151
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Biggs JS, Willcocks A, Burger M, Makeham MA. Digital health benefits evaluation frameworks: building the evidence to support Australia's National Digital Health Strategy. Med J Aust 2020; 210 Suppl 6:S9-S11. [PMID: 30927475 DOI: 10.5694/mja2.50034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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152
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Zanaboni P, Kummervold PE, Sørensen T, Johansen MA. Patient Use and Experience With Online Access to Electronic Health Records in Norway: Results From an Online Survey. J Med Internet Res 2020; 22:e16144. [PMID: 32031538 PMCID: PMC7055829 DOI: 10.2196/16144] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/04/2019] [Accepted: 12/16/2019] [Indexed: 01/16/2023] Open
Abstract
Background The electronic health record (EHR) has been fully established in all Norwegian hospitals. Patient-accessible electronic health records (PAEHRs) are available to citizens aged 16 years and older through the national health portal Helsenorge. Objective This study aimed at understanding how patients use PAEHRs. Three research questions were addressed in order to explore (1) characteristics of users, (2) patients’ use of the service, and (3) patient experience with the service. Methods We conducted an online survey of users who had accessed their EHR online at least once through the national health portal. Patients from two of the four health regions in Norway were invited to participate. Quantitative data were supplemented by qualitative information. Results A total of 1037 respondents participated in the survey, most of whom used the PAEHR regularly (305/1037, 29.4%) or when necessary (303/1037, 29.2%). Service utilization was associated with self-reported health, age, gender, education, and health care professional background. Patients found the service useful to look up health information (687/778, 88.3%), keep track of their treatment (684/778, 87.9%), prepare for a hospital appointment (498/778, 64.0%), and share documents with their general practitioner (292/778, 37.5%) or family (194/778, 24.9%). Most users found it easy to access their EHR online (965/1037, 93.1%) and did not encounter technical challenges. The vast majority of respondents (643/755, 85.2%) understood the content, despite over half of them acknowledging some difficulties with medical terms or phrases. The overall satisfaction with the service was very high (700/755, 92.7%). Clinical advantages to the patients included enhanced knowledge of their health condition (565/691, 81.8%), easier control over their health status (685/740, 92.6%), better self-care (571/653, 87.4%), greater empowerment (493/674, 73.1%), easier communication with health care providers (493/618, 79.8%), and increased security (655/730, 89.7%). Patients with complex, long-term or chronic conditions seemed to benefit the most. PAEHRs were described as useful, informative, effective, helpful, easy, practical, and safe. Conclusions PAEHRs in Norway are becoming a mature service and are perceived as useful by patients. Future studies should include experimental designs focused on specific populations or chronic conditions that are more likely to achieve clinically meaningful benefits. Continuous evaluation programs should be conducted to assess implementation and changes of wide-scale routine services over time.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | | | - Monika Alise Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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153
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Blease CR, Walker J, Torous J, O'Neill S. Sharing Clinical Notes in Psychotherapy: A New Tool to Strengthen Patient Autonomy. Front Psychiatry 2020; 11:527872. [PMID: 33192647 PMCID: PMC7655789 DOI: 10.3389/fpsyt.2020.527872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/22/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Charlotte R Blease
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Jan Walker
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Stephen O'Neill
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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154
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Han HR, Gleason KT, Sun CA, Miller HN, Kang SJ, Chow S, Anderson R, Nagy P, Bauer T. Using Patient Portals to Improve Patient Outcomes: Systematic Review. JMIR Hum Factors 2019; 6:e15038. [PMID: 31855187 PMCID: PMC6940868 DOI: 10.2196/15038] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/23/2019] [Accepted: 08/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND With the advent of electronic health record (EHR) systems, there is increasing attention on the EHR system with regard to its use in facilitating patients to play active roles in their care via secure patient portals. However, there is no systematic review to comprehensively address patient portal interventions and patient outcomes. OBJECTIVE This study aimed to synthesize evidence with regard to the characteristics and psychobehavioral and clinical outcomes of patient portal interventions. METHODS In November 2018, we conducted searches in 3 electronic databases, including PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature, and a total of 24 articles met the eligibility criteria. RESULTS All but 3 studies were conducted in the United States. The types of study designs varied, and samples predominantly involved non-Hispanic white and highly educated patients with sizes ranging from 50 to 22,703. Most of the portal interventions used tailored alerts or educational resources tailored to the patient's condition. Patient portal interventions lead to improvements in a wide range of psychobehavioral outcomes, such as health knowledge, self-efficacy, decision making, medication adherence, and preventive service use. Effects of patient portal interventions on clinical outcomes including blood pressure, glucose, cholesterol, and weight loss were mixed. CONCLUSIONS Patient portal interventions were overall effective in improving a few psychological outcomes, medication adherence, and preventive service use. There was insufficient evidence to support the use of patient portals to improve clinical outcomes. Understanding the role of patient portals as an effective intervention strategy is an essential step to encourage patients to be actively engaged in their health care.
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Affiliation(s)
- Hae-Ra Han
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
- The Johns Hopkins University, Center for Cardiovascular and Chronic Care, Baltimore, MD, United States
- The Johns Hopkins University, Center for Community Innovation and Scholarship, Baltimore, MD, United States
| | - Kelly T Gleason
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Chun-An Sun
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Hailey N Miller
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Soo Jin Kang
- Daegu University, Department of Nursing, Daegu, Republic of Korea
| | - Sotera Chow
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Rachel Anderson
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Paul Nagy
- The Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Tom Bauer
- The Johns Hopkins Hospitals and Health System, Baltimore, MD, United States
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155
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Fossa AJ, Bell SK, DesRoches C. OpenNotes and shared decision making: a growing practice in clinical transparency and how it can support patient-centered care. J Am Med Inform Assoc 2019; 25:1153-1159. [PMID: 29982659 DOI: 10.1093/jamia/ocy083] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/01/2018] [Indexed: 01/10/2023] Open
Abstract
Objective Prior studies suggest inviting patients to read their visit notes (OpenNotes) has important benefits for patient engagement. We utilized survey data to investigate our hypothesis that patients who read more notes would report greater shared decision making (SDM). Materials and Methods Our survey focused on the safety and quality implications of OpenNotes. 24 722 patients at an urban healthcare organization were invited to complete the survey, which included an item assessing the number of notes read and the CollaboRATE scale to measure SDM. We used log-binomial regression to estimate the relative probability of top CollaboRATE scores across number of notes read while controlling for several covariates. Results 6913 patients responded (28% response rate). Patients reading 4+ clinical notes in the past 12 months were 17% more likely to have top CollaboRATE scores when compared to patients who had not read a note in the previous 12 months (RR: 1.17, 95%CI: 1.04-1.32). Discussion There is a clear relationship between what SDM requires and the transparency OpenNotes provides. Access to clinicians' notes can support the SDM model, which relies on efficient information exchange between clinicians and well-informed patients. Conclusion Our study showed evidence of a relationship between note reading and perceived SDM. Implementation of SDM is likely to expand, given its association with improved patient satisfaction, adherence, and medical decision making. Findings from this study highlight OpenNotes as a policy that institutions can implement as a facilitator of SDM and a manifestation of their commitment to patient autonomy and transparency.
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Affiliation(s)
- Alan J Fossa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Catherine DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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156
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Mold F, Hendy J, Lai YL, de Lusignan S. Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Med Inform 2019; 7:e13042. [PMID: 31793888 PMCID: PMC6918214 DOI: 10.2196/13042] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.
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Affiliation(s)
- Freda Mold
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Jane Hendy
- Brunel Business School, Brunel University London, Uxbridge, United Kingdom
| | - Yi-Ling Lai
- Faculty of Business and Law, University of Portsmouth, Portsmouth, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
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157
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Denneson LM, Pisciotta M, Hooker ER, Trevino A, Dobscha SK. Impacts of a web-based educational program for veterans who read their mental health notes online. J Am Med Inform Assoc 2019; 26:3-8. [PMID: 30445648 DOI: 10.1093/jamia/ocy134] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
Objective This study evaluates whether a web-based educational program for patients who read their mental health notes online improves patient-clinician communication and increases patient activation. Methods The web-based educational program, developed with end-user input, was designed to educate patients on the content of mental health notes, provide guidance on communicating with clinicians about notes, and facilitate patients' safe and purposeful use of their health information. Eligible patients were engaged in mental health treatment (≥1 visit in the prior 6 months) and had logged into the Veterans Health Administration (VHA) patient portal at least twice. Participants completed measures of patient activation, perceived efficacy in healthcare interactions, patient trust in their clinicians, and patient assessment of the therapeutic relationship before and after participating in the program. A total of 247 participants had complete data and engaged with the program for 5 minutes or more, comprising the analytic sample. Multivariate analysis using mixed effects models were used to examine pre-post changes in outcomes. Results In bivariate analyses, patient activation, perceived efficacy in healthcare interactions, and trust in clinicians increased significantly between pre- and post-training assessments. In fully adjusted models, changes in patient activation [b = 2.71 (1.41, 4.00), P < 0.01] and perceived efficacy in healthcare interactions [b = 1.27 (0.54, 2.01), P < 0.01)] remained significant. Conclusions Findings suggest that this educational program may help empower mental health patients who read their notes online to be active participants in their care, while also providing information and tools that may facilitate better relationships with their clinicians.
