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Jiang Y, Hwang M, Cho Y, Friese CR, Hawley ST, Manojlovich M, Krauss JC, Gong Y. The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study. J Med Internet Res 2024; 26:e47685. [PMID: 38457204 PMCID: PMC10960221 DOI: 10.2196/47685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients' various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients' just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients' transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. OBJECTIVE We aim to assess oncology patients' perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. METHODS A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants' perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants' technology acceptance through bivariate correlation analyses and multiple logistic regressions. RESULTS Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). CONCLUSIONS In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care.
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Affiliation(s)
- Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Misun Hwang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Youmin Cho
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Christopher R Friese
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Sarah T Hawley
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
| | | | - John C Krauss
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Yang Gong
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
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O'Sullivan-Steben K, Galarneau L, Judd S, Laizner AM, Williams T, Kildea J. Design and implementation of a prototype radiotherapy menu in a patient portal. J Appl Clin Med Phys 2024; 25:e14201. [PMID: 37942985 DOI: 10.1002/acm2.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Radiotherapy patients often face undue anxiety due to misconceptions about radiation and their inability to visualize their upcoming treatments. Access to their personal treatment plans is one way in which pre-treatment anxiety may be reduced. But radiotherapy data are quite complex, requiring specialized software for display and necessitating personalized explanations for patients to understand them. Therefore, our goal was to design and implement a novel radiotherapy menu in a patient portal to improve patient access to and understanding of their radiotherapy treatment plans. METHODS A prototype radiotherapy menu was developed in our institution's patient portal following a participatory stakeholder co-design methodology. Customizable page templates were designed to render key radiotherapy data in the portal's patient-facing mobile phone app. DICOM-RT data were used to provide patients with relevant treatment parameters and generate pre-treatment 3D visualizations of planned treatment beams, while the mCODE data standard was used to provide post-treatment summaries of the delivered treatments. A focus group was conducted to gather initial patient feedback on the menu. RESULTS Pre-treatment: the radiotherapy menu provides patients with a personalized treatment plan overview, including a personalized explanation of their treatment, along with an interactive 3D rendering of their body, and treatment beams for visualization. Post-treatment: a summary of the delivered radiotherapy is provided, allowing patients to retain a concise personal record of their treatment that can easily be shared with future healthcare providers. Focus group feedback was overwhelmingly positive. Patients highlighted how the intuitive presentation of their complex radiotherapy data would better prepare them for their radiation treatments. CONCLUSIONS We successfully designed and implemented a prototype radiotherapy menu in our institution's patient portal that improves patient access to and understanding of their radiotherapy data. We used the mCODE data standard to generate post-treatment summaries in a way that is easily shareable and interoperable.
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Affiliation(s)
| | - Luc Galarneau
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Susie Judd
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea M Laizner
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Tristan Williams
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
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Abstract
This article, focused on outlining the digital domain as a "super" social determinant of health, considers the core issues of digital equity (ie, digital access, digital devices, and digital skills) to structure the implications that the digital domain has on human health and well-being. In addition to considering an ever-evolving landscape of digital health, telehealth, and other digital health technologies, we pay particular attention to the influence the digital domain has on patient-provider relationships, as well as the challenges, opportunities, and key considerations that advancements in digital health and technologies have for extending and enhancing direct patient care.
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Affiliation(s)
- Rachel Hanebutt
- Department of Human and Organizational Development, Vanderbilt University Peabody College, Nashville, TN, USA.
| | - Hasina Mohyuddin
- Department of Human and Organizational Development, Vanderbilt University Peabody College, Nashville, TN, USA
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Raj P, Cho Y, Jiang Y, Gong Y. Selecting patient-reported outcome measures for a patient-facing technology. JAMIA Open 2023; 6:ooad104. [PMID: 38098479 PMCID: PMC10719077 DOI: 10.1093/jamiaopen/ooad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/11/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Objective This article provides insight into our process and considerations for selecting patient-reported outcome measures (PROMs) designed for self-reporting symptoms and quality-of-life among breast cancer (BCA) patients undergoing oral anticancer agent treatment via a patient-facing technology (PFT) platform. Methods Following established guidelines, we conducted a thorough assessment of a specific set of PROMs, comparing their content to identify the most suitable options for studying BCA patients. Results We recommend utilizing the combination of EORTC QLQ-C30 + EORTC QLQ-BR45 as the preferred instrument, especially when developing a dedicated "breast cancer-only" application. Discussion When developing and maintaining a dashboard for a PFT platform that includes multiple cancer types, it is important to consider the feasibility of interface design and workload. To achieve this, we recommend using PRO-CTCAE+PROMIS 10 GH for the PFT. Moreover, it is important to consider adding ad hoc items to complement the chosen PROM(s). Conclusion This article describes our efforts to identify PROMs for self-reported data while considering patient and developer burdens, providing guidance to PFT developers facing similar challenges in PROM selection.
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Affiliation(s)
- Priyank Raj
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Youmin Cho
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States
| | - Yang Gong
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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McFarland JA, Huang J, Li Y, Gunn AJ, Morgan DE. Patient Engagement with Online Portals and Online Radiology Results. Curr Probl Diagn Radiol 2023; 52:106-109. [PMID: 36030140 DOI: 10.1067/j.cpradiol.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to examine patient portal enrollment and the usage with a specific focus on the utilization of on-line radiology reports by patients. Oracle SQL (Austin, TX, USA) queries were used to extract portal enrollment data over a 13-month period from March 1, 2017 through March 31, 2018 from the hospital system's EMR. Patient enrollment was collected as was patient information including basic demographics and utilization patterns. For enrolled patients, interaction within the portal with the "Radiology" work tab (RADTAB) was used as a surrogate for review of radiology results. As a comparator, interaction within the portal with the "Laboratory" work tab (LABTAB) was used as a surrogate for review of laboratory results. Statistical analysis on the data was performed using Chi-squared, Student's t-test, Logistic regression and multivariate analysis where appropriate. The population for analysis included 424,422 patients. Overall, 138,783 patients (32.7%) were enrolled in the portal. Patients enrolled in the portal were older (P < 0.0001), female (P < 0.0001) and Caucasian (P < 0.0001). Patients enrolled in the portal had higher levels of educational attainment (p < 0.0001), higher annual household income (P < 0.0001), and more outpatient clinic visits (P < 0.0001). The proportion of enrolled patients that interacted with the LABTAB (47.2%) was significantly higher than those that interacted with the RADTAB (27.1%) (P < 0.0001; Table 2). Patients that utilize the portal are more likely to utilize the Laboratory tab than the Radiology tab, and demographic differences do not account for this difference in usage. Further investigation is needed to better understand the reasons for the differing usage trends of Laboratory and Radiology tabs.
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Affiliation(s)
- J Alex McFarland
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
| | - Junjian Huang
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL.
| | - Yufeng Li
- Preventive Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Andrew J Gunn
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
| | - Desiree E Morgan
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
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Asagbra OE, Burch A, Chivela FL. The association between information technology sophistication and patient portal use: A cross sectional study in Eastern North Carolina. Health Informatics J 2023; 29:14604582231154478. [PMID: 36708279 DOI: 10.1177/14604582231154478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Even with the extolled benefits of patient portals, there has been some challenges to ensuring patient portal use. This study examines if a patient's level of information technology (IT) sophistication, defined as the degree of use of diverse information technologies by an individual, is associated with their use of a patient portal. Patients previous experience and exposure to other similar technologies like desktop computer, laptop, internet, smart phone, or social media explains their willingness to use information technology for their health. Data on a cross-sectional survey of 565 individuals in Eastern NC was available for analysis. Multinomial regression analyses revealed that IT sophistication is important in determining whether patients will use a patient portal. It specifies that patients with low IT sophistication compared to those with high IT sophistication were more likely to have never activated their patient portals (RRR = 2.2155, p < 0.009), or to have activated but never used a patient portal (RRR = 3.5869, p < 0.010). The findings of this study should aid healthcare leaders as they strive to improve patient engagement. They should continue to promote the benefits of the patient portal and consider offering personalized support programs for patients with low IT sophistication.
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Casacchia NJ, Rosenthal GE, O'Connell NS, Bundy R, Witek L, Wells BJ, Palakshappa D. Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis. Appl Clin Inform 2022; 13:1053-1062. [PMID: 36167336 PMCID: PMC9629981 DOI: 10.1055/a-1951-3153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The patient portal allows patients to engage with their health care team beyond the clinical encounter. While portals can improve patient outcomes, there may be disparities in which patients access the portal by sociodemographic factors. Understanding the characteristics of patients who use the portal could help design future interventions to expand portal adoption. OBJECTIVES This study aimed to (1) examine the socioeconomic factors, comorbid conditions, and health care utilization among patients of a large academic primary care network who are users and non-users of the patient portal; and (2) describe the portal functions most frequently utilized. METHODS We included all adult patients at Atrium Health Wake Forest Baptist who had at least two primary care visits between 2018 and 2019. Patients' demographics, comorbidities, health care utilization, and portal function usage were extracted from the electronic health record and merged with census data (income, education, and unemployment) from the American Community Survey. A myWakeHealth portal user was defined as a patient who used a bidirectional portal function at least once during the study period. We used multivariable logistic regression to determine which patient characteristics were independently associated with being a portal user. RESULTS Of the 178,720 patients who met inclusion criteria, 32% (N = 57,122) were users of myWakeHealth. Compared to non-users, users were more likely to be 18 to 64 years of age, female, non-Hispanic White, married, commercially insured, have higher disease burden, and have lower health care utilization. Patients residing in areas with the highest educational attainment had 51% higher odds of being a portal user than the lowest (p <0.001). Among portal users, the most commonly used function was messaging clinic providers. CONCLUSION We found that patient demographics and area socioeconomic factors were associated with patient portal adoption. These findings suggest that efforts to improve portal adoption should be targeted at vulnerable patients.
