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Fritz Z, Griffiths FE, Slowther AM. Custodians of Information: Patient and Physician Views on Sharing Medical Records in the Acute Care Setting. HEALTH COMMUNICATION 2021; 36:1879-1888. [PMID: 32814466 PMCID: PMC8601592 DOI: 10.1080/10410236.2020.1803553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the UK, in the acute in-patient setting, the only information that a patient receives about their medical care is verbal; there is no routine patient access to any part of the medical record. It has been suggested that this should change, so that patients can have real-time access to their notes, but no one has previously explored patient or clinician views on the impact this might have. Semi-structured interviews were conducted with 12 patients and 13 doctors about their experience of information sharing in the context of the acute care setting, and their views on sharing all of the medical records, or a summary note. Interviews were transcribed verbatim, double coded and analyzed using the constant comparative method. Patients were not given written information and did not ask questions even when they wanted to know things. Patients and doctors supported increased sharing of written information, but the purpose of the medical record - and the risks and benefits of sharing it - were disputed. Concerns included disclosing uncertainty, changing what was written, and causing patient anxiety. Benefits included increased transparency. Use of a summary record was welcomed as a way to empower patients, while doctors felt they had a responsibility to curate what information was given and when. A clinical summary for patients would be of benefit to doctors, nurses, patients and their relatives. It should be designed to reflect the needs of all users, and evaluated to consider patient-relevant outcomes and resource implications.
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Affiliation(s)
- Zoe Fritz
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge
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2
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Cheng YC, Lee TT, Hwang YT, Chan PT, Mills ME. Exploring the Outcomes and Satisfaction of Automated Physiological Monitoring Systems Among Nurses. Comput Inform Nurs 2021; 40:178-185. [PMID: 35244032 DOI: 10.1097/cin.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vital signs are central to the assessment of physiologic functions of patients and must be included in the electronic health record. The purpose of this retrospective and cross-sectional design study was to evaluate use of-and satisfaction with-automated physiological monitoring systems. Usage data from a hospital database were analyzed 3, 6, and 12 months after implementation of the automated system (June 2018 to May 2019). In addition, questionnaires were completed by 168 nurses, and 20 nurses were interviewed between August/September 2020 and October/November 2020, respectively. Results revealed that usage frequency of automated physiological monitoring devices increased steadily with user familiarity. Although respondents indicated general satisfaction with the devices, system downtime, sufficiency of the battery charge, and data transmission speed were identified as needing correction to smooth workflow and boost work efficiency. Although most interviewees considered devices easy to use, some mentioned transmission speed of the gateway, scanner sensitivity, and accuracy of the ear thermometer as needing improvement. For nurses to use automated physiological monitoring devices fully, a user-friendly design in functions and features is vital, and in-service training and a streamlined workflow are recommended to facilitate technology adoption.
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Affiliation(s)
- Yu-Chen Cheng
- Author Affiliations: Department of Nursing, En Cku Kong Hospital (Mss Cheng and Chan), New Taipei City, Taiwan; College of Nursing, National Yang Ming Chiao Tung University (Dr Lee), Taipei, Taiwan; Department of Statistics, National Taipei University (Dr Hwang), New Taipei City, Taiwan; and School of Nursing, University of Maryland (Dr Mills), Baltimore
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3
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Baek J, Simon-Friedt B, Lopez A, Kolman JM, Nicolas J, Jones SL, Phillips RA, Menser T. Assessing Patient Needs During Natural Disasters: Mixed Methods Analysis of Portal Messages Sent During Hurricane Harvey. J Med Internet Res 2021; 23:e31264. [PMID: 34468328 PMCID: PMC8444041 DOI: 10.2196/31264] [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: 07/09/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient portals play an important role in connecting patients with their medical care team, which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients' needs increase, whereas available resources, specifically access to care, become limited. OBJECTIVE This study aims to examine patients' health needs during a natural crisis by analyzing the electronic messages sent during Hurricane Harvey to guide future disaster planning efforts. METHODS We explored patient portal use data from a large Greater Houston area health care system focusing on the initial week of the Hurricane Harvey disaster, beginning with the date of landfall, August 25, 2017, to August 31, 2017. A mixed methods approach