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Maura Pisciotta
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Amira Trevino
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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158
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Huang JS, Yueh R, Ma S, Cruz R, Bauman L, Choi LJ. Adolescents' and Young Adults' Satisfaction with and Understanding of Medical Notes from a Pediatric Gastroenterology Practice: A Cross-Sectional Cohort Study. J Pediatr 2019; 215:264-266. [PMID: 31377044 DOI: 10.1016/j.jpeds.2019.06.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/13/2019] [Accepted: 06/21/2019] [Indexed: 11/27/2022]
Abstract
Medical note sharing enhances patient-physician relationships, increases medication adherence, and improves self-care. However, many institutions do not release medical notes to adolescents, citing poor understanding and patient harm concerns. We evaluated the results of medical note sharing among adolescents with chronic disease and found high satisfaction and adequate comprehension.
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Affiliation(s)
- Jeannie S Huang
- Rady Children's Hospital, San Diego, CA; University of California San Diego, La Jolla, CA.
| | - Ryan Yueh
- University of California San Diego, La Jolla, CA
| | - Stacy Ma
- University of California San Diego, La Jolla, CA
| | | | - Laura Bauman
- Rady Children's Hospital, San Diego, CA; University of California San Diego, La Jolla, CA
| | - Lillian J Choi
- Rady Children's Hospital, San Diego, CA; University of California San Diego, La Jolla, CA
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159
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Current Practices in Electronic Capture of Patient-Reported Outcomes for Measurement-Based Care and the Use of Patient Portals to Support Behavioral Health. Psychiatr Clin North Am 2019; 42:635-647. [PMID: 31672213 PMCID: PMC7778878 DOI: 10.1016/j.psc.2019.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Electronic health records combined with tethered patient portals now support a range of functions including electronic data capture of patient-reported outcomes, trend reporting on clinical targets, secure messaging, and patient-mediated health information exchange. The applications of these features require special consideration in psychiatric and behavioral health settings. Nonetheless, their potential to engage patients suffering from disorders in which passivity and withdrawal are endemic to their mental health condition, is great. This article presents the growing research base on these topics, including discussion of key issues and recommendations for optimal implementation of patient portals in behavioral health settings.
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160
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Austin E, Lee JR, Amtmann D, Bloch R, Lawrence SO, McCall D, Munson S, Lavallee DC. Use of patient-generated health data across healthcare settings: implications for health systems. JAMIA Open 2019; 3:70-76. [PMID: 32607489 PMCID: PMC7309248 DOI: 10.1093/jamiaopen/ooz065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/13/2019] [Accepted: 12/09/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The growing prevalence of chronic conditions requiring changes in lifestyle and at-home self-management has increased interest in and need for supplementing clinic visits with data generated by patients outside the clinic. Patient-generated health data (PGHD) support the ability to diagnose and manage chronic conditions, to improve health outcomes, and have the potential to facilitate more “connected health” between patients and their care teams; however, health systems have been slow to adopt PGHD use in clinical care. Materials and Methods We surveyed current and potential users of PGHD to catalog how PGHD is integrated into clinical care at an academic health center. The survey included questions about data type, method of collection, and clinical uses of PGHD. Current users were asked to provide detailed case studies of PGHD use in research and care delivery. Results Thirty-one respondents completed the survey. Seventeen individuals contributed detailed case studies of PGHD use across diverse areas of care, including behavioral health, metabolic and gastrointestinal conditions, musculoskeletal/progressive functional conditions, cognitive symptoms, and pain management. Sensor devices and mobile technologies were the most commonly reported platforms for collection. Clinicians and researchers involved in PGHD use cited the potential for PGHD to enhance care delivery and outcomes, but also indicated substantial barriers to more widespread PGHD adoption across healthcare systems. Conclusion The results of our survey illustrate how PGHD is used in targeted areas of one healthcare system and provide meaningful insights that can guide health systems in supporting the widespread use of PGHD in care delivery.
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Affiliation(s)
- Elizabeth Austin
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Jenney R Lee
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Rich Bloch
- Digital Healthcare I/O, Snohomish, Washington, USA
| | - Sarah O Lawrence
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Debbe McCall
- Rowan Tree Perspectives, LLC, Murietta, California, USA
| | - Sean Munson
- Department of Human Centered Design & Engineering, University of Washington, Seattle, Washington, USA
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161
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Crotty BH, Winn AN, Asan O, Nagavally S, Walker RJ, Egede LE. Clinician Encouragement and Online Health Record Usage. J Gen Intern Med 2019; 34:2345-2347. [PMID: 31313113 PMCID: PMC6848784 DOI: 10.1007/s11606-019-05162-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bradley H Crotty
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, WI, USA. .,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of General Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Aaron N Winn
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,School of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Onur Asan
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of General Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Sneha Nagavally
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of General Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of General Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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162
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Alpert JM, Morris BB, Thomson MD, Matin K, Brown RF. Identifying How Patient Portals Impact Communication in Oncology. HEALTH COMMUNICATION 2019; 34:1395-1403. [PMID: 29979886 PMCID: PMC6320725 DOI: 10.1080/10410236.2018.1493418] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Patient portals are becoming widespread throughout health-care systems. Initial research has demonstrated that they positively impact patient-provider communication and patients' health knowledge, but little is known about the impact of patient portals in the cancer setting, where highly complex and uncertain medical data are available for patients to view. To better understand communicative behaviors and perceptions of the patient portal and how it is utilized in oncology, in-depth, semi-structured interviews were conducted with 48 participants: 35 patients and 13 oncologists. Thematic analysis identified that portals help to enhance participation during in-person consultations, increase patients' self-advocacy, and build rapport with providers. However, patients' comfort level with reviewing information via the portal depended upon the severity of the test. Oncologists worried about patient anxiety and widening health disparities, but acknowledged that the portal can motivate them to expedite communication about laboratory and scan results. As patient portals become more widely used in all medical settings, oncologists should become more engaged with how patients are viewing their medical information and consider the portal within the framework of patient-centered care by valuing patients' communication preferences.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, College of Journalism and Communications, University of Florida
| | - Bonny B Morris
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine
| | - Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine
| | - Khalid Matin
- Department of Internal Medicine, Division of Hematology and Oncology, Virginia Commonwealth University School of Medicine
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine
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163
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Chimowitz H, Gerard M, Fossa A, Bourgeois F, Bell SK. Empowering Informal Caregivers with Health Information: OpenNotes as a Safety Strategy. Jt Comm J Qual Patient Saf 2019; 44:130-136. [PMID: 29499809 DOI: 10.1016/j.jcjq.2017.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/18/2017] [Accepted: 09/01/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Enabling family/friend caregivers with access to visit notes may help avoid errors, delayed diagnoses, or other ambulatory safety risks. Patient, parent, and caregiver perceptions of how shared notes affect safety behaviors and attitudes were studied in an exploratory study. METHODS To assess the impact of OpenNotes on safety, 24,722 patients with active portal accounts and ≥ 1 available visit notes during the prior year at an urban hospital were surveyed between June and September 2016. Surveys were sent to patient portal accounts, and respondents designated themselves as patients or caregivers. Although the hospital does not have formal proxy portal registration, some patients share access with their caregivers. RESULTS Of 24,722 portal accounts accessed during the study, 7,058 (28.5%) surveys were returned, with 150 (2.1%) participants identified as caregivers. Among patients who had tests and referrals, reading notes helped caregivers understand the reason for the test (96/120 [80.0%]) or referral (48/52 [92.3%]), remember to get patient tests done (66/120 [55.0%]), check (98/120 [81.7%]) and understand (98/120 [81.7%]) results, and remember patient appointments (36/52 [69.2%]). As a result of reading notes, 54.1% (59/109) of caregivers helping patients on prescription medications reported better assisting patients to take them correctly. Among note-reading caregivers, 53.7% (n = 72/134) trusted the clinician more (44.8% no change), and 58.2% (n = 78/134) reported better teamwork (41.0% no change) as a result of open notes. In total, 30.3% (n = 40/132) reported at least one mistake or possible mistake in the patient's notes. Finding a possible mistake did not negatively affect trust or teamwork. CONCLUSION OpenNotes may enable caregivers with patient health information, answering the call to better support this critical group in the health care system and to engage patients and families in safety efforts.