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Affiliation(s)
- Nicholas J. Casacchia
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Gary E. Rosenthal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Nathaniel S. O'Connell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Richa Bundy
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Lauren Witek
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Brian J. Wells
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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Zhang Z, Kmoth L, Luo X, He Z. User-Centered System Design for Communicating Clinical Laboratory Test Results: Design and Evaluation Study. JMIR Hum Factors 2021; 8:e26017. [PMID: 34842529 PMCID: PMC8723791 DOI: 10.2196/26017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/19/2021] [Accepted: 09/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Personal clinical data, such as laboratory test results, are increasingly being made available to patients via patient portals. However, laboratory test results are presented in a way that is difficult for patients to interpret and use. Furthermore, the indications of laboratory test results may vary among patients with different characteristics and from different medical contexts. To date, little is known about how to design patient-centered technology to facilitate the interpretation of laboratory test results. Objective The aim of this study is to explore design considerations for supporting patient-centered communication and comprehension of laboratory test results, as well as discussions between patients and health care providers. Methods We conducted a user-centered, multicomponent design research consisting of user studies, an iterative prototype design, and pilot user evaluations, to explore design concepts and considerations that are useful for supporting patients in not only viewing but also interpreting and acting upon laboratory test results. Results The user study results informed the iterative design of a system prototype, which had several interactive features: using graphical representations and clear takeaway messages to convey the concerning nature of the results; enabling users to annotate laboratory test reports; clarifying medical jargon using nontechnical verbiage and allowing users to interact with the medical terms (eg, saving, favoriting, or sorting); and providing pertinent and reliable information to help patients comprehend test results within their medical context. The results of a pilot user evaluation with 8 patients showed that the new patient-facing system was perceived as useful in not only presenting laboratory test results to patients in a meaningful way but also facilitating in situ patient-provider interactions. Conclusions We draw on our findings to discuss design implications for supporting patient-centered communication of laboratory test results and how to make technology support informative, trustworthy, and empathetic.
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Affiliation(s)
- Zhan Zhang
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Lukas Kmoth
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Xiao Luo
- School of Engineering & Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Zhe He
- School of Information, Florida State University, Tallahasse, FL, United States
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. A qualitative study of clinician perceptions regarding the potential role for digital health interventions for the management of COPD. Health Informatics J 2021; 27:1460458221994888. [PMID: 33653189 DOI: 10.1177/1460458221994888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Effective self-management of chronic obstructive pulmonary disease (COPD) can lead to increased patient control and reduced health care costs. However, both patients and healthcare professionals encounter significant challenges. Digital health interventions, such as smart oximeters and COPD self-management applications, promise to enhance the management of COPD, yet, there is little evidence to support their use and user-experience issues are still common. Understanding the needs of healthcare professionals is central for increasing adoption and engagement with digital health interventions but little is known about their perceptions of digital health interventions in COPD. This paper explored the perceptions of healthcare professionals regarding the potential role for DHI in the management of COPD. Snowball sampling was used to recruit the participants (n = 32). Each participant underwent a semi-structured interview. Using NVivo 12 software, thematic analysis was completed. Healthcare professionals perceive digital health interventions providing several potential benefits to the management of COPD including the capture of patient status indicators during the interappointment period, providing new patient data to support the consultation process and perceived digital health interventions as a potential means to improve patient engagement. The findings offer new insights regarding potential future use-cases for digital health interventions in COPD, which can help ease user-experience issues as they align with the needs of healthcare professionals.
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Affiliation(s)
| | | | - John Cullen
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Ireland.,St. Vincent's University Hospital, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
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Comber S, Wilson L, Kelly S, McCay-Peet L. Physician leaders' cross-boundary use of social media: what are the implications in the current COVID-19 environment? Leadersh Health Serv (Bradf Engl) 2021; ahead-of-print. [PMID: 34319016 DOI: 10.1108/lhs-06-2020-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to better understand social media (SM) factors that physician leaders need to consider, as they adapt their cross-boundary practices to engage with colleagues and patients. Firstly, this study explores why SM is being used by physicians to cross horizontal (physician to physician) and stakeholder (physician to patient) boundaries prior to COVID-19. Secondly, based on the studies reviewed, this study provides insights on the practical SM implications for physician leaders working in the COVID-19 environment to actively enhance their practices, reduce public confusion and improve patient care, thus informing health-care practices. DESIGN/METHODOLOGY/APPROACH A systematic literature review was used to conduct a structured transparent overview of peer reviewed articles that describe physicians' use of cross-boundary SM across several disciplines (e.g. health, information science). As a baseline assessment prior to COVID-19, the review synthesized 47 articles, identified and selected from six databases and Novanet. This study used NVivo 12 to thematical code the articles, leading to the emergence of four broad factors that influence SM use. FINDINGS A key reason noted in the literature for physicians use of SM to cross horizontal boundaries is to share knowledge. Regarding stakeholder boundaries, the most cited reasons are to improve patient's health and encourage behavioural changes. Insights garnered on the practical SM implications include the need for physicians to be stronger leaders in presenting trustworthy and consistent facts about health information to the public and fellow peers. As role models for the effective use of SM tools, physician leaders can mentor and coach their colleagues and counterparts. RESEARCH LIMITATIONS/IMPLICATIONS As this was a literature review, the authors did not collect primary data to further explore this rapidly changing and dynamic SM world. Next steps could include a survey to determine firstly, how physicians currently use SM in this COVID-19 environment, and secondly, how they could leverage it for their work. Findings from this survey will help us better understand the role of physician leaders as health-care influencers and how they could better create trust and inform the Canadian public in the health information that is being conveyed. PRACTICAL IMPLICATIONS Physician leaders can play a key role in positively influencing institutional support for ethical and safe SM use and engagement practices. Physicians need to participate in developing regulations and guidelines that are fundamentally to physician leader's SM use. Central to this research would be the need to understand how physicians cross-boundary practices have changed during and potentially post COVID-19. Physician leaders also need to monitor information sources for credibility and ensure that these sources are protected. As role models for the effective use of SM tools, physician leaders can mentor and coach their colleagues and counterparts in this area. ORIGINALITY/VALUE Although there have been studies of how physicians use SM, fewer studies explore why physician leaders' cross boundaries (horizontal and stakeholder) using SM. Important insights are gained in physician leaders practical use of SM. Key themes that emerged included: organizational and individual, information, professional and regulations and guideline factors. These factors strengthen physician leaders understanding of areas of foci to enhance their cross-boundary interactions. There is an urgency to study the complexity of SM and the effectiveness of regulations and guidelines for physicians, who are being required, at an accelerated rate, to strengthen and increase their cross-boundary practices.
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Affiliation(s)
- Scott Comber
- Rowe School of Business, Dalhousie University, Halifax, Canada
| | - Lisette Wilson
- Marine Affairs Program, Dalhousie University, Halifax, Canada
| | | | - Lori McCay-Peet
- School of Information Management, Dalhousie University Faculty of Management, Halifax, Canada
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Sieck CJ, Sheon A, Ancker JS, Castek J, Callahan B, Siefer A. Digital inclusion as a social determinant of health. NPJ Digit Med 2021; 4:52. [PMID: 33731887 PMCID: PMC7969595 DOI: 10.1038/s41746-021-00413-8] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Cynthia J Sieck
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. .,The Ohio State University Center for the Advancement of Team Science, Analytics, and Systems Thinking, Columbus, OH, USA.
| | - Amy Sheon
- Case Western Reserve University School of Medicine, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - Jessica S Ancker
- Weill Cornell Medical College, Department of Healthcare Policy & Research, Division of Health Informatics, New York City, NY, USA
| | - Jill Castek
- College of Education, Department of Teaching, Learning, and Sociocultural Studies, University of Arizona, Tucson, AZ, USA
| | - Bill Callahan
- National Digital Inclusion Alliance, Columbus, OH, USA
| | - Angela Siefer
- National Digital Inclusion Alliance, Columbus, OH, USA
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Elysee G, Yu H, Herrin J, Horwitz LI. Association between 30-day readmission rates and health information technology capabilities in US hospitals. Medicine (Baltimore) 2021; 100:e24755. [PMID: 33663091 PMCID: PMC7909153 DOI: 10.1097/md.0000000000024755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.