was used to assess patients' immediate health needs and concerns during the disruption of access to routine and emergent medical care. Quantitative analysis used logistic regression models to assess the predictive characteristics of patients using the portal during Hurricane Harvey. This study also included encounters by type (emergency, inpatient, observation, outpatient, and outpatient surgery) and time (before, during, and after Hurricane Harvey). For qualitative analysis, the content of these messages was examined using the constant comparative method to identify emerging themes found within the message texts. RESULTS Out of a total of 557,024 patients, 4079 (0.73%) sent a message during Hurricane Harvey, whereas 31,737 (5.69%) used the portal. Age, sex, race, and ethnicity were predictive factors for using the portal and sending a message during the natural disaster. We found that prior use of the patient portal increased the likelihood of portal use during Hurricane Harvey (odds ratio 13.688, 95% CI 12.929-14.491) and of sending a portal message during the disaster (odds ratio 14.172, 95% CI 11.879-16.907). Having an encounter 4 weeks before or after Hurricane Harvey was positively associated with increased use of the portal and sending a portal message. Patients with encounters during the main Hurricane Harvey week had a higher increased likelihood of portal use across all five encounter types. Qualitative themes included: access, prescription requests, medical advice (chronic conditions, acute care, urgent needs, and Hurricane Harvey-related injuries), mental health, technical difficulties, and provider constraints. CONCLUSIONS The patient portal can be a useful tool for communication between patients and providers to address the urgent needs and concerns of patients as a natural disaster unfolds. This was the first known study to include encounter data to understand portal use compared with care provisioning. Prior use was predictive of both portal use and message sending during Hurricane Harvey. These findings could inform the types of demands that may arise in future disaster situations and can serve as the first step in intentionally optimizing patient portal usability for emergency health care management during natural disasters.
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Affiliation(s)
- Juha Baek
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | | | - Adriana Lopez
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Juan Nicolas
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Stephen L Jones
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Surgery, Houston Methodist, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Robert A Phillips
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Cardiology, Houston Methodist, Houston, TX, United States.,Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Surgery, Houston Methodist, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States.,Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States
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4
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Reading Turchioe M, Grossman LV, Myers AC, Baik D, Goyal P, Masterson Creber RM. Visual analogies, not graphs, increase patients' comprehension of changes in their health status. J Am Med Inform Assoc 2021; 27:677-689. [PMID: 31999316 DOI: 10.1093/jamia/ocz217] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Patients increasingly use patient-reported outcomes (PROs) to self-monitor their health status. Visualizing PROs longitudinally (over time) could help patients interpret and contextualize their PROs. The study sought to assess hospitalized patients' objective comprehension (primary outcome) of text-only, non-graph, and graph visualizations that display longitudinal PROs. MATERIALS AND METHODS We conducted a clinical research study in 40 hospitalized patients comparing 4 visualization conditions: (1) text-only, (2) text plus visual analogy, (3) text plus number line, and (4) text plus line graph. Each participant viewed every condition, and we used counterbalancing (systematic randomization) to control for potential order effects. We assessed objective comprehension using the International Organization for Standardization protocol. Secondary outcomes included response times, preferences, risk perceptions, and behavioral intentions. RESULTS Overall, 63% correctly comprehended the text-only condition and 60% comprehended the line graph condition, compared with 83% for the visual analogy and 70% for the number line (P = .05) conditions. Participants comprehended the visual analogy significantly better than the text-only (P = .02) and line graph (P = .02) conditions. Of participants who comprehended at least 1 condition, 14% preferred a condition that they did not comprehend. Low comprehension was associated with worse cognition (P < .001), lower education level (P = .02), and fewer financial resources (P = .03). CONCLUSIONS The results support using visual analogies rather than text to display longitudinal PROs but caution against relying on graphs, which is consistent with the known high prevalence of inadequate graph literacy. The discrepancies between comprehension and preferences suggest factors other than comprehension influence preferences, and that future researchers should assess comprehension rather than preferences to guide presentation decisions.