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164
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Affiliation(s)
- Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Catherine DesRoches
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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165
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Galvin HK, Petersen C, Subbian V, Solomonides A. Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System. Appl Clin Inform 2019; 10:841-848. [PMID: 31694055 PMCID: PMC6834452 DOI: 10.1055/s-0039-1700536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/28/2019] [Indexed: 12/29/2022] Open
Abstract
Authentic inclusion and engagement of behavioral health patients in their care delivery and in the process of scientific discovery are often challenged in the health care system. Consequently, there is a growing need to engage with and better serve the needs of behavioral health patients, particularly by leveraging health information technologies. In this work, we present rationale and strategies for improving patient engagement in this population in research and clinical care. First, we describe the potential for creating meaningful patient-investigator partnerships in behavioral health research to allow for cocreation of knowledge with patients. Second, in the context of behavioral health services, we explore the utility of sharing clinical notes to promote patients' agency in care delivery. Both lines of inquiry are centered in a Learning Health System model for behavioral health, where patients are agents in enhancing the therapeutic alliance and advancing the process of knowledge generation. Recommendations include genuinely democratizing the health care system and biomedical research enterprise through patient-centered information technologies such as patient portals. In research and technology development, we recommend seeking and tailoring behavioral health patients' involvement to their abilities, promoting patient input in data analysis plans, evaluating research and informatics initiatives for patients and clinicians, and sharing success and research findings with patients. In clinical practice, we recommend encouraging patients to read behavioral health notes on portals, engaging in proactive communication regarding note content, assessing outcomes including stress and anxiety in response to note content, and working with technology providers to support note-sharing governance and deployment.
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Affiliation(s)
| | - Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Vignesh Subbian
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, United States
| | - Anthony Solomonides
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, Arizona, United States
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166
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Alpert JM, Morris BB, Thomson MD, Matin K, Sabo RT, Brown RF. Patient access to clinical notes in oncology: A mixed method analysis of oncologists' attitudes and linguistic characteristics towards notes. PATIENT EDUCATION AND COUNSELING 2019; 102:1917-1924. [PMID: 31109771 PMCID: PMC6716990 DOI: 10.1016/j.pec.2019.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Providers have expressed concern about patient access to clinical notes. There is the possibility that providers may linguistically censor notes knowing that patients have access. PURPOSE Qualitative interviews and a pre- and post- linguistic analysis of the implementation of OpenNotes was performed to determine whether oncologists changed the content and style of their notes. METHODS Mixed methods were utilized, including 13 semi-structured interviews with oncologists and random effects modeling of over 500 clinical notes. The Linguistic Inquiry and Word Count program was used to evaluate notes for emotions, thinking styles, and social concerns. RESULTS No significant differences from pre- and post-implementation of OpenNotes was found. Thematic analysis revealed that oncologists were concerned that changing their notes would negatively impact multidisciplinary communication. However, oncologists acknowledged that notes could be more patient-friendly and may stimulate patient-provider communication. CONCLUSIONS Although oncologists were aware that patients could have access, they felt strongly about not changing the content of notes. A comparison between pre- and post-implementation confirmed this view and found that notes did not change. PRACTICE IMPLICATIONS Patient access to oncologist's notes may serve as an opportunity to reinforce important aspects of the consultation.
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Affiliation(s)
| | - Bonny B Morris
- Virginia Commonwealth University, Health Behavior and Policy
| | - Maria D Thomson
- Virginia Commonwealth University, Health Behavior and Policy
| | - Khalid Matin
- Virginia Commonwealth University, Hematology/Oncology
| | - Roy T Sabo
- Virginia Commonwealth University, Biostatistics
| | - Richard F Brown
- Virginia Commonwealth University, Health Behavior and Policy
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167
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Affiliation(s)
- Irfan A Dhalla
- Health Quality Ontario (Dhalla, Tepper); Department of Medicine (Dhalla) and Department of Family and Community Medicine (Tepper) and Institute of Health Policy, Management and Evaluation (Dhalla, Tepper), University of Toronto; St. Michael's Hospital (Dhalla, Tepper), Toronto, Ont.
| | - Joshua Tepper
- Health Quality Ontario (Dhalla, Tepper); Department of Medicine (Dhalla) and Department of Family and Community Medicine (Tepper) and Institute of Health Policy, Management and Evaluation (Dhalla, Tepper), University of Toronto; St. Michael's Hospital (Dhalla, Tepper), Toronto, Ont
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168
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Erlingsdóttir G, Petersson L, Jonnergård K. A Theoretical Twist on the Transparency of Open Notes: Qualitative Analysis of Health Care Professionals' Free-Text Answers. J Med Internet Res 2019; 21:e14347. [PMID: 31573905 PMCID: PMC6785719 DOI: 10.2196/14347] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/28/2019] [Accepted: 08/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background The New Public Management movement strove for transparency so that policy makers and citizens could gain insight into the work and performance of health care. As the use of the electronic health record (EHR) started to diffuse, a foundation was laid for enhanced transparency within and between health care organizations. Now we appear to be experiencing a new kind of transparency in the health care sector. Many health care providers offer their patients online access to their EHRs (here referred to as Open Notes). The Open Notes system enables and strives for transparency between the health care organization and the patient. Hence, this study investigates health care professional (HCP) perceptions of Open Notes and deepens the understanding of the transparency that Open Notes implies. Objective Based on two survey studies of HCP perceptions of Open Notes, this paper aims to deepen the academic writing on the type of transparency that is connected to Open Notes. Methods HCPs in adult psychiatry in Region Skåne, Sweden, were surveyed before and after implementation of Open Notes. The empirical material presented consists of 1554 free-text answers from two Web surveys. A qualitative content analysis was performed. Results The theoretically informed analysis pivots around the following factors connected to transparency: effectiveness; trust; accountability; autonomy and control; confidentiality, privacy, and anonymity; fairness; and legitimacy. The results show that free-text answers can be sorted under these factors as trade-offs with transparency. According to HCPs, trade-offs affect their work, their relationship with patients, and not least, their work tool, the EHR. However, since many HCPs also state that they have not met many patients, and in some cases none, who have read their EHRs, these effects seem to be more connected to the possibility (or threat) of transparency than to the actual effectuated transparency. Conclusions The implementation (or reform) of Open Notes is policy driven while demanding real-time transparency on behalf of citizens/patients and not the authorities, which makes this particular form of transparency quite unique and interesting. We have chosen to call it governed individual real-time transparency. The effects of Open Notes may vary between different medical specialties relative to their sensitivity to both total and real-time transparency. When HCPs react by changing their ways of writing notes, Open Notes can affect the efficiency of the work of HCPs and the service itself in a negative manner. HCP reactions are aimed primarily at protecting patients and their relatives as well as their own relationship with the patients and secondly at protecting themselves. Thus, governed individual real-time transparency that provides full transparency of an actual practice in health care may have the intended positive effects but can also result in negative trade-offs between transparency and efficiency of the actual practice. This may imply that full transparency is not always most desirable but that other options can be considered on a scale between none and full transparency.
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Affiliation(s)
| | - Lena Petersson
- Department of Design Sciences, Lund University, Lund, Sweden
| | - Karin Jonnergård
- Department of Business Administration, Lund University, Lund, Sweden
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169
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Makeham M. My Health Record: Connecting Australians with their own health information. Health Inf Manag 2019. [DOI: 10.1177/1833358319841511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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170
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A Survey of Patient's Perceptions and Proposed Provision of a 'Patient Portal' in Endocrine Outpatients. THE ULSTER MEDICAL JOURNAL 2019; 88:157-161. [PMID: 31619849 PMCID: PMC6790643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Patient portals are online electronic medical record applications that allow patients greater control of their own health and encourage meaningful interaction with their healthcare providers. The uptake of this technology is commonplace throughout developed healthcare economies and is on the Northern Ireland Electronic Healthcare Record (NIECR) roadmap. AIM To assess patients' perceptions and proposed provision of a patient portal in endocrinology outpatients. METHODS Patients (n=75) attending three endocrinology outpatient clinics were eligible to participate. After discussion at clinic, invited patients were contacted via e-mail to complete a confidential and anonymised online survey. There were a total of 23 questions in the survey which included a mix of free text and categorical responses. The survey duration was conducted over a 6-month period. RESULTS The survey response rate was 51/75 (68%), M33:F18. 46/51 (90%) had access to smart phones, 45/51 (88%) used the internet daily. 31/51 (60%) of respondents were aged between 18-45, 20/51 (40%) were aged ≥ 45 years. 50/51 (98%) reported they would use the technology if available. 47/51 (92%) felt engaging with a patient portal would enhance communication with their doctor and improve understanding of their medical issues. Reported perceived applications of use included; remote access and advice for test results and medical questions, arranging appointments, requesting prescriptions and health promotion. 90% of respondents said they would be content to access results even if abnormal. Possible barriers to adoption of this technology included data protection and understanding medical terminology. CONCLUSIONS The overall response to the provision of this technology was positive, although concerns regarding data protection remain prevalent. Perceived benefits included enhanced doctor-patient communication, optimizing workflow and improving patient engagement.