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Affiliation(s)
- Gerald Elysee
- Health Information Technology Programs, Benjamin Franklin Institute of Technology, Boston, MA
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven
| | - Jeph Herrin
- Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, New Haven, CT
| | - Leora I. Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, Center for Healthcare Innovation and Delivery Science, New York University Grossman School of Medicine, New York, NY
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13
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Understanding cancer patients' use and perceptions of inpatient portal: A case study at a tertiary hospital in Saudi Arabia. Int J Med Inform 2021; 148:104398. [PMID: 33571744 DOI: 10.1016/j.ijmedinf.2021.104398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inpatient portals have been introduced into tertiary hospitals to meet patients' information and communication needs, to increase their awareness of health care, and to facilitate their transition after discharge. However, there is inadequate knowledge about hospitalised oncology patients' use and perceptions of these technologies. OBJECTIVE To explore cancer patients' use and perceptions of an inpatient portal in a tertiary hospital and to identify the main benefits and barriers for patients in using the portal. METHOD A qualitative case study was conducted in a tertiary hospital in Riyadh, Saudi Arabia. Only cancer patients were invited to participate. Twenty-two semi-structured interviews were conducted in the patient's room in a cancer care centre in January 2020. Interviews were audio-recorded, fully transcribed, and analysed using a thematic analysis method. RESULTS Most patients used the portal for the first time. The most used features were entertainment, watching fall prevention videos and viewing medication lists. Although the majority of patients were positive towards the portal, and considered it to be useful and easy to use, only a small number of them used the key clinical feature of the system such as pain assessment, health education, and discharge preparation. The patients would like to see further improvement in usability of the portal, appropriate user training, adding further information, and incorporating more services and features in the portal. CONCLUSION The introduction of the inpatient portal is successful in improving cancer patients' hospitalisation experience. It helped cancer patients to acquire knowledge about their own health, to actively engage in their care processes, and to request and acquire electronic services, in addition to providing entertainment. Future research on which factors inspire patients' use of the portal and how the influence is achieved is needed for the successful integration of the portal into the patients' hospital care process.
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14
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Iorfino F, Piper SE, Prodan A, LaMonica HM, Davenport TA, Lee GY, Capon W, Scott EM, Occhipinti JA, Hickie IB. Using Digital Technologies to Facilitate Care Coordination Between Youth Mental Health Services: A Guide for Implementation. FRONTIERS IN HEALTH SERVICES 2021; 1:745456. [PMID: 36926493 PMCID: PMC10012639 DOI: 10.3389/frhs.2021.745456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022]
Abstract
Enhanced care coordination is essential to improving access to and navigation between youth mental health services. By facilitating better communication and coordination within and between youth mental health services, the goal is to guide young people quickly to the level of care they need and reduce instances of those receiving inappropriate care (too much or too little), or no care at all. Yet, it is often unclear how this goal can be achieved in a scalable way in local regions. We recommend using technology-enabled care coordination to facilitate streamlined transitions for young people across primary, secondary, more specialised or hospital-based care. First, we describe how technology-enabled care coordination could be achieved through two fundamental shifts in current service provisions; a model of care which puts the person at the centre of their care; and a technology infrastructure that facilitates this model. Second, we detail how dynamic simulation modelling can be used to rapidly test the operational features of implementation and the likely impacts of technology-enabled care coordination in a local service environment. Combined with traditional implementation research, dynamic simulation modelling can facilitate the transformation of real-world services. This work demonstrates the benefits of creating a smart health service infrastructure with embedded dynamic simulation modelling to improve operational efficiency and clinical outcomes through participatory and data driven health service planning.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sarah E Piper
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.,School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Grace Yeeun Lee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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15
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Zhang Z, Citardi D, Xing A, Luo X, Lu Y, He Z. Patient Challenges and Needs in Comprehending Laboratory Test Results: Mixed Methods Study. J Med Internet Res 2020; 22:e18725. [PMID: 33284117 PMCID: PMC7752528 DOI: 10.2196/18725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Patients are increasingly able to access their laboratory test results via patient portals. However, merely providing access does not guarantee comprehension. Patients could experience confusion when reviewing their test results. Objective The aim of this study is to examine the challenges and needs of patients when comprehending laboratory test results. Methods We conducted a web-based survey with 203 participants and a set of semistructured interviews with 13 participants. We assessed patients’ perceived challenges and needs (both informational and technological needs) when they attempted to comprehend test results, factors associated with patients’ perceptions, and strategies for improving the design of patient portals to communicate laboratory test results more effectively. Descriptive and correlation analysis and thematic analysis were used to analyze the survey and interview data, respectively. Results Patients face a variety of challenges and confusion when reviewing laboratory test results. To better comprehend laboratory results, patients need different types of information, which are grouped into 2 categories—generic information (eg, reference range) and personalized or contextual information (eg, treatment options, prognosis, what to do or ask next). We also found that several intrinsic factors (eg, laboratory result normality, health literacy, and technology proficiency) significantly impact people’s perceptions of using portals to view and interpret laboratory results. The desired enhancements of patient portals include providing timely explanations and educational resources (eg, a health encyclopedia), increasing usability and accessibility, and incorporating artificial intelligence–based technology to provide personalized recommendations. Conclusions Patients face significant challenges in interpreting the meaning of laboratory test results. Designers and developers of patient portals should employ user-centered approaches to improve the design of patient portals to present information in a more meaningful way.
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Affiliation(s)
- Zhan Zhang
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Daniel Citardi
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Aiwen Xing
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Xiao Luo
- School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Yu Lu
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL, United States
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16
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Fu HNC, Jin D, Adam TJ. Content Analysis: First-Time Patient User Challenges with Top-Rated Commercial Diabetes Apps. Telemed J E Health 2020; 27:663-669. [PMID: 32795144 DOI: 10.1089/tmj.2020.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background/Introduction: Using a mobile application (app) may improve diabetes self-management. However, the use of diabetes apps is low, possibly due to design and usability issues. The purpose of this study was to identify barriers to app use among adult patients with diabetes who were testing diabetes apps for the first time. Materials and Methods: We conducted a content analysis of observation notes and patient comments collected during the testing of two top commercially available diabetes apps as part of a crossover randomized trial. Participants were adult patients with type 1 or type 2 diabetes on insulin therapy. We analyzed field notes and transcriptions of audio recordings. Open coding derived categories of usability issues, which then were grouped into themes and subthemes on usability problem types. Results: A total of 92 adult Android smartphone users were recruited online (e.g., Facebook) and in-person postings. Three major themes described problems with data input, app report display and presentation, and self-learning options. Data entry modes were problematic because of overcrowded app screens, complicated "save data" steps, and a lack of data entry confirmation. The app icons, wording, entry headings, and analysis reports were not intuitive to understand. Participants wanted self-learning options (e.g., pop-up messages) during app use. Conclusions: Patient testing of top commercially available diabetes apps revealed key usability design issues in data entry, app report, and self-help learning options. Good app training for patients is necessary for both initial use and long-term use of diabetes apps to support self-management.
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Affiliation(s)
- Helen N C Fu
- Center for Aging Science and Care Innovation, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Diana Jin
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Terrence J Adam
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA.,College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
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17
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Ozer EM, Rowe J, Tebb KP, Berna M, Penilla C, Giovanelli A, Jasik C, Lester JC. Fostering Engagement in Health Behavior Change: Iterative Development of an Interactive Narrative Environment to Enhance Adolescent Preventive Health Services. J Adolesc Health 2020; 67:S34-S44. [PMID: 32718513 PMCID: PMC9575382 DOI: 10.1016/j.jadohealth.2020.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/24/2020] [Accepted: 04/22/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Accidents and unintentional injuries account for the greatest number of adolescent deaths, often involving use of alcohol and other substances. This article describes the iterative design and development of Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE), a narrative-centered behavior change environment for adolescents focused on reducing alcohol use. INSPIRE is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded intervention for health behavior change by leveraging 3D game engine and interactive narrative technologies. METHODS Adolescents were engaged in all aspects of the iterative, multiyear development process of INSPIRE through over 20 focus groups and iterative pilot testing involving more than 145 adolescents. Qualitative findings from focus groups are reported, as well as quantitative findings from small-scale pilot sessions investigating adolescent engagement with a prototype version of INSPIRE using a combination of questionnaire and interaction trace log data. RESULTS Adolescents reported that they found INSPIRE to be engaging, believable, and relevant to their lives. The majority of participants indicated that the narrative's protagonist character was like them (84%) and that the narrative featured virtual characters that they could relate to (79%). In the interactive narrative, the goals most frequently chosen by adolescents were "stay in control" (60%) and "do not get in trouble" (55%). CONCLUSIONS With a strong theoretical framework (social-cognitive behavior change theory) and technology advances (narrative-centered learning environments), the field is well positioned to design health behavior change systems that can realize significant impacts on behavior change for adolescent preventive health.
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Affiliation(s)
- Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California; Office of Diversity & Outreach, University of California, San Francisco, San Francisco, California.
| | - Jonathan Rowe
- Department of Computer Science, College of Engineering, North Carolina State University, Raleigh, North Carolina
| | - Kathleen P Tebb
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Mark Berna
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Carlos Penilla
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Alison Giovanelli
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Carolyn Jasik
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - James C Lester
- Department of Computer Science, College of Engineering, North Carolina State University, Raleigh, North Carolina
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18
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Chattopadhyay D, Ma T, Sharifi H, Martyn-Nemeth P. Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e18839. [PMID: 32729837 PMCID: PMC7426801 DOI: 10.2196/18839] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. OBJECTIVE The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. METHODS Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. RESULTS Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged - simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). CONCLUSIONS We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.