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Affiliation(s)
- Meghan Reading Turchioe
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Annie C Myers
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Dawon Baik
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ruth M Masterson Creber
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
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5
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Beal LL, Kolman JM, Jones SL, Khleif A, Menser T. Quantifying Patient Portal Use: Systematic Review of Utilization Metrics. J Med Internet Res 2021; 23:e23493. [PMID: 33629962 PMCID: PMC7952240 DOI: 10.2196/23493] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/16/2020] [Accepted: 01/31/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Use of patient portals has been associated with positive outcomes in patient engagement and satisfaction. Portal studies have also connected portal use, as well as the nature of users' interactions with portals, and the contents of their generated data to meaningful cost and quality outcomes. Incentive programs in the United States have encouraged uptake of health information technology, including patient portals, by setting standards for meaningful use of such technology. However, despite widespread interest in patient portal use and adoption, studies on patient portals differ in actual metrics used to operationalize and track utilization, leading to unsystematic and incommensurable characterizations of use. No known review has systematically assessed the measurements used to investigate patient portal utilization. OBJECTIVE The objective of this study was to apply systematic review criteria to identify and compare methods for quantifying and reporting patient portal use. METHODS Original studies with quantifiable metrics of portal use published in English between 2014 and the search date of October 17, 2018, were obtained from PubMed using the Medical Subject Heading term "Patient Portals" and related keyword searches. The first search round included full text review of all results to confirm a priori data charting elements of interest and suggest additional categories inductively; this round was supplemented by the retrieval of works cited in systematic reviews (based on title screening of all citations). An additional search round included broader keywords identified during the full-text review of the first round. Second round results were screened at abstract level for inclusion and confirmed by at least two raters. Included studies were analyzed for metrics related to basic use/adoption, frequency of use, duration metrics, intensity of use, and stratification of users into "super user" or high utilizers. Additional categories related to provider (including care team/administrative) use of the portal were identified inductively. Additional analyses included metrics aligned with meaningful use stage 2 (MU-2) categories employed by the US Centers for Medicare and Medicaid Services and the association between the number of portal metrics examined and the number of citations and the journal impact factor. RESULTS Of 315 distinct search results, 87 met the inclusion criteria. Of the a priori metrics, plus provider use, most studies included either three (26 studies, 30%) or four (23 studies, 26%) metrics. Nine studies (10%) only reported the patient use/adoption metric and only one study (1%) reported all six metrics. Of the US-based studies (n=76), 18 (24%) were explicitly motivated by MU-2 compliance; 40 studies (53%) at least mentioned these incentives, but only 6 studies (8%) presented metrics from which compliance rates could be inferred. Finally, the number of metrics examined was not associated with either the number of citations or the publishing journal's impact factor. CONCLUSIONS Portal utilization measures in the research literature can fall below established standards for "meaningful" or they can substantively exceed those standards in the type and number of utilization properties measured. Understanding how patient portal use has been defined and operationalized may encourage more consistent, well-defined, and perhaps more meaningful standards for utilization, informing future portal development.
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Affiliation(s)
- Lauren L Beal
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen L Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Aroub Khleif
- Ambulatory Clinical Systems, Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
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Greysen SR, Harrison JD, Rareshide C, Magan Y, Seghal N, Rosenthal J, Jacolbia R, Auerbach AD. A randomized controlled trial to improve engagement of hospitalized patients with their patient portals. J Am Med Inform Assoc 2019; 25:1626-1633. [PMID: 30346543 DOI: 10.1093/jamia/ocy125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives To test a patient-centered, tablet-based bedside educational intervention in the hospital and to evaluate the efficacy of this intervention to increase patient engagement with their patient portals during hospitalization and after discharge. Materials and Methods We conducted a randomized controlled trial of adult patients admitted to the hospitalist service in one large, academic medical center. All participants were supplied with a tablet computer for 1 day during their inpatient stay and assistance with portal registration and initial login as needed. Additionally, intervention group patients received a focused bedside education to demonstrate key functions of the portal and explain the importance of these functions to their upcoming transition to post-discharge care. Our primary outcomes were proportion of patients who logged into the portal and completed specific tasks after discharge. Secondary outcomes were observed ability to navigate the portal before discharge and self-reported patient satisfaction with bedside tablet use to access the portal. Results We enrolled 97 participants (50 intervention; 47 control); overall 57% logged into their portals ≥1 time within 7 days of discharge (58% intervention vs. 55% control). Mean number of logins was higher for the intervention group (3.48 vs. 2.94 control), and mean number of specific portal tasks performed was higher in the intervention group; however, no individual comparison reached statistical significance. Observed ability to login and navigate the portal in the hospital was higher for the intervention group (64% vs. 60% control), but only 1 specific portal task was significant (view provider messaging tab: 92% vs. 77% control, P = .04). Time needed to deliver the intervention was brief (<15 min for 80%), and satisfaction with the bedside tablet to access the portal was high in the intervention group (88% satisfied/very satisfied). Conclusion Our intervention was highly feasible and acceptable to patients, and we found a highly consistent, but statistically non-significant, trend towards higher inpatient engagement and post-discharge use of key portal functions among patients in the intervention group.
