Record Integration of a SMART Application to Facilitate Patient-Provider Communication for Medication Management. Comput Inform Nurs 2022; 40:538-546. [PMID: 35234708 DOI: 10.1097/cin.0000000000000891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increased treatment complexity in patients with diabetes contributes to medication nonadherence. Patient portals that are accessible through electronic health records may offer improved patient-provider communication and better medication management in patients with diabetes and uncontrolled hypertension. We conducted a prospective, mixed-methods evaluation of the Duke PillBox application, a SMART-on-FHIR medication management application integrated into the electronic health record patient portal. Adults with active portal status, diabetes, and uncontrolled hypertension participated in a usability/feasibility survey and communicated with a pharmacist via the portal-based application who conducted medication reconciliation and discussed medication indications, side effects, and barriers to use with patients. Of the eligible patients (n = 285), 29 (10%) were interested, and 12 (8%) participated. Challenges to usability were due to the electronic health record-portal communication interface (91%), browser access and compatibility (55%), and persistent lists of unused medications in the electronic health record (27%). The findings of this study suggest that electronic health record-integrated medication applications are desirable as indicated in patient interactions at the outset and conclusion of the study. Persistent challenges included electronic health record integration, interoperability, user interface, and browser connectivity for both patients and providers.
Collapse
Affiliation(s)
- Susan E Spratt
- Author Affiliations: Division of Endocrinology and Metabolism, Department of Medicine, Duke University School of Medicine (Drs Spratt and Derstine), Durham, NC; Nordic Consulting Partners, Inc (Mr Ravneberg), Madison, WI; Duke University School of Nursing (Dr Granger), Durham, NC
| | | | | | | |
Collapse
|
8
|
Di Tosto G, Walker DM, Sieck CJ, Wallace L, MacEwan SR, Gregory ME, Scarborough S, Huerta TR, McAlearney AS. Examining the Relationship between Health Literacy, Health Numeracy, and Patient Portal Use. Appl Clin Inform 2022; 13:692-699. [PMID: 35793698 DOI: 10.1055/s-0042-1751239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES The objective of this study is to investigate the relationships between health literacy and numeracy (HLN) and patient portal use, measured in inpatient and outpatient settings. METHODS Using data collected as part of a pragmatic randomized controlled trial conducted across the inpatient population of a U.S.-based academic medical center, the present study evaluated the relationships between patients' perceptions of health literacy and their skills, interpreting medical information with metrics of engagement with patient portals. RESULTS Self-reported levels of HLN for patients in the study sample (n = 654) were not significantly associated with inpatient portal use as measured by frequency of use or the number of different inpatient portal functions used. Use of the outpatient version of the portal over the course of 6 months following hospital discharge was also not associated with HLN. A subsequent assessment of patients after 6 months of portal use postdischarge (response rate 40%) did not reveal any differences with respect to portal use and health numeracy; however, a significant increase in self-reported levels of health literacy was found at this point. CONCLUSION While previous studies have suggested that low HLN might represent a barrier to inpatient portal adoption and might limit engagement with outpatient portals, we did not find these associations to hold. Our findings, however, suggest that the inpatient setting may be effective in facilitating technology acceptance. Specifically, the introduction of an inpatient portal made available on hospital-provided tablets may have practical implications and contribute to increased adoption of patient-facing health information technology tools.
Collapse
Affiliation(s)
- Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Cynthia J Sieck
- Center for Health Equity, Dayton Children's Hospital, Dayton, Ohio, United States
| | - Lorraine Wallace
- Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Megan E Gregory
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Seth Scarborough
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
9
|
Morgan E, Schnell P, Singh P, Fareed N. Outpatient portal use among pregnant individuals: Cross-sectional, temporal, and cluster analysis of use. Digit Health 2022; 8:20552076221109553. [PMID: 35837662 PMCID: PMC9274807 DOI: 10.1177/20552076221109553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Outpatient portal technology can improve patient engagement. For pregnant individuals, the level of engagement could have important implications for maternal and infant outcomes. Objective This study: (1) cross-sectionally and temporally characterized the outpatient portal use among pregnant individuals seen at our academic medical center; and (2) identified clusters of the outpatient portal user groups based on the cross-sectional and temporal patterns of use. Methods We used outpatient portal server-side log files to execute a hierarchical clustering algorithm to group 7663 pregnant individuals based on proportions of outpatient portal function use. Post-hoc analyses were performed to further assess outpatient portal use on key encounter characteristics. Results The most frequently used functions were MyRecord (access personal health information), Visits (manage appointments), Messaging (send/receive messages), and Billing (view bills, insurance information). Median outpatient portal function use plateaued by the third trimester. Four distinct clusters were identified among all pregnant individuals: “Schedulers,” “Resulters,” “Intense Digital Engagers,” and “Average Users.” Post-hoc analyses revealed that the use of the Visits function increased and the use of the MyRecord function decreased over time among clusters. Conclusions Our identification of distinct cluster groups of outpatient portal users among pregnant individuals underscores the importance of avoiding the use of generalizations when describing how such patients might engage with patient-facing technologies such as an outpatient portal. These results can be used to improve user experience and training with outpatient portal functions and may educate maternal health providers on patient engagement with the outpatient portal.