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171
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Blease CR, Bell SK. Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety. Diagnosis (Berl) 2019; 6:213-221. [DOI: 10.1515/dx-2018-0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/08/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Error resulting from missed, delayed, or wrong diagnoses is estimated to occur in 10–15% of ambulatory and inpatient encounters, leading to serious harm in around half of such cases. When it comes to conceptualizing diagnostic error, most research has focused on factors pertaining to: (a) physician cognition and (b) ergonomic or systems factors related to the physician’s working environment. A third factor – the role of patients in diagnostic processes – remains relatively under-investigated. Yet, as a growing number of researchers acknowledge, patients hold unique knowledge about themselves and their healthcare experience, and may be the most underutilized resource for mitigating diagnostic error. This opinion article examines recent findings from patient surveys about sharing visit notes with patients online. Drawing on these survey results, we suggest three ways in which sharing visit notes with patients might enhance diagnostic processes: (1) avoid delays and missed diagnoses by enhancing timely follow up of recommended tests, results, and referrals; (2) identify documentation errors that may undermine diagnostic accuracy; and (3) strengthen patient-clinician relationships thereby creating stronger bidirectional diagnostic partnerships. We also consider the potential pitfalls or unintended consequences of note transparency, and highlight areas in need of further research.
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172
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Vreugdenhil MMT, Ranke S, de Man Y, Haan MM, Kool RB. Patient and Health Care Provider Experiences With a Recently Introduced Patient Portal in an Academic Hospital in the Netherlands: Mixed Methods Study. J Med Internet Res 2019; 21:13743. [PMID: 31432782 PMCID: PMC6788335 DOI: 10.2196/13743] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/14/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the Netherlands, the health care system and related information technology landscape are fragmented. Recently, hospitals have started to launch patient portals. It is not clear how these portals are used by patients and their health care providers (HCPs). OBJECTIVE The objective of this study was to explore the adoption, use, usability, and usefulness of a recently introduced patient portal in an academic hospital to learn lessons for the implementation of patient portals in a fragmented health care system. METHODS A mixed methods study design was used. In the quantitative study arm, characteristics of patients who used the portal were analyzed, in addition to the utilization of the different functionalities of the portal. In the qualitative study arms, think-aloud observations were made to explore usability. Focus group discussions were conducted among patients and HCPs of the dermatology and ophthalmology outpatient departments. Thematic content analysis of qualitative data was carried out and overarching themes were identified using a framework analysis. RESULTS One year after the introduction of the portal, 24,514 patients, 13.49% of all patients who visited the hospital, had logged in to the portal. Adoption of the portal was associated with the age group 45 to 75 years, a higher socioeconomic status, and having at least one medical diagnosis. Overarching themes from the qualitative analyses were (1) usability and user-friendliness of the portal, (2) HCP-patient communication through the portal, (3) usefulness of the information that can be accessed through the portal, (4) integration of the portal in care and work processes, and (5) HCP and patient roles and relationships. CONCLUSIONS One year after the introduction of the patient portal, patients and HCPs who used the portal recognized the potential of the portal to engage patients in their care processes, facilitate patient-HCP communication, and increase patient convenience. Uncertainties among patients and HCPs about how to use the messaging functionality and limited integration of the portal in care and work processes are likely to have limited portal use and usefulness.
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Affiliation(s)
| | - Sander Ranke
- IQ healthcare, Radboudumc, Nijmegen, Netherlands
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173
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Wolff JL, Aufill J, Echavarria D, Heughan JA, Lee KT, Connolly RM, Fetting JH, Jelovac D, Papathakis K, Riley C, Stearns V, Thorner E, Zafman N, Levy HP, Dy SM, Wolff AC. Sharing in care: engaging care partners in the care and communication of breast cancer patients. Breast Cancer Res Treat 2019; 177:127-136. [PMID: 31165374 PMCID: PMC6640103 DOI: 10.1007/s10549-019-05306-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Family is often overlooked in cancer care. We developed a patient-family agenda setting intervention to engage family in cancer care communication. METHODS We conducted a pilot randomized controlled trial (NCT03283553) of patients on active treatment for breast cancer and their family "care partner." Intervention dyads (n = 69) completed a self-administered checklist to clarify care partner roles, establish a shared visit agenda, and facilitate MyChart patient portal access. Control dyads (n = 63) received usual care. We assessed intervention acceptability and initial effects from post-visit surveys and MyChart utilization at 6 weeks. RESULTS At baseline, most patients (89.4%) but few care partners (1.5%) were registered for MyChart. Most patients (79.4%) wanted their care partner to have access to their records and 39.4% of care partners reported accessing MyChart. In completing the checklist, patients and care partners endorsed active communication roles for the care partner and identified a similar visit agenda: most (> 90%) reported the checklist was easy, useful, and recommended it to others. At 6 weeks, intervention (vs control) care partners were more likely to be registered for MyChart (75.4% vs 1.6%; p < 0.001), to have logged in (43.5% vs 0%; p < 0.001) and viewed clinical notes (30.4% vs 0%; p < 0.001), but were no more likely to exchange direct messages with clinicians (1.5% vs 0%; p = 0.175). No differences in patients' MyChart use were observed, but intervention patients more often viewed clinical notes (50.7% vs 9.5%; p < 0.001). CONCLUSIONS A patient-family agenda setting intervention was acceptable and affected online practices of cancer patients and care partners.
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Affiliation(s)
- Jennifer L Wolff
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA.
| | - Jennifer Aufill
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - Diane Echavarria
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - JaAlah-Ai Heughan
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - Kimberley T Lee
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Roisin M Connolly
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - John H Fetting
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Danijela Jelovac
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Katie Papathakis
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Carol Riley
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Vered Stearns
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Elissa Thorner
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Nelli Zafman
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Howard P Levy
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney M Dy
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA.
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174
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O’Neill S, Chimowitz H, Leveille S, Walker J. Embracing the new age of transparency: mental health patients reading their psychotherapy notes online. J Ment Health 2019; 28:527-535. [DOI: 10.1080/09638237.2019.1644490] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Stephen O’Neill
- BIDMC Social Work Department, Harvard Medical School, Boston, MA, USA
| | - Hannah Chimowitz
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
| | - Suzanne Leveille
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jan Walker
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
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175
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DesRoches CM, Bell SK, Dong Z, Elmore J, Fernandez L, Fitzgerald P, Liao JM, Payne TH, Delbanco T, Walker J. Patients Managing Medications and Reading Their Visit Notes: A Survey of OpenNotes Participants. Ann Intern Med 2019; 171:69-71. [PMID: 31132794 DOI: 10.7326/m18-3197] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Catherine M DesRoches
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (C.M.D., S.K.B., L.F., T.D., J.W.)
| | - Sigall K Bell
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (C.M.D., S.K.B., L.F., T.D., J.W.)
| | - Zhiyong Dong
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.D.)
| | - Joann Elmore
- David Geffen School of Medicine at UCLA, Los Angeles, California (J.E.)
| | - Leonor Fernandez
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (C.M.D., S.K.B., L.F., T.D., J.W.)
| | | | - Joshua M Liao
- University of Washington School of Medicine, Seattle, Washington (J.M.L., T.H.P.)
| | - Thomas H Payne
- University of Washington School of Medicine, Seattle, Washington (J.M.L., T.H.P.)
| | - Tom Delbanco
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (C.M.D., S.K.B., L.F., T.D., J.W.)
| | - Jan Walker
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (C.M.D., S.K.B., L.F., T.D., J.W.)
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176
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Blumenthal D, Abrams MK. Ready or Not, We Live in an Age of Health Information Transparency. Ann Intern Med 2019; 171:64-65. [PMID: 31132792 DOI: 10.7326/m19-1366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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177
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Herlihy M, Harcourt K, Fossa A, Folcarelli P, Golen T, Bell SK. An Opportunity to Engage Obstetrics and Gynecology Patients Through Shared Visit Notes. Obstet Gynecol 2019; 134:128-137. [PMID: 31188333 DOI: 10.1097/aog.0000000000003309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess obstetrics and gynecology patients' interest in reading their ambulatory visit notes, identification of documentation errors, and perceptions of sensitive language through a quality improvement (QI) initiative. METHODS Beginning April 2016, as part of a QI project all obstetrics and gynecology patients (except family planning) were invited to read their ambulatory visit notes and provide feedback using a patient reporting tool codeveloped with patients. Two physicians with safety expertise reviewed all patient-reported errors over the first 16 months. RESULTS Among obstetrics and gynecology patients with an active portal account and an available note, 6,594 of 9,550 (69%) read at least one note. Two hundred twelve (3.2%) patients used the electronic reporting tool, submitting a total of 232 reports, in a "natural" environment with no advertisement, incentives, or clinician encouragement. In total, 94% felt they understood the notes, 95% understood the next steps in the care plan, and 92% felt the notes accurately described their visit. Of all reports, 27% of patients identified inaccuracies in the notes, including descriptions of symptoms (29%); family history (21%); medications (15%); health problems (15%); social history and physical examination, including elements that were reportedly documented but not performed (each 11%). Patients rated inaccuracies as important in 58% of reports, and, on clinician review, 75% of patient-reported mistakes had the potential to affect care. Among all reports, 7% of patients indicated bothersome words. More than half (56%) of patients included voluntary positive feedback such as appreciation for the health care provider, reassurance from notes, greater visit recall and care plan adherence, and positive effects on the patient-doctor relationship. DISCUSSION Obstetrics and gynecology patients are interested in reading notes, which can promote engagement and safety. Few patients provided feedback, but those who did identified documentation inaccuracies in about one quarter of reports; the majority were relevant to care. Greater outreach and patient encouragement are needed to further engage patients in safety.