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Affiliation(s)
- Debaleena Chattopadhyay
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Tengteng Ma
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Hasti Sharifi
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Pamela Martyn-Nemeth
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, United States
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19
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Chung S, Martinez MC, Frosch DL, Jones VG, Chan AS. Patient-Centric Scheduling With the Implementation of Health Information Technology to Improve the Patient Experience and Access to Care: Retrospective Case-Control Analysis. J Med Internet Res 2020; 22:e16451. [PMID: 32519970 PMCID: PMC7315363 DOI: 10.2196/16451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/09/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cancellations and rescheduling of doctor’s appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take the slot. Building on an existing online patient portal, a large health care system adopted an automated rescheduling system, Fast Pass, that sends out an earlier appointment offer to patients via email or SMS text messaging and allows patients to reschedule their appointment through the online portal. Objective We examined the uptake of Fast Pass at its early stage of implementation. We assessed program features and patient and visit characteristics associated with higher levels of Fast Pass utilization and the association between Fast Pass use and no-show and cancellation rates. Methods This study was a retrospective analysis of Fast Pass offers sent between July and December 2018. Multivariable logistic regression was used to assess the independent contribution of program, patient, and visit characteristics on the likelihood of accepting an offer. We then assessed the appointment outcome (completion, cancellation, or no-show) of Fast Pass offered appointments compared to appointments with the same patient and visit characteristics, but without an offer. Results Of 177,311 Fast Pass offers sent, 14,717 (8.3%) were accepted. Overall, there was a 1.3 percentage point (38%) reduction in no-show rates among Fast Pass accepted appointments compared to other appointments with matching characteristics (P<.001). The offers were more likely to be accepted if they were sent in the evening (versus early morning), the first (versus repeated) offer for the same appointment, for a slot 1-31 days ahead (versus same-day), for later in a day (versus before 10am), for a primary care (versus specialty) visit, sent via SMS text messaging (versus email only), for an appointment made through the online patient portal (versus via phone call or in-person), or for younger adults aged 18-49 years (versus those aged 65 years or older; all at P<.001). Factors negatively associated with offer acceptance were a higher number of comorbidities (P=.02) and visits scheduled for chronic conditions (versus acute conditions only; P=.002). Conclusions An automated rescheduling system can improve patients’ access by reducing wait times for an appointment, with an added benefit of reducing no-shows by serving as a reminder of an upcoming appointment. Future modifications, such as increasing the adoption of SMS text messaging offers and targeting older adults or patients with complex conditions, may make the system more patient-centered and help promote wider utilization.
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Affiliation(s)
- Sukyung Chung
- Quantitative Sciences Unit, School of Medicine, Stanford University, Palo Alto, CA, United States.,Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Meghan C Martinez
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Veena G Jones
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States.,Palo Alto Medical Foundation, Palo Alto, CA, United States.,Sutter Health, Sacramento, CA, United States
| | - Albert S Chan
- Palo Alto Medical Foundation, Palo Alto, CA, United States.,Sutter Health, Sacramento, CA, United States.,Center for Biomedical Information Research, Stanford University, Palo Alto, CA, United States
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20
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Gupta S, Johnson EM, Peacock JG, Jiang L, McBee MP, Sneider MB, Krupinski EA. Radiology, Mobile Devices, and Internet of Things (IoT). J Digit Imaging 2020; 33:735-746. [PMID: 31898039 PMCID: PMC7256153 DOI: 10.1007/s10278-019-00311-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Radiology by its nature is intricately connected to the Internet and is at the forefront of technology in medicine. The past few years have seen a dramatic rise in Internet-based technology in healthcare, with imaging as a core application. Numerous Internet-based applications and technologies have made forays into medicine, and for radiology it is more seamless than in other clinical specialties. Many applications in the practice of radiology are Internet based and more applications are being added every day. Introduction of mobile devices and their integration into imaging workflow has reinforced the role played by the Internet in radiology. Due to the rapid proliferation of wearable devices and smartphones, IoT-enabled technology is evolving healthcare from conventional hub-based systems to more personalized healthcare systems. This article briefly discusses how the IoT plays a useful role in daily imaging workflow and current and potential future applications, how mobile devices can be integrated into radiology workflows, and the impact of the IoT on resident and medical student education, research, and patient engagement in radiology.
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Affiliation(s)
- Supriya Gupta
- Department of Radiology and Imaging, Amita St. Mary’s Medical Center/ Affiliate faculty at Yale University Medical Center, 500 W Court St, Kankakee, IL 60901 USA
| | | | - Justin G. Peacock
- Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78234 USA
| | - Liwei Jiang
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | | | - Michael B. Sneider
- Medical Director of Student Electives, Department of Radiology & Medical Imaging, University of Virginia Health System, P.O. Box 800170, Charlottesville, VA 22908 USA
| | - Elizabeth A. Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE D107, Atlanta, GA 30322 USA
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21
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McAlearney AS, Walker DM, Gaughan A, Moffatt-Bruce S, Huerta TR. Helping Patients Be Better Patients: A Qualitative Study of Perceptions About Inpatient Portal Use. Telemed J E Health 2020; 26:1184-1187. [PMID: 31990635 DOI: 10.1089/tmj.2019.0198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: As more hospitals introduce inpatient portals, it is increasingly important to understand their impact on patient experience and the care process. We conducted this study to learn from patients and care team members about their experience with an inpatient portal. Methods: We interviewed 120 patients and 433 care team members across a seven-hospital academic medical center that offers an inpatient portal to hospitalized patients. Interviewees were asked about their use of the inpatient portal and its impact on patient experience. Recorded interviews were transcribed and rigorously analyzed using both inductive and deductive methods. Results: We found that the inpatient portal was perceived to help patients be "better patients" by improving their ability to be informed about their health and by enabling them to be more involved in the care process. Care team members suggested portal use could be improved by addressing challenges with tablet administration, use of the patient education feature, and the functionality of the scheduling feature. Conclusions: Across interviewees, we found that inpatient portals were perceived to improve the hospital experience and increase empowerment for patients by offering information about care in a manner that allowed patients to join their care teams as active, participating members.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Alice Gaughan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Susan Moffatt-Bruce
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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22
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Walker DM, Gaughan A, Fareed N, Moffatt-Bruce S, McAlearney AS. Facilitating Organizational Change to Accommodate an Inpatient Portal. Appl Clin Inform 2019; 10:898-908. [PMID: 31777056 DOI: 10.1055/s-0039-1700867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation. OBJECTIVE We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal. METHODS We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization. RESULTS The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use. CONCLUSION Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Susan Moffatt-Bruce
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
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23
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. A qualitative study of chronic obstructive pulmonary disease patient perceptions of the barriers and facilitators to adopting digital health technology. Digit Health 2019; 5:2055207619871729. [PMID: 31489206 PMCID: PMC6710666 DOI: 10.1177/2055207619871729] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
Objective Non-adherence to self-management plans in chronic obstructive pulmonary
disease (COPD) results in poorer outcomes for patients. Digital health
technology (DHT) promises to support self-management by enhancing the sense
of control patients possess over their disease. COPD digital health studies
have yet to show significant evidence of improved outcomes for patients,
with many user-adoption issues still present in the literature. To help
better address the adoption needs of COPD patients, this paper explores
their perceived barriers and facilitators to the adoption of DHT. Methods A sample of convenience was chosen and patients (n = 30)
were recruited from two Dublin university hospitals. Each patient completed
a qualitative semi-structured interview. Thematic analysis of the data was
performed using NVivo 12 software. Results Barrier sub-themes included lack of perceived usefulness, digital literacy,
illness perception, and social context; facilitator sub-themes included
existing digital self-efficacy, personalised education, and community-based
support. Conclusion The findings represent a set of key considerations for researchers and
clinicians to inform the design of patient-centred study protocols that aim
to account for the needs and preferences of patients in the development of
implementation and adoption strategies for DHT in COPD.