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Affiliation(s)
- S Ryan Greysen
- Section of Hospital Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James D Harrison
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Charles Rareshide
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Yimdriuska Magan
- School of Medicine, University of California Davis, Davis, CA, USA
| | - Neil Seghal
- School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | | | - Ronald Jacolbia
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
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Runaas L, Hoodin F, Munaco A, Fauer A, Sankaran R, Churay T, Mohammed S, Seyedsalehi S, Chappell G, Carlozzi N, Fetters MD, Kentor R, McDiarmid L, Brookshire K, Warfield C, Byrd M, Kaziunas S, Maher M, Magenau J, An L, Cohn A, Hanauer DA, Choi SW. Novel Health Information Technology Tool Use by Adult Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: Longitudinal Quantitative and Qualitative Patient-Reported Outcomes. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652535 PMCID: PMC6873938 DOI: 10.1200/cci.17.00110] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Health information technology (IT) is an ideal medium to improve the delivery of patient-centered care and increase patient engagement. Health IT interventions should be designed with the end user in mind and be specific to the needs of a given population. Hematopoietic cell transplantation (HCT), commonly referred to as blood and marrow transplantation (BMT), is a prime example of a complex medical procedure where patient-caregiver-provider engagement is central to a safe and successful outcome. We have previously reported on the design and development of an HCT-specific health IT tool, BMT Roadmap. Methods This study highlights longitudinal quantitative and qualitative patient-reported outcomes (PROs) in 20 adult patients undergoing allogeneic HCT. Patients completed PROs at three time points (baseline, day 30 post-HTC, and day 100 post-HCT) and provided weekly qualitative data through semistructured interviews while using BMT Roadmap. Results The mean hospital stay was 23.3 days (range, 17 to 37 days), and patients had access to BMT Roadmap for a mean of 21.3 days (range, 15 to 37 days). The total time spent on BMT Roadmap ranged from 0 to 139 minutes per patient, with a mean of 55 minutes (standard deviation, 47.6 minutes). We found that patients readily engaged with the tool and completed qualitative interviews and quantitative PROs. The Patient Activation Measure, a validated measure of patient engagement, increased for patients from baseline to discharge and day 100. Activation was significantly and negatively correlated with depression and anxiety PROs at discharge, suggesting that this may be an important time point for intervention. Conclusion Given the feasibility and promising results reported in this study, next steps include expanding our current health IT platform and implementing a randomized trial to assess the impact of BMT Roadmap on critical PROs.