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Affiliation(s)
- Mary Herlihy
- Departments of Obstetrics and Gynecology, Medicine, and Health Care Quality, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Niburski K. Imprinting Care and the Loss of Patient Narrative: Creation and Standardization of Medical Records. Perm J 2019; 23:18-144. [PMID: 31314723 PMCID: PMC6636539 DOI: 10.7812/tpp/18-144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical records manufacture a representational model of a person. Yet, little has been done to analyze the historical construction of patient charts, the deliberations in the process of their creation, and how early patient charts displaced patients' narratives. OBJECTIVES To retrospectively study the structure and production of old patient charts. METHODS Anchored by the Archives of Ontario's medical records from three 19th century psychiatric asylums-Hamilton, London, and Kingston, Canada-the paper tools are reproduced on the basis of their original manufacturing processes using cast-iron presses and relevant typesetting. This includes mirroring the process of assembly, recontextualizing the form's limitations as a function of its construction, making historical the diagnostic considerations relevant at the time, and noting the continuum of practical and operational choices that have stretched into current records. RESULTS An explication of the advance of physicians' objective records and the decline of the subjective patient view is given from index-card inception through design, accreditation, standardization, forms, and quantity, to analysis replacing narration. CONCLUSION Through this artistic work, medical paradigms become realized through paper borders. With ink, lead, and historical manufacturing, a world view is re-created. Such a marriage of medicine and art challenges the static interpretations of paper tools as only ends to the objectification of patients; instead, a tradition of reconfiguring the medical body as a thing dissolving into objectification becomes apparent. This trend continues now through the lack of narrative balancing a person's health care experience and his/her medical record.
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Affiliation(s)
- Kacper Niburski
- McGill University, Montreal, Ontario, Canada
- McGill Faculty of Medicine, Montreal, Ontario, Canada
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179
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Dobscha SK, Kenyon EA, Pisciotta MK, Niederhausen M, Woods S, Denneson LM. Impacts of a Web-Based Course on Mental Health Clinicians' Attitudes and Communication Behaviors Related to Use of OpenNotes. Psychiatr Serv 2019; 70:474-479. [PMID: 30890047 DOI: 10.1176/appi.ps.201800416] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The OpenNotes initiative encourages health care systems to provide patients online access to clinical notes. Some individuals have expressed concerns about use of OpenNotes in mental health care. This study evaluated changes in mental health clinicians' attitudes and communications with patients after participation in a Web-based course designed to reduce potential for unintended consequences and enhance likelihood of positive outcomes of OpenNotes. METHODS All 251 mental health clinicians (physicians, nurse practitioners, psychologists, and social workers) of a large U.S. Department of Veterans Affairs facility were invited to participate. Clinicians completed surveys at baseline and 3 months after course participation. Ten items were examined that addressed clinicians' concerns and communication behaviors with patients. Mixed-effects models with repeated measures were used to compare pre-post data. RESULTS Of the 251 clinicians, 141 (56%) completed baseline surveys, and 113 (80%) completed baseline and postcourse surveys. Of the 141 clinicians, 63% were female, 46% were social workers, 34% were psychologists, 16% were psychiatrists, and 4% were nurse practitioners. In final adjusted models, pre-post item scores indicated significant increases in clinicians' ability to communicate with and educate patients (p<.01) and in the frequency with which clinicians educated patients about OpenNotes access (p<.001), advised patients to access and read notes (p<.01), and asked patients about questions or concerns they have with notes (p=.04). There was also a significant reduction in clinicians' worry about negative consequences (p=.05). CONCLUSIONS A Web-based course for mental health clinicians on use of OpenNotes resulted in self-reported improvements in some concerns and in aspects of patient-clinician communication.
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Affiliation(s)
- Steven K Dobscha
- Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon (Dobscha, Kenyon, Pisciotta, Niederhausen, Denneson); Department of Psychiatry, Oregon Health and Science University, Portland (Dobscha, Denneson); School of Public Health, Oregon Health and Science University-Portland State University, Portland (Niederhausen); Northern Light Mercy Hospital, Portland, Maine (Woods)
| | - Emily A Kenyon
- Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon (Dobscha, Kenyon, Pisciotta, Niederhausen, Denneson); Department of Psychiatry, Oregon Health and Science University, Portland (Dobscha, Denneson); School of Public Health, Oregon Health and Science University-Portland State University, Portland (Niederhausen); Northern Light Mercy Hospital, Portland, Maine (Woods)
| | - Maura K Pisciotta
- Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon (Dobscha, Kenyon, Pisciotta, Niederhausen, Denneson); Department of Psychiatry, Oregon Health and Science University, Portland (Dobscha, Denneson); School of Public Health, Oregon Health and Science University-Portland State University, Portland (Niederhausen); Northern Light Mercy Hospital, Portland, Maine (Woods)
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon (Dobscha, Kenyon, Pisciotta, Niederhausen, Denneson); Department of Psychiatry, Oregon Health and Science University, Portland (Dobscha, Denneson); School of Public Health, Oregon Health and Science University-Portland State University, Portland (Niederhausen); Northern Light Mercy Hospital, Portland, Maine (Woods)
| | - Susan Woods
- Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon (Dobscha, Kenyon, Pisciotta, Niederhausen, Denneson); Department of Psychiatry, Oregon Health and Science University, Portland (Dobscha, Denneson); School of Public Health, Oregon Health and Science University-Portland State University, Portland (Niederhausen); Northern Light Mercy Hospital, Portland, Maine (Woods)
| | - Lauren M Denneson
- Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon (Dobscha, Kenyon, Pisciotta, Niederhausen, Denneson); Department of Psychiatry, Oregon Health and Science University, Portland (Dobscha, Denneson); School of Public Health, Oregon Health and Science University-Portland State University, Portland (Niederhausen); Northern Light Mercy Hospital, Portland, Maine (Woods)
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180
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van Dalen ASHM, Legemaate J, Schlack WS, Legemate DA, Schijven MP. Legal perspectives on black box recording devices in the operating environment. Br J Surg 2019; 106:1433-1441. [PMID: 31112294 PMCID: PMC6790687 DOI: 10.1002/bjs.11198] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
Background A video and medical data recorder in the operating theatre is possible, but concerns over privacy, data use and litigation have limited widespread implementation. The literature on legal considerations and challenges to overcome, and guidelines related to use of data recording in the surgical environment, are presented in this narrative review. Methods A review of PubMed and Embase databases and Cochrane Library was undertaken. International jurisprudence on the topic was searched. Practice recommendations and legal perspectives were acquired based on experience with implementation and use of a video and medical data recorder in the operating theatre. Results After removing duplicates, 116 citations were retrieved and abstracts screened; 31 articles were assessed for eligibility and 20 papers were finally included. According to the European General Data Protection Regulation and US Health Insurance Portability and Accountability Act, researchers are required to make sure that personal data collected from patients and healthcare professionals are used fairly and lawfully, for limited and specifically stated purposes, in an adequate and relevant manner, kept safe and secure, and stored for no longer than is absolutely necessary. Data collected for the sole purpose of healthcare quality improvement are not required to be added to the patient's medical record. Conclusion Transparency on the use and purpose of recorded data should be ensured to both staff and patients. The recorded video data do not need to be used as evidence in court if patient medical records are well maintained. Clear legislation on data responsibility is needed to use the medical recorder optimally for quality improvement initiatives.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Legemaate
- Department of Public Health and Health Law, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W S Schlack
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D A Legemate
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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181
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Choe EK, Duarte ME, Suh H, Pratt W, Kientz JA. Communicating Bad News: Insights for the Design of Consumer Health Technologies. JMIR Hum Factors 2019; 6:e8885. [PMID: 31102374 PMCID: PMC6543800 DOI: 10.2196/humanfactors.8885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/05/2018] [Accepted: 02/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background As people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient’s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news. Objective The aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health. Methods On the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients’ family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design. Results We describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians’ specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients’ visit, anticipating patients’ feelings, building a partnership of trust with patients, acknowledging patients’ physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients’ level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek. Conclusions The results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients’ individual preferences, supporting interfaces for sharing patients’ context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next.