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Affiliation(s)
- Patrick Slevin
- The Insight Centre for Data Analytics, University College Dublin, Ireland
| | - Threase Kessie
- The Insight Centre for Data Analytics, University College Dublin, Ireland
| | - John Cullen
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Brian Caulfield
- The Insight Centre for Data Analytics, University College Dublin, Ireland
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24
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Burns K, McBride CA, Patel B, FitzGerald G, Mathews S, Drennan J. Creating Consumer-Generated Health Data: Interviews and a Pilot Trial Exploring How and Why Patients Engage. J Med Internet Res 2019; 21:e12367. [PMID: 31199312 PMCID: PMC6598415 DOI: 10.2196/12367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/24/2019] [Accepted: 03/24/2019] [Indexed: 01/19/2023] Open
Abstract
Background Consumer-generated health data (CGHD) are any clinically relevant data collected by patients or their carers (consumers) that may improve health care outcomes. Like patient experience measures, these data reflect the consumer perspective and is part of a patient-centric agenda. The use of CGHD is believed to enhance diagnosis, patient engagement, and thus foster an improved therapeutic partnership with health care providers. Objective The aim of this study was to further identify how these data were used by consumers and how it influences engagement via a validated framework. In addition, carer data has not been explored for the purpose of engagement. Methods Study 1 used interviews with CGHD-experienced patients, carers, and doctors to understand attitudes about data collection and use, developing an ontological framework. Study 2 was a pilot trial with carers (parents) of children undergoing laparoscopic appendectomy. For 10 days carers generated and emailed surgical site photographs to a tertiary children’s hospital. Subsequently, carers were interviewed about the engagement framework. In total, 60 interviews were analyzed using theme and content analysis. Results This study validates a framework anchored in engagement literature, which categorizes CGHD engagement outcomes into 4 domains: physiological, cognitive, emotional, and behavioral. CGHD use is complex, interconnected, and can be organized into 10 themes within these 4 domains. Conclusions CGHD can instigate an ecosystem of engagement and provide clinicians with an enhanced therapeutic relationship through an extended view into the patient’s world. In addition to clinical diagnosis and efficient use of health care resources, data offer another tool to manage consumers service experience, especially the emotions associated with the health care journey. Collection and use of data increases consumers sense of reassurance, improves communication with providers, and promotes greater personal responsibility, indicating an empowering consumer process. Finally, it can also improve confidence and satisfaction in the service.
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Affiliation(s)
- Kara Burns
- QUT Business School, Queensland University of Technology, Brisbane, Australia
| | - Craig A McBride
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Bhaveshkumar Patel
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Gerard FitzGerald
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
| | - Shane Mathews
- QUT Business School, Queensland University of Technology, Brisbane, Australia
| | - Judy Drennan
- QUT Business School, Queensland University of Technology, Brisbane, Australia
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25
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McAlearney AS, Sieck CJ, Gaughan A, Fareed N, Volney J, Huerta TR. Patients' Perceptions of Portal Use Across Care Settings: Qualitative Study. J Med Internet Res 2019; 21:e13126. [PMID: 31172960 PMCID: PMC6592494 DOI: 10.2196/13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 01/22/2023] Open
Abstract
Background Patient portals are a promising instrument to improve patient-centered care, as they provide patients information and tools that can help them better manage their health. The implementation of portals in both the inpatient and outpatient setting gives health care providers an opportunity to support patients both during hospitalization and after discharge. Thus, there is a need to better understand how inpatient and outpatient portals are used across care contexts. Objective This study aimed to examine patients’ perceptions of using inpatient and outpatient portals across the care settings, including how they used the portals and the benefits and concerns associated with portal use. Methods This study was conducted in a large Midwestern academic medical center consisting of seven hospitals. We interviewed 120 patients who had used an inpatient portal during their hospitalization, at 15 days and 6 months postdischarge, to determine their perspectives of portal use in both hospital and outpatient settings. Interview transcripts were analyzed inductively and deductively by using team coding processes consistent with a grounded theory approach. Results Interviews focused on three main areas of portal use: experience with the portal features, perceived benefits, and concerns. Responses at 15 days (n=60) and 6 months (n=60) postdischarge were consistent with respect to perceptions about portal use. Patients identified viewing their health information, managing their schedule, and communicating with providers as notable activities. Convenience, access to information, and better engagement in care were indicated as benefits. Concerns were related to technology issues and privacy/security risks. Conclusions Implementation of inpatient portals as a complement to outpatient portals is increasing and can enable patients to better manage aspects of their care. Although care processes vary substantively across settings, the benefits of convenience, improved access to information, and better engagement in care provide opportunities for portal use across care settings to support patient-centered care.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Alice Gaughan
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Naleef Fareed
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Jaclyn Volney
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
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26
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Asagbra OE, Burke D, Liang H. The association between patient engagement HIT functionalities and quality of care: Does more mean better? Int J Med Inform 2019; 130:103893. [PMID: 31442845 DOI: 10.1016/j.ijmedinf.2019.05.029] [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] [Received: 04/08/2018] [Revised: 01/23/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore the relationship between the number (breadth) of patient engagement functionalities offered through health information technology (HIT) by hospitals and the hospitals' quality of care. METHODS Data on hospital adoption of patient engagement functionalities were combined with quality data obtained from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare. Fixed effects regression models were used to analyze a panel data consisting 1,463 hospitals from 2012 to 2014. RESULTS This study revealed a significant positive relationship between the breadth of patient engagement functionalities and patient satisfaction (β = 0.126, p < 0.05). The number of functionalities was also found to be negatively associated with 30-day readmission rates for myocardial infarction (β= -0.085, p < 0.05), heart failure (β= -0.109, p < 0.05), and pneumonia (β= -0.048, p < 0.05). DISCUSSION The breadth of functionalities offered by hospitals to engage patients was a significant factor in decreasing hospital 30-day readmission rates for pneumonia, acute myocardial infarction, and heart failure, and also influenced patients' perception of the hospital. CONCLUSIONS The findings suggest that hospitals with more patient engagement HIT functionalities are likely to have higher patient satisfaction and lower readmission rates for infarction, heart failure, and pneumonia. This study will potentially assist hospital administrators to justify their strategic deployment of HIT resources to improve both perceived and actual care quality.
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Affiliation(s)
- O Elijah Asagbra
- Department of Health Services and Information Management, College of Allied Health Sciences, East Carolina University, 4340P Health Sciences Building, Greenville, NC, USA
| | - Darrell Burke
- Department of Health Services Administration, School of Health Professions, SHP Building 590G, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huigang Liang
- Department of Business Information & Technology, Fogelman College of Business & Economics, University of Memphis, Memphis, TN 38152, USA.
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27
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McAlearney AS, Gaughan A, MacEwan SR, Fareed N, Huerta TR. Improving Acceptance of Inpatient Portals: Patients' and Care Team Members' Perspectives. Telemed J E Health 2019; 26:310-326. [PMID: 31081723 DOI: 10.1089/tmj.2019.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Inpatient portals are gaining interest as a means to increase patient-centered care during hospitalization. However, acceptance of a new technology such as the inpatient portal relies on perceptions of both its usefulness and ease of use. These factors have not been studied in the context of inpatient portal implementation. Methods: We interviewed patients (n = 123) and care team members (n = 447) about their experiences using an inpatient portal that had been implemented across a large, academic medical center. Interviews lasted 5-15 min, were audio-recorded, transcribed verbatim, and then analyzed using a combination of deductive and inductive methods. Results: Collectively, interviewees reported that the inpatient portal was a useful tool as it improved patients' access to information, enhanced communication, facilitated education, and appeared to promote patients' sense of control while in the hospital. Most interviewees also found the technology easy to use. However, there were concerns that the portal was not easy to use for those less experienced with technology. Interviewees identified the need to emphasize the value of the technology to both patients and care team members and the need to provide additional training to support portal use, as ways to promote acceptance of the tool. Discussion and Conclusions: Inpatient portals can improve patient-centered care, but such improvements require acceptance of the tool by both patients and care team members. Our findings about the usefulness and ease of use of an inpatient portal can inform future efforts to improve the implementation and acceptance of this new technology.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Alice Gaughan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Naleef Fareed
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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28
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. Exploring the potential benefits of digital health technology for the management of COPD: a qualitative study of patient perceptions. ERJ Open Res 2019; 5:00239-2018. [PMID: 31111039 PMCID: PMC6513035 DOI: 10.1183/23120541.00239-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/08/2019] [Indexed: 11/05/2022] Open
Abstract
Engaging chronic obstructive pulmonary disease (COPD) patients to actively participate in self-management has proven difficult. Digital health technology (DHT) promises to facilitate a patient-centred care model for the management of COPD by empowering patients to self-manage effectively. However, digital health studies in COPD have yet to demonstrate significant patient outcomes, suggesting that this research has still to adequately address the needs of patients in the intervention development process. The current study explored COPD patients' perceptions of the potential benefits of DHT in the self-management and treatment of their disease. A sample of convenience was chosen and participants (n=30) were recruited from two Dublin university hospitals and each underwent a qualitative semi-structured interview. Thematic analysis of the data was completed using NVivo 12 software. Six themes were identified: symptom management, anxiety management, interaction with physician, care management, personalising care and preventative intervention. In our findings, patients reported a willingness to take a more active role in self-management using DHT. They perceived DHT potentially enhancing their self-management by improving self-efficacy and engagement and by supporting healthcare professionals to practise preventative care provision. The findings can be used to inform patient-centred COPD digital interventions for researchers and clinicians who wish to develop study aims that align with the needs and preferences of patients.