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Affiliation(s)
- Lyndsey Runaas
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Flora Hoodin
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Anna Munaco
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Alex Fauer
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Roshun Sankaran
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Tracey Churay
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Saara Mohammed
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sajjad Seyedsalehi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Grant Chappell
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Noelle Carlozzi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Michael D Fetters
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Rachel Kentor
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Leah McDiarmid
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Kristina Brookshire
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Casiana Warfield
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Michelle Byrd
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sharon Kaziunas
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Molly Maher
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - John Magenau
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Larry An
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Amy Cohn
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - David A Hanauer
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sung Won Choi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
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Foster B, Krasowski MD. The Use of an Electronic Health Record Patient Portal to Access Diagnostic Test Results by Emergency Patients at an Academic Medical Center: Retrospective Study. J Med Internet Res 2019; 21:e13791. [PMID: 31254335 PMCID: PMC6625217 DOI: 10.2196/13791] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/14/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electronic health record (EHR) patient portals provide a means by which patients can access their health information, including diagnostic test results. Little is known about portal usage by emergency department (ED) patients. OBJECTIVE The study aimed to assess patient portal utilization by ED patients at an academic medical center using account activation rates along with the rates of access of diagnostic test results (laboratory results and radiology reports), analyzing the impact of age, gender, and self-reported patient race. METHODS This institutional review board-approved retrospective study was performed at a 60,000-visits-per-year university-based ED. We utilized EHR data reporting tools to examine EHR portal activation and utilization for all patients who had at least one ED encounter with one or more diagnostic tests performed between October 1, 2016, and October 1, 2017. The total dataset for laboratory testing included 208,635 laboratory tests on 25,361 unique patients, of which 9482 (37.39%) had active portal accounts. The total dataset for radiologic imaging included 23,504 radiology studies on 14,455 unique patients, of which 5439 (37.63%) had an active portal account. RESULTS Overall, 8.90% (18,573/208,635) of laboratory tests and 8.97% (2019/22,504) of radiology reports ordered in the ED were viewed in the patient portal. The highest rates of viewing of laboratory and radiology results were seen for those who were female, were aged 0 to 11 years (parent or guardian viewing by proxy) and 18 to 60 years, and self-reported their race as Caucasian or Asian. The lowest rates were for those who were teenagers, aged older than 81 years, African American/black, and Hispanic/Latino. Infectious disease, urinalysis, and pregnancy testing constituted the highest number of laboratory tests viewed. Magnetic resonance imaging reports were viewed at higher rates than computed tomography or x-ray studies (P<.001). Approximately half of all the diagnostic test results accessed by patients were reviewed within 72 hours of availability in the patient portal (laboratory results: 9904/18,573, 53.32% and radiology reports: 971/2019, 48.1%). On the other extreme, 19.9% (3701/18,573) of laboratory results and 31.6% (639/2019) of radiology reports were viewed more than 2 weeks after availability in the portal. CONCLUSIONS The data highlight the relatively low use of a patient portal by ED patients and existing disparities between patient groups. There can be wide lag time (months) between result/report availability and access by patients. Opportunities for improvement exist for both activation and more robust utilization of patient portals by ED patients.
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Affiliation(s)
- Brody Foster
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Matthew David Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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9
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Inpatients Sign On: An Opportunity to Engage Hospitalized Patients and Caregivers Using Inpatient Portals. Med Care 2019; 57:98-100. [PMID: 30520834 DOI: 10.1097/mlr.0000000000001043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inpatient portals are online patient portals linked to electronic health records that provide hospitalized patients and caregivers secure access to real-time clinical information and tools to enhance their communication with providers and hospital experience. OBJECTIVE The main objective of this commentary was to provide a perspective that inpatient portals are innovative tools poised to engage patients and caregivers during hospitalization and, thus, enhance patient-centered care. RESULTS Inpatient portals are desired by patients and caregivers and may contribute to improved recognition of their inpatient care team, knowledge of their treatment plan and overall inpatient experience. A sociotechnical systems approach is recommended to mitigate potential unintended consequences of inpatient portal use and support effective portal design, implementation and evaluation. CONCLUSIONS This article highlights the potential of using inpatient portals to engage hospitalized patients and caregivers and proposes next steps to evaluate this emerging technology.
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10
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Dumitrascu AG, Burton MC, Dawson NL, Thomas CS, Nordan LM, Greig HE, Aljabri DI, Naessens JM. Patient portal use and hospital outcomes. J Am Med Inform Assoc 2019; 25:447-453. [PMID: 29300961 DOI: 10.1093/jamia/ocx149] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives To determine whether use of a patient portal during hospitalization is associated with improvement in hospital outcomes, 30-day readmissions, inpatient mortality, and 30-day mortality. Materials and Methods We performed a retrospective propensity score-matched study that included all adult patients admitted to Mayo Clinic Hospital in Jacksonville, Florida, from August 1, 2012, to July 31, 2014, who had signed up for a patient portal account prior to hospitalization (N = 7538). Results Out of the admitted patients with a portal account, 1566 (20.8%) accessed the portal while in the hospital. Compared to patients who did not access the portal, patients who accessed the portal were younger (58.8 years vs 62.3 years), had fewer elective admissions (54.2% vs 64.1%), were more frequently admitted to medical services (45.8% vs 35.2%), and were more likely to have liver disease (21.9% vs 12.9%) and higher disease severity scores (0.653 vs 0.456). After propensity score matching, there was no statistically significant difference between the 2 cohorts with respect to 30-day readmission (P = .13), inpatient mortality (P = .82), or 30-day mortality (P = .082). Conclusion Use of the patient portal in the inpatient setting may not improve hospital outcomes. Future research should examine the association of portal use with more immediate inpatient health outcomes such as patient experience, patient engagement, medication reconciliation, and prevention of adverse events.