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Affiliation(s)
- Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, United States
| | - Marisa E Duarte
- School of Social Transformation, Arizona State University, Tempe, AZ, United States
| | - Hyewon Suh
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
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182
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Slotwiner DJ, Tarakji KG, Al-Khatib SM, Passman RS, Saxon LA, Peters NS, McCall D, Turakhia MP, Schaeffer J, Mendenhall GS, Hindricks G, Narayan SM, Davenport EE, Marrouche NF. Transparent sharing of digital health data: A call to action. Heart Rhythm 2019; 16:e95-e106. [PMID: 31077802 DOI: 10.1016/j.hrthm.2019.04.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- David J Slotwiner
- NewYork-Presbyterian Queens, Cardiology Division, Weill Cornell Medical College, New York, New York.
| | | | | | - Rod S Passman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leslie A Saxon
- Center for Body Computing, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Debbe McCall
- Functioning as the lay volunteer/patient representative
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183
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Walker J, Leveille S, Bell S, Chimowitz H, Dong Z, Elmore JG, Fernandez L, Fossa A, Gerard M, Fitzgerald P, Harcourt K, Jackson S, Payne TH, Perez J, Shucard H, Stametz R, DesRoches C, Delbanco T. OpenNotes After 7 Years: Patient Experiences With Ongoing Access to Their Clinicians' Outpatient Visit Notes. J Med Internet Res 2019; 21:e13876. [PMID: 31066717 PMCID: PMC6526690 DOI: 10.2196/13876] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/03/2023] Open
Abstract
Background Following a 2010-2011 pilot intervention in which a limited sample of primary care doctors offered their patients secure Web-based portal access to their office visit notes, the participating sites expanded OpenNotes to nearly all clinicians in primary care, medical, and surgical specialty practices. Objective The aim of this study was to examine the ongoing experiences and perceptions of patients who read ambulatory visit notes written by a broad range of doctors, nurses, and other clinicians. Methods A total of 3 large US health systems in Boston, Seattle, and rural Pennsylvania conducted a Web-based survey of adult patients who used portal accounts and had at least 1 visit note available in a recent 12-month period. The main outcome measures included patient-reported behaviors and their perceptions concerning benefits versus risks. Results Among 136,815 patients who received invitations, 21.68% (29,656/136,815) responded. Of the 28,782 patient respondents, 62.82% (18,081/28,782) were female, 72.90% (20,982/28,782) were aged 45 years or older, 76.94% (22,146/28,782) were white, and 14.30% (4115/28,782) reported fair or poor health. Among the 22,947 who reported reading 1 or more notes, 3 out of 4 reported reading them for 1 year or longer, half reported reading at least 4 notes, and 37.74% (8588/22,753) shared a note with someone else. Patients rated note reading as very important for helping take care of their health (16,354/22,520, 72.62%), feeling in control of their care (15,726/22,515, 69.85%), and remembering the plan of care (14,821/22,516, 65.82%). Few were very confused (737/22,304, 3.3%) or more worried (1078/22,303, 4.83%) after reading notes. About a third reported being encouraged by their clinicians to read notes and a third told their clinicians they had read them. Less educated, nonwhite, older, and Hispanic patients, and individuals who usually did not speak English at home, were those most likely to report major benefits from note reading. Nearly all respondents (22,593/22,947, 98.46%) thought Web-based access to visit notes a good idea, and 62.38% (13,427/21,525) rated this practice as very important for choosing a future provider. Conclusions In this first large-scale survey of patient experiences with a broad range of clinicians working in practices in which shared notes are well established, patients find note reading very important for their health management and share their notes frequently with others. Patients are rarely troubled by what they read, and those traditionally underserved in the United States report particular benefit. However, fewer than half of clinicians and patients actively address their shared notes during visits. As the practice continues to spread rapidly in the United States and internationally, our findings indicate that OpenNotes brings benefits to patients that largely outweigh the risks.
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Affiliation(s)
- Jan Walker
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Suzanne Leveille
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, United States
| | - Sigall Bell
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Hannah Chimowitz
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Zhiyong Dong
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joann G Elmore
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Leonor Fernandez
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Alan Fossa
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Macda Gerard
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Patricia Fitzgerald
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Kendall Harcourt
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Sara Jackson
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - Thomas H Payne
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, United States.,Department of Medicine, Medicine Information Technology Services, University of Washington, Seattle, WA, United States
| | - Jocelyn Perez
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hannah Shucard
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - Rebecca Stametz
- Steele Institute for Health Innovation, Geisinger, Danville, PA, United States
| | - Catherine DesRoches
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Tom Delbanco
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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184
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Davoody N, Koch S, Krakau I, Hägglund M. Accessing and sharing health information for post-discharge stroke care through a national health information exchange platform - a case study. BMC Med Inform Decis Mak 2019; 19:95. [PMID: 31053141 PMCID: PMC6500022 DOI: 10.1186/s12911-019-0816-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 04/16/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients and citizens need access to their health information to get a retrospective as well as a prospective view on their care and rehabilitation processes. However, patients' health information is stored in several health information systems and interoperability problems often hamper accessibility. In Sweden a national health information exchange (HIE) platform has been developed that enables information exchange between different health information systems. The aim of this study is to explore the opportunities and limitations of accessing and interacting with important health information through the Swedish national HIE platform. METHODS A single case study approach was used for this study as an in-depth understanding of the subject was needed. A fictive patient case with a pseudo-name was created based on an interview with a stroke coordinator in Stockholm County. Information access through the national health information exchange platform and available service contracts and application programming interfaces were studied using different scenarios. RESULTS Based on the scenarios created in this study, patients would be able to access some health related information from their electronic health records using the national health information exchange platform. However, there is necessary information which is not retrievable as it is either stored in electronic health records and eHealth services which are not connected to the national health information exchange platform or there is no service contract developed for these types of information. In addition, patients are not able to share information with healthcare professionals. CONCLUSION The national Swedish HIE platform provides the building blocks needed to allow patients online access to their health information in a fragmented and distributed health system. However, more complex interaction scenarios allowing patients to communicate with their health care providers or to update their health related information are not yet supported. Therefore it is of great importance to involve patients throughout the design and evaluation of eHealth services on both national and local levels to ensure that their needs for interoperability and information exchange are met.
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Affiliation(s)
- Nadia Davoody
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Sabine Koch
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Ingvar Krakau
- Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Stockholm, Sweden
| | - Maria Hägglund
- Department of Womens and Childrens Health, Uppsala Universitet, Akademiska sjukhuset, 751 85 Uppsala, Sweden
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185
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Abstract
This article outlines a research project conducted to learn more about NPs' attitudes regarding sharing clinical notes with patients through a patient portal. Perceptions were positive overall. To achieve effective health outcomes, patient and family engagement is essential. Shared clinical notes provide an opportunity to achieve these goals.
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Affiliation(s)
- Deborah S Adelman
- Deborah S. Adelman is a professor at Purdue University Global's School of Nursing, Chicago, Ill. Catherine Fant is an adjunct professor at Walden University's School of Nursing, Minneapolis, Minn. Debbie Nogueras Conner is a professor at Franklin University's College of Health and Public Administration, Columbus, Ohio
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186
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Shen N, Bernier T, Sequeira L, Strauss J, Silver MP, Carter-Langford A, Wiljer D. Understanding the patient privacy perspective on health information exchange: A systematic review. Int J Med Inform 2019; 125:1-12. [DOI: 10.1016/j.ijmedinf.2019.01.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/01/2018] [Accepted: 01/31/2019] [Indexed: 12/16/2022]
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187
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Topaz M, Bar-Bachar O, Admi H, Denekamp Y, Zimlichman E. Patient-centered care via health information technology: a qualitative study with experts from Israel and the U.S. Inform Health Soc Care 2019; 45:217-228. [PMID: 30917717 DOI: 10.1080/17538157.2019.1582055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although patient-centered care (PCC) is one of the cornerstones of modern healthcare, the role that health information technology (HIT) plays in supporting PCC remains unclear. In this qualitative study, we interviewed academic and clinical experts from the US and Israel to understand to what extent current HIT systems are supportive of PCC and how PCC should be supported by HIT in the future. A maximum variation sampling approach was used to identify nine experts in both HIT and PCC from clinical and academic settings in Israel and the US. A qualitative descriptive method was used to analyze the interviews and identify major themes. Experts suggested that patient ownership of their disease is a core component of PCC. The majority of the experts agreed that in both Israel and the US, the current situation of PCC implementation is relatively poor. However, HIT should play an important role in making patients owners of their health and treatment and helping providers in delivering better PCC. Central domains of PCC via HIT were providing clear information and support for patients and promoting care that is based on patient values and preferences.