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Affiliation(s)
- Patrick Slevin
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Threase Kessie
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - John Cullen
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Dublin, Ireland.,St Vincent's University Hospital, Dublin, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Brian Caulfield
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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29
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Kolodychuk NL, Wong M, Chimento G, Adams T, Gastanaduy M, Waddell BS. Web-based patient portal access in an orthopedic adult reconstruction patient population. Arthroplast Today 2019; 5:83-87. [PMID: 31020029 PMCID: PMC6470345 DOI: 10.1016/j.artd.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 11/26/2022] Open
Abstract
Background We surveyed patients in an adult reconstruction practice as to their use of the Web-based portal provided by our electronic health record, seeking to reveal patterns of use and helpfulness. Methods A total of 150 completed surveys were received. The survey queried demographics, the number of clinic visits, Internet access, portal activation, portal use frequency, and portal information questions and how patients answered them. Helpfulness was rated from 1 (not helpful) to 5 (very helpful). Statistical analysis included bivariate analysis and logistic regression, with odds ratio (OR) and 95% confidence interval (CI) reported. Results The mean age was 67.6 years. Most were females (n = 97, 65.1%). Most (68.7%) patients used the portal. Younger age (OR, 0.94; CI, 0.90-0.99) and access to Internet (OR, 31.8; CI, 8.5-119.4) predicted portal use (P < .005), whereas gender and number of clinic visits did not (P > .373). Of all, 47.5% of patients were unclear about online chart information. Older age indicated being unclear of portal information (68.5 vs 66, P = .0002). Of those who clarified doubts regarding information (n = 67), 23 used the Internet (34.3%), 32 (47.7%) called the physician, and 12 (17.9%) asked a friend and/or family member. Most (90.3%) patients felt the portal was helpful in gathering health information. Conclusions Age and Internet access affected portal usage; ability to understand chart information decreased with age. Most patients used the Internet or a family member to clarify doubts regarding portal information. The use of portal data resulted in 32 extra communications to the physician.
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Affiliation(s)
| | - Michael Wong
- Department of Orthopedics, Ochsner Medical Center, Jefferson, LA, USA
| | - George Chimento
- Department of Orthopedics, Ochsner Medical Center, Jefferson, LA, USA
| | - Tyler Adams
- Department of Orthopedics, Ochsner Medical Center, Jefferson, LA, USA
| | - Mariella Gastanaduy
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Bradford S Waddell
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
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30
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Kildea J, Battista J, Cabral B, Hendren L, Herrera D, Hijal T, Joseph A. Design and Development of a Person-Centered Patient Portal Using Participatory Stakeholder Co-Design. J Med Internet Res 2019; 21:e11371. [PMID: 30741643 PMCID: PMC6388099 DOI: 10.2196/11371] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background Patient portals are increasingly accepted as part of standard medical care. However, to date, most patient portals provide just passive access to medical data. The use of modern technology such as smartphones and data personalization algorithms offers the potential to make patient portals more person-centered and enabling. Objective The aim of this study is to share our experience in designing and developing a person-centered patient portal following a participatory stakeholder co-design approach. Methods Our stakeholder co-design approach comprised 6 core elements: (1) equal coleadership, including a cancer patient on treatment; (2) patient preference determination; (3) security, governance, and legal input; (4) continuous user evaluation and feedback; (5) continuous staff input; and (6) end-user testing. We incorporated person-centeredness by recognizing that patients should decide for themselves their level of medical data access, all medical data should be contextualized with explanatory content, and patient educational material should be personalized and timely. Results Using stakeholder co-design, we built, and are currently pilot-testing, a person-centered patient portal smartphone app called Opal. Conclusions Inclusion of all stakeholders in the design and development of patient-facing software can help ensure that the necessary elements of person-centeredness, clinician acceptability, and informatics feasibility are achieved.
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Affiliation(s)
- John Kildea
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.,Medical Physics Unit, McGill University, Montreal, QC, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - John Battista
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Briana Cabral
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Laurie Hendren
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,School of Computer Science, McGill University, Montreal, QC, Canada
| | - David Herrera
- School of Computer Science, McGill University, Montreal, QC, Canada
| | - Tarek Hijal
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Ackeem Joseph
- Department of Medical Physics, McGill University Health Centre, Montreal, QC, Canada
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31
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Sheridan SL, Donahue KE, Brenner AT. Beginning with high value care in mind: A scoping review and toolkit to support the content, delivery, measurement, and sustainment of high value care. PATIENT EDUCATION AND COUNSELING 2019; 102:238-252. [PMID: 30553576 DOI: 10.1016/j.pec.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To create a shared vision for the content, delivery, measurement, and sustainment of patient-centered high value care. METHODS We performed a scoping review and translated findings into toolkit for system leaders. For our scoping review, we searched Medline, 2005-November 2015, for literature on patient-centered care (PCC) and its relationship to a high value care change model. We supplemented searches with key author, Google Scholar, and key website searches. One author reviewed all titles, abstracts, and articles for inclusion; another reviewed a random 20%. To develop our toolkit, we translated evidence into simple, actionable briefs on key topics and added resources. We then iteratively circulated briefs and the overall toolkit to potential users, making updates as needed. RESULTS In our scoping review, we found multiple interventions and measures to support the components of PCC and our change model. We found little on the overall effects of PCC or how PCC creates value. Potential users reported our toolkit was simple, understandable, thorough, timely, and likely to be globally useful. CONCLUSIONS Considerable evidence supports patient-centered high value care and a toolkit garnered enthusiasm. PRACTICE IMPLICATIONS The toolkit is ready for use, but needs comparison to other approaches.
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Affiliation(s)
| | - Katrina E Donahue
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family and Community Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison T Brenner
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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32
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Jensen RE, Gummerson SP, Chung AE. Overview of Patient-Facing Systems in Patient-Reported Outcomes Collection: Focus and Design in Cancer Care. J Oncol Pract 2018; 12:873-875. [PMID: 27601515 DOI: 10.1200/jop.2016.015685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Roxanne E Jensen
- Georgetown University; Lombardi Comprehensive Cancer Center, Washington, DC; University of North Carolina at Chapel Hill School of Medicine; Lineberger Comprehensive Cancer Center Outcomes Research Program; and Carolina Health Informatics Program, Chapel Hill, NC
| | - Scott P Gummerson
- Georgetown University; Lombardi Comprehensive Cancer Center, Washington, DC; University of North Carolina at Chapel Hill School of Medicine; Lineberger Comprehensive Cancer Center Outcomes Research Program; and Carolina Health Informatics Program, Chapel Hill, NC
| | - Arlene E Chung
- Georgetown University; Lombardi Comprehensive Cancer Center, Washington, DC; University of North Carolina at Chapel Hill School of Medicine; Lineberger Comprehensive Cancer Center Outcomes Research Program; and Carolina Health Informatics Program, Chapel Hill, NC
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33
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Woolen SA, Kazerooni EA, Steenburg SD, Nan B, Ma T, Wall A, Linna NB, Gayed MJ, Kushdilian MV, Parent K, Cahalan S, Alameddine M, Ladd LM, Davenport MS. Optimizing Electronic Release of Imaging Results through an Online Patient Portal. Radiology 2018; 290:136-143. [PMID: 30398436 DOI: 10.1148/radiol.2018180883] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine an optimal embargo period preceding release of radiologic test results to an online patient portal. Materials and Methods This prospective discrete choice conjoint survey with modified orthogonal design was administered to patients by trained interviewers at four outpatient sites and two institutions from December 2016 to February 2018. Three preferences for receiving imaging results associated with a possible or known cancer diagnosis were evaluated: delay in receipt of results (1, 3, or 14 days), method of receipt (online portal, physician's office, or phone), and condition of receipt (before, at the same time as, or after health care provider). Preferences (hereafter, referred to as utilities) were derived from parameter estimates (β) of multinomial regression stratified according to study participant and choice set. Results Among 464 screened participants, the response and completion rates were 90.5% (420 of 464) and 99.5% (418 of 420), respectively. Participants preferred faster receipt of results (P < .001) from their physician (P < .001) over the telephone (P < .001). Each day of delay decreased preference by 13 percentage points. Participants preferred immediate receipt of results through an online portal (utility, -.57) if made to wait more than 6 days to get results in the office and more than 11 days to get results by telephone. Compared with receiving results in their physician's office on day 7 (utility, -.60), participants preferred immediate release through the online portal without physician involvement if followed by a telephone call within 6 days (utility, -0.49) or an office visit within 2 days (utility, -.53). Older participants preferred physician-directed communication (P < .001). Conclusion The optimal embargo period preceding release of results through an online portal depends on the timing of traditional telephone- and office-based styles of communication. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Arenson et al in this issue.