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Affiliation(s)
- Adrian G Dumitrascu
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - M Caroline Burton
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nancy L Dawson
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen S Thomas
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Lisa M Nordan
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Hope E Greig
- Administration, Mayo Clinic, Jacksonville, FL, USA
| | - Duaa I Aljabri
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - James M Naessens
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA.,Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
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11
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Masterson Creber RM, Grossman LV, Ryan B, Qian M, Polubriaginof FCG, Restaino S, Bakken S, Hripcsak G, Vawdrey DK. Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal. J Am Med Inform Assoc 2019; 26:115-123. [PMID: 30534990 PMCID: PMC6339515 DOI: 10.1093/jamia/ocy146] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the effects of an inpatient portal intervention on patient activation, patient satisfaction, patient engagement with health information, and 30-day hospital readmissions. Methods and Materials From March 2014 to May 2017, we enrolled 426 English- or Spanish-speaking patients from 2 cardiac medical-surgical units at an urban academic medical center. Patients were randomized to 1 of 3 groups: 1) usual care, 2) tablet with general Internet access (tablet-only), and 3) tablet with an inpatient portal. The primary study outcome was patient activation (Patient Activation Measure-13). Secondary outcomes included all-cause readmission within 30 days, patient satisfaction, and patient engagement with health information. Results There was no evidence of a difference in patient activation among patients assigned to the inpatient portal intervention compared to usual care or the tablet-only group. Patients in the inpatient portal group had lower 30-day hospital readmissions (5.5% vs. 12.9% tablet-only and 13.5% usual care; P = 0.044). There was evidence of a difference in patient engagement with health information between the inpatient portal and tablet-only group, including looking up health information online (89.6% vs. 51.8%; P < 0.001). Healthcare providers reported that patients found the portal useful and that the portal did not negatively impact healthcare delivery. Conclusions Access to an inpatient portal did not significantly improve patient activation, but it was associated with looking up health information online and with a lower 30-day hospital readmission rate. These results illustrate benefit of providing hospitalized patients with real-time access to their electronic health record data while in the hospital. Trial Registration ClinicalTrials.gov Identifier: NCT01970852.
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Affiliation(s)
- Ruth M Masterson Creber
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Beatriz Ryan
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Min Qian
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Fernanda C G Polubriaginof
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susan Restaino
- Columbia University Medical Center, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Data Science Institute, Columbia University, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
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12
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Grossman LV, Masterson Creber RM, Ancker JS, Ryan B, Polubriaginof F, Qian M, Alarcon I, Restaino S, Bakken S, Hripcsak G, Vawdrey DK. Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use. Appl Clin Inform 2019; 10:40-50. [PMID: 30650448 PMCID: PMC6335107 DOI: 10.1055/s-0038-1676971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/22/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use. OBJECTIVE To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance. MATERIALS AND METHODS This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use. RESULTS More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay. DISCUSSION AND CONCLUSION Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.