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Affiliation(s)
- Maxim Topaz
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa , Haifa, Israel.,General Medicine, Harvard Medical School & Brigham and Women's Hospital , Boston, MA, USA
| | - Ofrit Bar-Bachar
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa , Haifa, Israel
| | - Hanna Admi
- General Medicine, Rambam Health Care Campus , Haifa, Israel
| | - Yaron Denekamp
- Health Information Technology, Clalit Health Services , Tel Aviv, Israel
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188
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Wolff JL, Kim VS, Mintz S, Stametz R, Griffin JM. An environmental scan of shared access to patient portals. J Am Med Inform Assoc 2019; 25:408-412. [PMID: 29025034 DOI: 10.1093/jamia/ocx088] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
We sought to understand the comprehensiveness of consumer-oriented information describing the availability of shared access to adult patient portals from publicly reported information on institutional websites of 20 large and geographically diverse health systems. All 20 health systems reported that they offer patients the ability to share access to their patient portal account with a family member or friend; however, the comprehensiveness of information regarding registration procedures, features, and terminology varied widely. Half of the systems (n = 10) reported having shared access available on their patient portal registration webpage. Few systems (n = 2) reported affording patients the ability to differentiate specific role-based privileges. No systems reported uptake of shared access among adult patients, which was variably described as "proxy," "caregiver," "parental," or "delegate" access. Findings suggest that engaging families through health information technology will require greater efforts to promote awareness and differentiate privileges that respect patients' choice and control in information-sharing preferences.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria S Kim
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
| | | | - Rebecca Stametz
- Clinical Innovation, Advanced Application Development Team, Geisinger Health System, Danville, PA, USA
| | - Joan M Griffin
- Health Sciences Research, Division of Health Care Policy and Research, and Robert D and Patricia E Kern Scientific Director in the Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
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189
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Qureshi N, Mehrotra A, Rudin RS, Fischer SH. Common Laboratory Results Frequently Misunderstood by a Sample of Mechanical Turk Users. Appl Clin Inform 2019; 10:175-179. [PMID: 30866000 DOI: 10.1055/s-0039-1679960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES More patients are receiving their test results via patient portals. Given test results are written using medical jargon, there has been concern that patients may misinterpret these results. Using sample colonoscopy and Pap smear results, our objective was to assess how frequently people can identify the correct diagnosis and when a patient should follow up with a provider. METHODS We used Mechanical Turk-a crowdsourcing tool run by Amazon that enables easy and fast gathering of users to perform tasks like answering questions or identifying objects-to survey individuals who were shown six sample test results (three colonoscopy, three Pap smear) ranging in complexity. For each case, respondents answered multiple choice questions on the correct diagnosis and recommended return time. RESULTS Among the three colonoscopy cases (n = 642) and three Pap smear cases (n = 642), 63% (95% confidence interval [CI]: 60-67%) and 53% (95% CI: 49-57%) of the respondents chose the correct diagnosis, respectively. For the most complex colonoscopy and Pap smear cases, only 29% (95% CI: 23-35%) and 9% (95% CI: 5-13%) chose the correct diagnosis. CONCLUSION People frequently misinterpret colonoscopy and Pap smear test results. Greater emphasis needs to be placed on assisting patients in interpretation.
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Affiliation(s)
- Nabeel Qureshi
- RAND Corporation, Santa Monica, California, United States
| | - Ateev Mehrotra
- RAND Corporation, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
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190
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Tai-Seale M, Downing NL, Jones VG, Milani RV, Zhao B, Clay B, Sharp CD, Chan AS, Longhurst CA. Technology-Enabled Consumer Engagement: Promising Practices At Four Health Care Delivery Organizations. Health Aff (Millwood) 2019; 38:383-390. [DOI: 10.1377/hlthaff.2018.05027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ming Tai-Seale
- Ming Tai-Seale is a professor in the Department of Family Medicine and Public Health at the University of California San Diego (UCSD) School of Medicine, director of outcomes analysis and scholarship at UC San Diego Health, and director of research at UCSD Health Sciences International, in La Jolla
| | - N. Lance Downing
- N. Lance Downing is a clinical assistant professor of medicine at the Stanford School of Medicine and program director for the Stanford Program in AI-Assisted Care, both in Palo Alto, California
| | - Veena Goel Jones
- Veena Goel Jones is medical director of digital patient experience and a pediatric hospitalist at Sutter Health and an adjunct clinical assistant professor of pediatrics at the Stanford School of Medicine
| | - Richard V. Milani
- Richard V. Milani is chief clinical transformation officer at Ochsner Health System in New Orleans, Louisiana
| | - Beiqun Zhao
- Beiqun Zhao is a National Library of Medicine/National Institutes of Health biomedical informatics fellow and a general surgery resident at UC San Diego Health
| | - Brian Clay
- Brian Clay is a chief medical information officer at UC San Diego Health and a clinical professor of medicine at the UCSD School of Medicine
| | - Christopher Demuth Sharp
- Christopher Demuth Sharp is chief medical information officer at Stanford Health Care and a clinical associate professor at the Stanford School of Medicine
| | - Albert Solomon Chan
- Albert Solomon Chan is chief of digital patient experience and an investigator at Sutter Health and an adjunct professor at the Stanford Center for Biomedical Informatics Research, Stanford School of Medicine
| | - Christopher A. Longhurst
- Christopher A. Longhurst is chief information officer and associate chief medical officer at UC San Diego Health, and a clinical professor of medicine and pediatrics at the UCSD School of Medicine
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191
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Alpert JM, Morris BB, Thomson MD, Matin K, Geyer CE, Brown RF. OpenNotes in oncology: oncologists' perceptions and a baseline of the content and style of their clinician notes. Transl Behav Med 2019; 9:347-356. [PMID: 29596633 PMCID: PMC6417152 DOI: 10.1093/tbm/iby029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Patients' ability to access their provider's clinical notes (OpenNotes) has been well received and has led to greater transparency in health systems. However, the majority of this research has occurred in primary care, and little is known about how patients' access to notes is used in oncology. This study aims to understand oncologists' perceptions of OpenNotes, while also establishing a baseline of the linguistic characteristics and patterns used in notes. Data from 13 in-depth, semistructured interviews with oncologists were thematically analyzed. In addition, the Linguistic Inquiry and Word Count (LIWC) program evaluated over 200 clinician notes, measuring variables encompassing emotions, thinking styles, social concerns, and parts of speech. Analysis from LIWC revealed that notes contained negative emotional tone, low authenticity, high clout, and high analytical writing. Oncologists' use of stigmatized and sensitive words, such as "obese" and "distress," was mainly absent. Themes from interviews revealed that oncologists were uncertain about patients' access to their notes and may edit their notes to avoid problematic terminology. Despite their reluctance to embrace OpenNotes, they envisioned opportunities for an improved patient-provider relationship due to patients initiating interactions from viewing notes. Oncologists believe notes are not intended for patients and altering their content may compromise the integrity of the note. This study established a baseline for further study to compare notes pre-implementation to post-implementation. Further analysis will clarify whether oncologists are altering the style and content of their notes and determine the presence of patient-centered language.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, USA
| | - Bonny B Morris
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Khalid Matin
- Department of Internal Medicine, Division of Hematology and Oncology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Charles E Geyer
- Department of Internal Medicine, Division of Hematology and Oncology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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192
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OD, OS, and OU: Talking in Code? J Patient Saf 2019; 15:e1-e2. [DOI: 10.1097/pts.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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193
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Wolf A, Vella R, Fors A. The impact of person-centred care on patients’ care experiences in relation to educational level after acute coronary syndrome: secondary outcome analysis of a randomised controlled trial. Eur J Cardiovasc Nurs 2019; 18:299-308. [DOI: 10.1177/1474515118821242] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Research supporting the benefits of person-centred care is growing, still knowledge about patients’ experiences of person-centred care is limited. Aim: To evaluate the effects of person-centred care on patients’ experiences of care, and also in relation to educational level, after an acute coronary syndrome. Method: A total of 199 patients aged less than 75 years, hospitalised for acute coronary syndrome, were randomly assigned to either standard cardiac care ( n=105) or person-centred care plus standard cardiac care ( n=94). Experience of care was assessed at three healthcare settings (hospital, outpatient and primary care) using the 15-item Picker patient experience questionnaire plus two questions concerning information and documentation. Results: No significant difference was found at the three healthcare settings between the two study groups in the Picker patient experience questionnaire total score. Item level analysis showed that the person-centred care group significantly improved at all three healthcare settings on information received and in documentation of care compared with the standard cardiac care group ( P<0.05). In outpatient care, the person-centred care group reported significantly better family–physician communication ( P=0.004) and information for the family ( P=0.007) compared with the standard cardiac care group. In patients without postsecondary education, the corresponding figures were even more in favour of the person-centred care group ( P=0.0005 and P=0.0049, respectively), and they also reported higher involvement in care decisions ( P=0.023). Conclusion: A person-centred care approach after an event of acute coronary syndrome improves patients’ care experiences for information, shared documentation and involvement of family and friends. This effect was especially prominent in patients with a low educational level, who were also more involved in care decisions. Trial registration: Swedish registry, Researchweb.org , ID NR 65 791
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Affiliation(s)
- Axel Wolf
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - Rebecca Vella
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Sweden
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194
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Lalor JP, Woolf B, Yu H. Improving Electronic Health Record Note Comprehension With NoteAid: Randomized Trial of Electronic Health Record Note Comprehension Interventions With Crowdsourced Workers. J Med Internet Res 2019; 21:e10793. [PMID: 30664453 PMCID: PMC6351990 DOI: 10.2196/10793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/28/2018] [Accepted: 10/26/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patient portals are becoming more common, and with them, the ability of patients to access their personal electronic health records (EHRs). EHRs, in particular the free-text EHR notes, often contain medical jargon and terms that are difficult for laypersons to understand. There are many Web-based resources for learning more about particular diseases or conditions, including systems that directly link to lay definitions or educational materials for medical concepts. OBJECTIVE Our goal is to determine whether use of one such tool, NoteAid, leads to higher EHR note comprehension ability. We use a new EHR note comprehension assessment tool instead of patient self-reported scores. METHODS In this work, we compare a passive, self-service educational resource (MedlinePlus) with an active resource (NoteAid) where definitions are provided to the user for medical concepts that the system identifies. We use Amazon Mechanical Turk (AMT) to recruit individuals to complete ComprehENotes, a new test of EHR note comprehension. RESULTS Mean scores for individuals with access to NoteAid are significantly higher than the mean baseline scores, both for raw scores (P=.008) and estimated ability (P=.02). CONCLUSIONS In our experiments, we show that the active intervention leads to significantly higher scores on the comprehension test as compared with a baseline group with no resources provided. In contrast, there is no significant difference between the group that was provided with the passive intervention and the baseline group. Finally, we analyze the demographics of the individuals who participated in our AMT task and show differences between groups that align with the current understanding of health literacy between populations. This is the first work to show improvements in comprehension using tools such as NoteAid as measured by an EHR note comprehension assessment tool as opposed to patient self-reported scores.