Collapse
Affiliation(s)
- Evan Morgan
- Department of Biomedical Informatics, The Ohio State University, USA
| | | | - Priti Singh
- Department of Biomedical Informatics, The Ohio State University, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, USA
| |
Collapse
|
10
|
McAlearney AS, Sieck CJ, Gregory M, Di Tosto G, MacEwan SR, DePuccio MJ, Lee JA, Huerta TR, Walker DM. Examining Patients' Capacity to Use Patient Portals: Insights for Telehealth. Med Care 2021; 59:1067-1074. [PMID: 34593709 PMCID: PMC8595621 DOI: 10.1097/mlr.0000000000001639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The increase in telehealth in response to the coronavirus disease 2019 pandemic highlights the need to understand patients' capacity to utilize this care modality. Patient portals are a tool whose use requires similar resources and skills as those required for telehealth. Patients' capacity to use patient portals may therefore provide insight regarding patients' readiness and capacity to use telehealth. OBJECTIVE The aim of this study was to examine factors related to patients' capacity to use a patient portal and test the impact of these factors on patients' portal use. RESEARCH DESIGN AND SUBJECTS Using data from a large-scale pragmatic randomized controlled trial of patient portal use, 1081 hospitalized patients responded to survey items that were then mapped onto the 4 dimensions of the Engagement Capacity Framework: self-efficacy, resources, willingness, and capabilities. MEASURES The outcome variable was frequency of outpatient portal use. We evaluated associations between Engagement Capacity Framework dimensions and patient portal use, using regression analyses. RESULTS Patients with fewer resources, fewer capabilities, lower willingness, and lower overall capacity to use patient portals used the portal less; in contrast, those with lower perceived self-efficacy used the portal more. CONCLUSIONS Our findings highlight differences in patients' capacity to use patient portals, which provide an initial understanding of factors that may influence the use of telehealth and offer important guidance in efforts to support patients' telehealth use. Offering patients training tailored to the use of telehealth tools may be particularly beneficial.
Collapse
Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia J. Sieck
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Megan Gregory
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah R. MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Matthew J. DePuccio
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A. Lee
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
11
|
Singh P, Jonnalagadda P, Morgan E, Fareed N. Outpatient portal use in prenatal care: differential use by race, risk, and area social determinants of health. J Am Med Inform Assoc 2021; 29:364-371. [PMID: 34741505 DOI: 10.1093/jamia/ocab242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
To report the relationship of outpatient portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women. Regression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using log files and clinical data. Overall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like Visit (scheduling) and My Record (test results). We also found significant interactive associations between race/ethnicity, clinical risk, and SDoH. Non-Hispanic Black women and those living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas. More research must be conducted to learn of OPP use implications for pregnant women with specific clinical diagnoses.
Collapse
Affiliation(s)
- Priti Singh
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - Pallavi Jonnalagadda
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - Evan Morgan
- Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - Naleef Fareed
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
12
|
Fareed N, Jonnalagadda P, MacEwan SR, Di Tosto G, Scarborough S, Huerta TR, McAlearney AS. Differential Effects of Outpatient Portal User Status on Inpatient Portal Use: Observational Study. J Med Internet Res 2021; 23:e23866. [PMID: 33929328 PMCID: PMC8122294 DOI: 10.2196/23866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/23/2020] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background The decision to use patient portals can be influenced by multiple factors, including individuals’ perceptions of the tool, which are based on both their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users in particular may have confidence in their ability to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of other portals has not been studied. Objective This study aims to understand how patients’ use of an inpatient portal is influenced by outpatient portal use. Methods This study included patients from an academic medical center who were provided access to an inpatient portal during their hospital stays between 2016 and 2018 (N=1571). We analyzed inpatient portal log files to investigate how inpatient portal use varied by using 3 categories of outpatient portal users: prior users, new users, and nonusers. Results Compared with prior users (695/1571, 44.24%) of an outpatient portal, new users (214/1571, 13.62%) had higher use of a select set of inpatient portal functions (messaging function: incidence rate ratio [IRR] 1.33, 95% CI 1.06-1.67; function that provides access to the outpatient portal through the inpatient portal: IRR 1.34, 95% CI 1.13-1.58). Nonusers (662/1571, 42.14%), compared with prior users, had lower overall inpatient portal use (all active functions: IRR 0.68, 95% CI 0.60-0.78) and lower use of specific functions, which included the function to review vitals and laboratory results (IRR 0.51, 95% CI 0.36-0.73) and the function to access the outpatient portal (IRR 0.53, 95% CI 0.45-0.62). In comparison with prior users, nonusers also had lower odds of being comprehensive users (defined as using 8 or more unique portal functions; odds ratio [OR] 0.57, 95% CI 0.45-0.73) or composite users (defined as comprehensive users who initiated a 75th or greater percentile of portal sessions) of the inpatient portal (OR 0.42, 95% CI 0.29-0.60). Conclusions Patients’ use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings.