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Affiliation(s)
- Sean A Woolen
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Ella A Kazerooni
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Scott D Steenburg
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Bin Nan
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Tianwen Ma
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Amber Wall
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Nathaniel B Linna
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Matthew J Gayed
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Michael V Kushdilian
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Kelly Parent
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Shannon Cahalan
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Mitchell Alameddine
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Lauren M Ladd
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Matthew S Davenport
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
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Joneidy S, Burke M. Towards a deeper understanding of meaningful use in electronic health records. Health Info Libr J 2018; 36:134-152. [DOI: 10.1111/hir.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
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Generation and Implementation of a Patient-Centered and Patient-Facing Genomic Test Report in the EHR. EGEMS 2018; 6:14. [PMID: 30094286 PMCID: PMC6078113 DOI: 10.5334/egems.256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Context Communication of genetic laboratory results to patients and providers is impeded by the complexity of results and reports. This can lead to misinterpretation of results, causing inappropriate care. Patients often do not receive a copy of the report leading to possible miscommunication. To address these problems, we conducted patient-centered research to inform design of interpretive reports. Here we describe the development and deployment of a specific patient-centered clinical decision support (CDS) tool, a multi-use patient-centered genomic test report (PGR) that interfaces with an electronic health record (EHR). Implementation Process A PGR with a companion provider report was configured for implementation within the EHR using locally developed software (COMPASS™) to manage secure data exchange and access. Findings We conducted semi-structured interviews with patients, family members, and clinicians that showed they sought clear information addressing findings, family implications, resources, prognosis and next steps relative to the genomic result. Providers requested access to applicable, available clinical guidelines. Initial results indicated patients and providers found the PGR contained helpful, valuable information and would provide a basis for result-related conversation between patients, providers and family. Major Themes Direct patient involvement in the design and development of a PGR identified format and presentation preferences, and delivery of relevant information to patients and providers, prompting the creation of a CDS tool. Conclusions Research and development of patient-centered CDS tools designed to support improved patient outcomes, are enhanced by early and substantial engagement of patients in contributing to all phases of tool design and development.
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Williams MS, Kern MS, Lerch VR, Billet J, Williams JL, Moore GJ. Implementation of a patient-facing genomic test report in the electronic health record using a web-application interface. BMC Med Inform Decis Mak 2018; 18:32. [PMID: 29843696 PMCID: PMC5975475 DOI: 10.1186/s12911-018-0614-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/22/2018] [Indexed: 11/30/2022] Open
Abstract
Background Genomic medicine is emerging into clinical care. Communication of genetic laboratory results to patients and providers is hampered by the complex technical nature of the laboratory reports. This can lead to confusion and misinterpretation of the results resulting in inappropriate care. Patients usually do not receive a copy of the report leading to further opportunities for miscommunication. To address these problems, interpretive reports were created using input from the intended end users, patients and providers. This paper describes the technical development and deployment of the first patient-facing genomic test report (PGR) within an electronic health record (EHR) ecosystem using a locally developed standards-based web-application interface. Methods A patient-facing genomic test report with a companion provider report was configured for implementation within the EHR using a locally developed software platform, COMPASS™. COMPASS™ is designed to manage secure data exchange, as well as patient and provider access to patient reported data capture and clinical display tools. COMPASS™ is built using a Software as a Service (SaaS) approach which exposes an API that apps can interact with. Results An authoring tool was developed that allowed creation of patient-specific PGRs and the accompanying provider reports. These were converted to a format that allowed them to be presented in the patient portal and EHR respectively using the existing COMPASS™ interface thus allowing patients, caregivers and providers access to individual reports designed for the intended end user. Conclusions The PGR as developed was shown to enhance patient and provider communication around genomic results. It is built on current standards but is designed to support integration with other tools and be compatible with emerging opportunities such as SMART on FHIR. This approach could be used to support genomic return of results as the tool is scalable and generalizable.
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Affiliation(s)
- Marc S Williams
- Genomic Medicine Institute, Geisinger, 100 North Academy Avenue, Danville, PA, USA.
| | - Melissa S Kern
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Virginia R Lerch
- Institute for Advanced Application, Geisinger, Danville, PA, USA
| | - Jonathan Billet
- Institute for Advanced Application, Geisinger, Danville, PA, USA
| | - Janet L Williams
- Genomic Medicine Institute, Geisinger, 100 North Academy Avenue, Danville, PA, USA
| | - Gregory J Moore
- Institute for Advanced Application, Geisinger, Danville, PA, USA
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Cooley ME, Abrahm JL, Berry DL, Rabin MS, Braun IM, Paladino J, Nayak MM, Lobach DF. Algorithm-based decision support for symptom self-management among adults with Cancer: results of usability testing. BMC Med Inform Decis Mak 2018; 18:31. [PMID: 29843767 PMCID: PMC5975425 DOI: 10.1186/s12911-018-0608-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is essential that cancer patients understand anticipated symptoms, how to self-manage these symptoms, and when to call their clinicians. However, patients are often ill-prepared to manage symptoms at home. Clinical decision support (CDS) is a potentially innovative way to provide information to patients where and when they need it. The purpose of this project was to design and evaluate a simulated model of an algorithm-based CDS program for self-management of cancer symptoms. METHODS This study consisted of three phases; development of computable algorithms for self-management of cancer symptoms using a modified ADAPTE process, evaluation of a simulated model of the CDS program, and identification of design objectives and lessons learned from the evaluation of patient-centered CDS. In phase 1, algorithms for pain, constipation and nausea/vomiting were developed by an expert panel. In phase 2, we conducted usability testing of a simulated symptom assessment and management intervention for self-care (SAMI-Self-Care) CDS program involving focus groups, interviews and surveys with cancer patients, their caregivers and clinicians. The Acceptability E-scale measured acceptability of the program. In phase 3, we developed design objectives and identified barriers to uptake of patient-centered CDS based on the data gathered from stakeholders. RESULTS In phase 1, algorithms were reviewed and approved through a consensus meeting and majority vote. In phase 2, 24 patients & caregivers and 13 clinicians participated in the formative evaluation. Iterative changes were made in a simulated SAMI-Self-Care CDS program. Acceptability scores were high among patients, caregivers and clinicians. In phase 3, we formulated CDS design objectives, which included: 1) ensure patient safety, 2) communicate clinical concepts effectively, 3) promote communication with clinicians, 4) support patient activation, and 5) facilitate navigation and use. We identified patient barriers and clinician concerns to using CDS for symptom self-management, which were consistent with the chronic care model, a theoretical framework used to enhance patient-clinician communication and patient self-management. CONCLUSION Patient safety and tool navigation were critical features of CDS for patient self-management. Insights gleaned from this study may be used to inform the development of CDS resources for symptom self-management in patients with other chronic conditions.
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Affiliation(s)
- Mary E Cooley
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA.
| | - Janet L Abrahm
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Donna L Berry
- The Phyllis F. Cantor Center and the Department of Medicine, Dana-Farber Cancer Institute, 450 Brookline Ave, LW-512, Boston, MA, 02115, USA
| | - Michael S Rabin
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Ilana M Braun
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Joanna Paladino
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Manan M Nayak
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - David F Lobach
- Klesis Healthcare and Department of Family Medicine, Durham, NC, 27705, USA.,Department of Family Medicine, Duke University Medical Center, 2100 Erwin Road, Durham, NC, 27710, USA
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Giardina TD, Baldwin J, Nystrom DT, Sittig DF, Singh H. Patient perceptions of receiving test results via online portals: a mixed-methods study. J Am Med Inform Assoc 2018; 25:440-446. [PMID: 29240899 PMCID: PMC5885801 DOI: 10.1093/jamia/ocx140] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/14/2017] [Indexed: 02/05/2023] Open
Abstract
Objective Online portals provide patients with access to their test results, but it is unknown how patients use these tools to manage results and what information is available to promote understanding. We conducted a mixed-methods study to explore patients' experiences and preferences when accessing their test results via portals. Materials and Methods We conducted 95 interviews (13 semistructured and 82 structured) with adults who viewed a test result in their portal between April 2015 and September 2016 at 4 large outpatient clinics in Houston, Texas. Semistructured interviews were coded using content analysis and transformed into quantitative data and integrated with the structured interview data. Descriptive statistics were used to summarize the structured data. Results Nearly two-thirds (63%) did not receive any explanatory information or test result interpretation at the time they received the result, and 46% conducted online searches for further information about their result. Patients who received an abnormal result were more likely to experience negative emotions (56% vs 21%; P = .003) and more likely to call their physician (44% vs 15%; P = .002) compared with those who received normal results. Discussion Study findings suggest that online portals are not currently designed to present test results to patients in a meaningful way. Patients experienced negative emotions often with abnormal results, but sometimes even with normal results. Simply providing access via portals is insufficient; additional strategies are needed to help patients interpret and manage their online test results. Conclusion Given the absence of national guidance, our findings could help strengthen policy and practice in this area and inform innovations that promote patient understanding of test results.
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Affiliation(s)
- Traber D Giardina
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jessica Baldwin
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel T Nystrom
- Department of Biomedical Informatics, University of Utah, and VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Dean F Sittig
- Center for Healthcare Quality and Safety, School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Öberg U, Isaksson U, Jutterström L, Orre CJ, Hörnsten Å. Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support. JMIR Diabetes 2018; 3:e7. [PMID: 30291075 PMCID: PMC6238867 DOI: 10.2196/diabetes.9059] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/27/2017] [Accepted: 01/26/2018] [Indexed: 12/14/2022] Open
Abstract
Background Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services. Objective The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care. Methods This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D. Results Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty. Conclusions Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.
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Affiliation(s)
- Ulrika Öberg
- Department of Nursing, Umeå University, Umeå, Sweden.,Arctic Research Centre, Umeå University, Umeå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden.,Arctic Research Centre, Umeå University, Umeå, Sweden
| | | | - Carl Johan Orre
- Department of Computer Science and Media Technology, Malmö University, Malmö, Sweden
| | - Åsa Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden
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Ackerman SL, Sarkar U, Tieu L, Handley MA, Schillinger D, Hahn K, Hoskote M, Gourley G, Lyles C. Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California. J Am Med Inform Assoc 2018; 24:903-912. [PMID: 28340229 DOI: 10.1093/jamia/ocx015] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/13/2017] [Indexed: 11/13/2022] Open
Abstract
Objective US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations. Materials and Methods Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n = 12), informal focus groups with front-line staff ( n = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n = 45). Results Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain "meaningful use" as defined by and for their patients. Discussion Health systems' efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU's assumptions about patients' demand for electronic access to health information and ability to make use of it directed clinics' attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context. Conclusion We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.