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Affiliation(s)
- John P Lalor
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States
| | - Beverly Woolf
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States
| | - Hong Yu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States.,Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.,Bedford Veterans Affairs Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
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195
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Mishra VK, Hoyt RE, Wolver SE, Yoshihashi A, Banas C. Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes. Appl Clin Inform 2019; 10:10-18. [PMID: 30602196 DOI: 10.1055/s-0038-1676588] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers. OBJECTIVES This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity. MATERIALS AND METHODS Patients at an academic health care system who accessed the patient portal from February 2016 to May 2016 were provided a link to complete a 15-item online survey. Those who had viewed at least one note were asked about patient characteristics, frequency of note access, note usefulness, note understanding, and if any action was taken after accessing the note. Free-text comments were associated with nine questions which were analyzed using qualitative methods. RESULTS A total of 23% (1,487/6,439) of patients who viewed the survey in the portal, participated. Seventy-six percent (1,126/1,487) knew that the notes were available on the portal, and of those, 957 had viewed at least one note to continue the survey. Ninety percent of those were older than 30 years of age, and 90% had some college education. The majority (83%) thought OpenNotes helped them take better care of themselves, without increasing worry (94%) or contacting the physician after reading the note (91%). The qualitative analysis of free-text responses demonstrated multiple positive and negative themes, and they were analyzed for potential improvement opportunities. CONCLUSION Our survey confirms that patients who choose to access their primary care and specialists' online medical records perceive benefits of OpenNotes. Additionally, the qualitative analysis of comments revealed positive benefits and several potential patient portal improvement opportunities which could inform implementation of OpenNotes at other health systems.
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Affiliation(s)
- Vimal K Mishra
- Division of Hospital Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, United States
| | - Robert E Hoyt
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, United States
| | - Susan E Wolver
- Division of General Internal Medicine, Physician Informaticist, Virginia Commonwealth University Health System, Richmond, Virginia, United States
| | | | - Colin Banas
- Division of Hospital Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, United States
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196
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Wells S, Mahony F, Huang Y, Day K. Perspectives of New Zealand patients and GPs at the beginning of patient portal implementation. J Prim Health Care 2019. [DOI: 10.1071/hc19016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONNew Zealand health policy encourages patient access to their electronic medical records via portals.
AIMTo discover patient and general practitioner (GP) perspectives of access to electronic medical records and e-messaging in the early portal implementation phase.
METHODSIn 2014, Auckland primary health organisations and an Accident & Medical organisation were asked to invite their GPs to complete an online survey and consent for a researcher to attend their waiting room and invite patients to complete a survey.
RESULTSIn total, 421 patients (13% Māori, 18% Pacific, 7% Asian, 53% NZ European/Other) participated from 13 general practices. Most (77%) knew they were entitled to see their medical records and 90% were interested in viewing them. Over two-thirds thought that viewing their records online and e-messaging their practice was a good idea. Over 80% disagreed that they would be worried, confused or embarrassed by seeing their records, with 59% expecting portals to facilitate understanding of their medical conditions. Internet security and privacy concerned 40% of patients. Among 83 GPs who completed the survey, six (7%) had already implemented portals. Few were comfortable to open up the whole health record, especially visit notes. While GPs thought that portal access may help patients better understand their plan of care, their main concerns related to causing confusion and worry. Portal implementation was expected to change GP documentation and increase practice workload and costs without demonstrable benefit to practices.
DISCUSSIONAt the beginning of portal adoption, patients were interested. GPs were more reticent, unsure whether the benefits would outweigh the downsides for their patients and practice workload.
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197
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McMillan B, Eastham R, Brown B, Fitton R, Dickinson D. Primary Care Patient Records in the United Kingdom: Past, Present, and Future Research Priorities. J Med Internet Res 2018; 20:e11293. [PMID: 30567695 PMCID: PMC6315263 DOI: 10.2196/11293] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/04/2018] [Indexed: 12/25/2022] Open
Abstract
This paper briefly outlines the history of the medical record and the factors contributing to the adoption of computerized records in primary care in the United Kingdom. It discusses how both paper-based and electronic health records have traditionally been used in the past and goes on to examine how enabling patients to access their own primary care record online is changing the form and function of the patient record. In addition, it looks at the evidence for the benefits of Web-based access and discusses some of the challenges faced in this transition. Finally, some suggestions are made regarding the future of the patient record and research questions that need to be addressed to help deepen our understanding of how they can be used more beneficially by both patients and clinicians.
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Affiliation(s)
- Brian McMillan
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Robert Eastham
- Whitehall Surgery, Wortley Beck Health Centre, Lower Wortley, Leeds, United Kingdom
| | - Benjamin Brown
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Centre for Health Informatics, Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Richard Fitton
- West Pennine Local Medical Committee, Barley Clough Medical Centre, Nugget Street, Oldham, United Kingdom
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198
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Affiliation(s)
| | - Liz Salmi
- OpenNotes, Sacramento, California (L.S.)
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199
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Nickel WK, Weinberger SE, Guze PA, Carney J, Ende J, Hoy E, Myerson S, Rothholz M, Sands D, Schneider D, Sweeney JM, Sweet DE. Principles for Patient and Family Partnership in Care: An American College of Physicians Position Paper. Ann Intern Med 2018; 169:796-799. [PMID: 30476985 DOI: 10.7326/m18-0018] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this position paper, the American College of Physicians (ACP) examines the rationale for patient and family partnership in care and reviews outcomes associated with this concept, including greater adherence to care plans, improved satisfaction, and lower costs. The paper also explores and acknowledges challenges associated with implementing patient- and family-centered models of care. On the basis of a comprehensive literature review and a multistakeholder vetting process, the ACP's Patient Partnership in Healthcare Committee developed a set of principles that form the foundation for authentic patient and family partnership in care. The principles position patients in their rightful place at the center of care while acknowledging the importance of partnership between the care team and patient in improving health care and reducing harm. The principles state that patients and families should be treated with dignity and respect, be active partners in all aspects of their care, contribute to the development and improvement of health care systems, and be partners in the education of health care professionals. This paper also recommends ways to implement these principles in daily practice.
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Affiliation(s)
- Wendy K Nickel
- American College of Physicians, Philadelphia, Pennsylvania (W.K.N.)
| | - Steven E Weinberger
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (S.E.W.)
| | - Phyllis A Guze
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (P.G.)
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Anthony DL, Campos-Castillo C, Lim PS. Who Isn’t Using Patient Portals And Why? Evidence And Implications From A National Sample Of US Adults. Health Aff (Millwood) 2018; 37:1948-1954. [DOI: 10.1377/hlthaff.2018.05117] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Denise L. Anthony
- Denise L. Anthony is a professor of health management and policy and of sociology in the Department of Health Management and Policy, University of Michigan School of Public Health, in Ann Arbor
| | - Celeste Campos-Castillo
- Celeste Campos-Castillo is an assistant professor in the Department of Sociology, University of Wisconsin–Milwaukee
| | - Paulina S. Lim
- Paulina S. Lim is a graduate student in the Department of Psychology, University of Wisconsin–Milwaukee
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