Collapse
Affiliation(s)
- Naleef Fareed
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Sarah R MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Gennaro Di Tosto
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Seth Scarborough
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
13
|
Beal LL, Kolman JM, Jones SL, Khleif A, Menser T. Quantifying Patient Portal Use: Systematic Review of Utilization Metrics. J Med Internet Res 2021; 23:e23493. [PMID: 33629962 PMCID: PMC7952240 DOI: 10.2196/23493] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/16/2020] [Accepted: 01/31/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Use of patient portals has been associated with positive outcomes in patient engagement and satisfaction. Portal studies have also connected portal use, as well as the nature of users' interactions with portals, and the contents of their generated data to meaningful cost and quality outcomes. Incentive programs in the United States have encouraged uptake of health information technology, including patient portals, by setting standards for meaningful use of such technology. However, despite widespread interest in patient portal use and adoption, studies on patient portals differ in actual metrics used to operationalize and track utilization, leading to unsystematic and incommensurable characterizations of use. No known review has systematically assessed the measurements used to investigate patient portal utilization. OBJECTIVE The objective of this study was to apply systematic review criteria to identify and compare methods for quantifying and reporting patient portal use. METHODS Original studies with quantifiable metrics of portal use published in English between 2014 and the search date of October 17, 2018, were obtained from PubMed using the Medical Subject Heading term "Patient Portals" and related keyword searches. The first search round included full text review of all results to confirm a priori data charting elements of interest and suggest additional categories inductively; this round was supplemented by the retrieval of works cited in systematic reviews (based on title screening of all citations). An additional search round included broader keywords identified during the full-text review of the first round. Second round results were screened at abstract level for inclusion and confirmed by at least two raters. Included studies were analyzed for metrics related to basic use/adoption, frequency of use, duration metrics, intensity of use, and stratification of users into "super user" or high utilizers. Additional categories related to provider (including care team/administrative) use of the portal were identified inductively. Additional analyses included metrics aligned with meaningful use stage 2 (MU-2) categories employed by the US Centers for Medicare and Medicaid Services and the association between the number of portal metrics examined and the number of citations and the journal impact factor. RESULTS Of 315 distinct search results, 87 met the inclusion criteria. Of the a priori metrics, plus provider use, most studies included either three (26 studies, 30%) or four (23 studies, 26%) metrics. Nine studies (10%) only reported the patient use/adoption metric and only one study (1%) reported all six metrics. Of the US-based studies (n=76), 18 (24%) were explicitly motivated by MU-2 compliance; 40 studies (53%) at least mentioned these incentives, but only 6 studies (8%) presented metrics from which compliance rates could be inferred. Finally, the number of metrics examined was not associated with either the number of citations or the publishing journal's impact factor. CONCLUSIONS Portal utilization measures in the research literature can fall below established standards for "meaningful" or they can substantively exceed those standards in the type and number of utilization properties measured. Understanding how patient portal use has been defined and operationalized may encourage more consistent, well-defined, and perhaps more meaningful standards for utilization, informing future portal development.
Collapse
Affiliation(s)
- Lauren L Beal
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen L Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Aroub Khleif
- Ambulatory Clinical Systems, Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
| |
Collapse
|
14
|
Hsu CL, Chen WX, Le TV. An Autonomous Log Storage Management Protocol with Blockchain Mechanism and Access Control for the Internet of Things. Sensors (Basel) 2020; 20:E6471. [PMID: 33198399 DOI: 10.3390/s20226471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022]
Abstract
As the Internet of Things (IoT) has become prevalent, a massive number of logs produced by IoT devices are transmitted and processed every day. The logs should contain important contents and private information. Moreover, these logs may be used as evidences for forensic investigations when cyber security incidents occur. However, evidence legality and internal security issues in existing works were not properly addressed. This paper proposes an autonomous log storage management protocol with blockchain mechanism and access control for the IoT. Autonomous model allows sensors to encrypt their logs before sending it to gateway and server, so that the logs are not revealed to the public during communication process. Along with blockchain, we introduce the concept “signature chain”. The integration of blockchain and signature chain provides efficient management functions with valuable security properties for the logs, including robust identity verification, data integrity, non-repudiation, data tamper resistance, and the legality. Our work also employs attribute-based encryption to achieve fine-grained access control and data confidentiality. The results of security analysis using AVSIPA toolset, GNY logic and semantic proof indicate that the proposed protocol meets various security requirements. Providing good performance with elliptic curve small key size, short BLS signature, efficient signcryption method, and single sign-on solution, our work is suitable for the IoT.
Collapse
|