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Affiliation(s)
- Sara L Ackerman
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Urmimala Sarkar
- Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA
| | - Lina Tieu
- Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Dean Schillinger
- Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA
| | - Kenneth Hahn
- Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA
| | - Mekhala Hoskote
- Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA
| | - Gato Gourley
- Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA
| | - Courtney Lyles
- Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA
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When traditionally inseparable services are separated by technology: the case of patient portal features offered by primary care providers. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2013.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Göransson C, Eriksson I, Ziegert K, Wengström Y, Langius-Eklöf A, Brovall M, Kihlgren A, Blomberg K. Testing an app for reporting health concerns-Experiences from older people and home care nurses. Int J Older People Nurs 2017; 13:e12181. [PMID: 29210218 DOI: 10.1111/opn.12181] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of using an app among older people with home-based health care and their nurses. BACKGROUND Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. DESIGN Explorative qualitative design. METHODS For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. RESULTS The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. CONCLUSIONS The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. IMPLICATIONS FOR PRACTICE The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.
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Affiliation(s)
- Carina Göransson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Yvonne Wengström
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Brovall
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Annica Kihlgren
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Clinician-Stakeholders' Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results. J Genet Couns 2017; 27:349-357. [PMID: 29159545 DOI: 10.1007/s10897-017-0179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record's patient portal may increase the efficiency of returning results and could activate patient follow-up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow-up and providing resources to notify at-risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.
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Arcury TA, Quandt SA, Sandberg JC, Miller DP, Latulipe C, Leng X, Talton JW, Melius KP, Smith A, Bertoni AG. Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study. JMIR Med Inform 2017; 5:e47. [PMID: 29138129 PMCID: PMC5705857 DOI: 10.2196/medinform.8026] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/03/2017] [Accepted: 09/21/2017] [Indexed: 12/03/2022] Open
Abstract
Background Patient portals can improve patient communication with providers, provide patients with greater health information access, and help improve patient decision making, if they are used. Because research on factors facilitating and limiting patient portal utilization has not been conceptually based, no leverage points have been indicated for improving utilization. Objective The primary objective for this analysis was to use a conceptual framework to determine potentially modifiable factors affecting patient portal utilization by older adults (aged 55 years and older) who receive care at clinics that serve low income and ethnically diverse communities. The secondary objective was to delineate how patient portal utilization is associated with perceived usefulness and usability. Methods Patients from one urban and two rural clinics serving low income patients were recruited and completed interviewer-administered questionnaires on patient portal utilization. Results A total of 200 ethnically diverse patients completed questionnaires, of which 41 (20.5%) patients reported utilizing portals. Education, social support, and frequent Internet utilization improve the odds of patient portal utilization; receiving health care at a rural clinic decreases the odds of portal utilization. Conclusions Leverage points to address disparities in patient portal utilization include providing training for older adults in patient portal utilization, involving spouses or other care partners in this training, and making information technology access available at public places in rural and urban communities.
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Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Joanne C Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Celine Latulipe
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Xiaoyan Leng
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jenifer W Talton
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Kathryn P Melius
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Alden Smith
- Greene County Health Care, Inc, Snow Hill, NC, United States
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Woods SS, Forsberg CW, Schwartz EC, Nazi KM, Hibbard JH, Houston TK, Gerrity M. The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users. J Med Internet Res 2017; 19:e345. [PMID: 29042345 PMCID: PMC5663951 DOI: 10.2196/jmir.7895] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time. OBJECTIVE The study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions. METHODS We prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment. RESULTS A total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively. CONCLUSIONS Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services.
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Affiliation(s)
- Susan S Woods
- VA Maine Healthcare System, Augusta, ME, United States.,VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States.,Connected Care Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, United States
| | - Christopher W Forsberg
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
| | - Erin C Schwartz
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
| | - Kim M Nazi
- Connected Care Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, United States
| | - Judith H Hibbard
- Health Policy Research Group, University of Oregon, Eugene, OR, United States
| | - Thomas K Houston
- Bedford VA Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
| | - Martha Gerrity
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
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Long S, Monsen K, Pieczkiewicz D, Wolfson J, Khairat S. An Evaluation of Overcoming Barriers to Engage Consumers in the Use of Health Care Information Technology. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2017. [DOI: 10.1080/15398285.2017.1361715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sandra Long
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Karen Monsen
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Saif Khairat
- University of North Carolina, Chapel Hill, North Carolina, USA
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47
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Henry BW, Block DE, Ciesla JR, McGowan BA, Vozenilek JA. Clinician behaviors in telehealth care delivery: a systematic review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:869-888. [PMID: 27696102 DOI: 10.1007/s10459-016-9717-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider-patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.
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Affiliation(s)
- Beverly W Henry
- Northern Illinois University, Wirtz Hall Room 227, Dekalb, IL, USA.
| | - Derryl E Block
- Dean College of Health and Human Sciences, Northern Illinois University, Dekalb, IL, USA
| | - James R Ciesla
- College of Health and Human Sciences, Northern Illinois University, Dekalb, IL, 60115, USA
| | - Beth Ann McGowan
- Northern Illinois University Libraries, Northern Illinois University, 1425 Lincoln Hwy, Dekalb, IL, 60115, USA
| | - John A Vozenilek
- Jump Simulation and Education Center, 1306 N Berkeley Ave, Peoria, IL, 61603, USA
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Barrett AK, Stephens KK. Making Electronic Health Records (EHRs) Work: Informal Talk and Workarounds in Healthcare Organizations. HEALTH COMMUNICATION 2017; 32:1004-1013. [PMID: 27463257 DOI: 10.1080/10410236.2016.1196422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A key provision of the American Recovery and Reinvestment Act of 2009 mandated that electronic health records (EHR) be adopted in US healthcare organizations by 2015. The purpose of this study is to examine the communicative processes involved as healthcare workers implement an EHR and make changes, known as workarounds. Guided by theories in social influence, and diffusion of innovations, we conducted a survey of healthcare professionals using an EHR system in an organization. Our structural equation modeling (SEM) and multiple regression results reveal coworker communication, in the form of informal social support and feedback, play an important role in whether people engage in workarounds. Understanding this relationship is important because our study also demonstrates that workarounds predict healthcare employees' overall satisfaction with the EHR system. Specifically, workarounds are associated with higher perceptions of the EHR's relative advantage, higher perceptions of EHR implementation success, and lower levels of resistance to EHR change. This study offers a health communication contribution to the growing research on EHR systems and demonstrates the persuasive effects that coworkers have on new technology use in healthcare organizations.
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Totzkay D, Silk KJ, Sheff SE. The Effect of Electronic Health Record Use and Patient-Centered Communication on Cancer Screening Behavior: An Analysis of the Health Information National Trends Survey. JOURNAL OF HEALTH COMMUNICATION 2017; 22:554-561. [PMID: 28682179 DOI: 10.1080/10810730.2017.1338801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present study used the 2013 Health Information National Trends Survey (N = 3185) to examine the effects of patient-centered communication (PCC) and the use of electronic health records (EHRs) on the likelihood of patients receiving a recommended screening for cancer (i.e., mammogram, PSA test). Self-determination theory, a framework of self-initiated extrinsic behaviors, was applied to test mediation models of PCC and EHR use, respectively, through patient activation. The results demonstrated that PCC and EHR use predicted cancer screening (mediated through patient activation), but only for women recommended for biannual mammograms. The aforementioned relationship was not found for men who are recommended for prostate cancer screening. PCC and EHRs do appear to facilitate a patient's ability to take care of their own health, but only under certain circumstances. It was additionally found that men were more likely to report higher degrees of physician PCC when their physicians maintained an EHR, whereas women reported no difference. Future research should examine more nuanced personality factors that affect the perception of PCC in the presence of EHRs and the relationship between men's activation and likelihood of receiving a cancer screen.
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Affiliation(s)
- Daniel Totzkay
- a Department of Communication , Michigan State University , East Lansing , Michigan , USA
| | - Kami J Silk
- a Department of Communication , Michigan State University , East Lansing , Michigan , USA
| | - Sarah E Sheff
- b Department of Communication , University of Kentucky , Lexington , Kentucky , USA
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Randhawa GS, Ahern DK, Hesse BW. Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care. HEALTH POLICY AND TECHNOLOGY 2017; 6:67-71. [PMID: 28948138 PMCID: PMC5609681 DOI: 10.1016/j.hlpt.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system. This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients. We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.
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Affiliation(s)
- Gurvaneet S Randhawa
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, 3E442, Bethesda, MD 20892-9761, United States
| | - David K Ahern
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
- Program in Behavioral Informatics and eHealth, Brigham & Women's Hospital, United States
| | - Bradford W Hesse
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
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