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Affiliation(s)
- Lisa V. Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Ruth M. Masterson Creber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Jessica S. Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Beatriz Ryan
- Value Institute, New York-Presbyterian Hospital, New York, New York, United States
| | | | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Irma Alarcon
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Susan Restaino
- Department of Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - David K. Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
- Value Institute, New York-Presbyterian Hospital, New York, New York, United States
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13
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Grossman LV, Masterson Creber RM, Ryan B, Restaino S, Alarcon I, Polubriaginof F, Bakken S, Vawdrey DK. Providers' Perspectives on Sharing Health Information through Acute Care Patient Portals. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1273-1281. [PMID: 30815169 PMCID: PMC6371328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Engaging healthcare providers in acute care patient portal implementation is critical to ensure productive use. However, few studies have assessed provider's perceptions of an acute care portal after implementation. In this study, we surveyed 63 nurses, physicians, and physician assistants following a 3-year randomized trial of an acute care portal. The survey assessed providers' perceptions of the portal and its impact on care delivery. Respondents reported that the portal positively impacted care, and they perceived that their patients found it usable and trustworthy. Respondents reported that all the portal's features were useful, especially the display of laboratory test results. Compared with the results of a patient survey, providers underestimated the portal's usefulness to patients, and ranked features as very useful significantly less often than patients (57% vs. 74%; p<0.001). Our study found that providers supported their patients' use of the portal, but may have underappreciated the portal's value to patients.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY
- College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - Beatriz Ryan
- Value Institute, NewYork-Presbyterian Hospital, New York, NY
| | - Susan Restaino
- Department of Medicine, Columbia University, New York, NY
| | - Irma Alarcon
- Department of Medicine, Columbia University, New York, NY
| | | | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY
- School of Nursing, Columbia University, New York, NY
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY
- Value Institute, NewYork-Presbyterian Hospital, New York, NY
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14
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Prey JE, Polubriaginof F, Grossman LV, Masterson Creber R, Tsapepas D, Perotte R, Qian M, Restaino S, Bakken S, Hripcsak G, Efird L, Underwood J, Vawdrey DK. Engaging hospital patients in the medication reconciliation process using tablet computers. J Am Med Inform Assoc 2018; 25:1460-1469. [PMID: 30189000 PMCID: PMC7263785 DOI: 10.1093/jamia/ocy115] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/30/2018] [Accepted: 08/10/2018] [Indexed: 12/30/2022] Open
Abstract
Objective Unintentional medication discrepancies contribute to preventable adverse drug events in patients. Patient engagement in medication safety beyond verbal participation in medication reconciliation is limited. We conducted a pilot study to determine whether patients' use of an electronic home medication review tool could improve medication safety during hospitalization. Materials and Methods Patients were randomized to use a tool before or after hospital admission medication reconciliation to review and modify their home medication list. We assessed the quantity, potential severity, and potential harm of patients' and clinicians' medication changes. We also surveyed clinicians to assess the tool's usefulness. Results Of 76 patients approached, 65 (86%) participated. Forty-eight (74%) made changes to their home medication list [before: 29 (81%), after: 19 (66%), p = .170]. Before group participants identified 57 changes that clinicians subsequently missed on admission medication reconciliation. Thirty-nine (74%) had a significant or greater potential severity, and 19 (36%) had a greater than 50-50 chance of harm. After group patients identified 68 additional changes to their reconciled medication lists. Fifty-one (75%) had a significant or greater potential severity, and 33 (49%) had a greater than 50-50 chance of harm. Clinicians reported believing that the tool would save time, and patients would supply useful information. Discussion The results demonstrate a high willingness of patients to engage in medication reconciliation, and show that patients were able to identify important medication discrepancies and often changes that clinicians missed. Conclusion Engaging patients in admission medication reconciliation using an electronic home medication review tool may improve medication safety during hospitalization.
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Affiliation(s)
- Jennifer E Prey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | | | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | | | - Demetra Tsapepas
- Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
- Department of Surgery, Columbia University, New York, New York, USA
| | - Rimma Perotte
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Min Qian
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Susan Restaino
- Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
- Department of Medicine, Columbia University, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- School of Nursing, Columbia University, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Leigh Efird
- Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Joseph Underwood
- Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
- Department of Medicine, Columbia University, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
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Sieck CJ, Walker DM, Hefner JL, Volney J, Huerta TR, McAlearney AS. Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement. Appl Clin Inform 2018; 9:860-868. [PMID: 30517969 PMCID: PMC6281442 DOI: 10.1055/s-0038-1675814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature. OBJECTIVE To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal. MATERIALS AND METHODS This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). We analyzed a total of 2,598 messages, categorizing them by sender (patient, family, or care team member), type, and topic, and conducted a descriptive analysis of categories and an examination of code co-occurrence. RESULTS Patients were the most frequent message senders (63%); family members sent the fewest messages (10%). We identified five types of messages: Alert/Request; Thanks; Response; Question; and Other (typo/test message). Patient messages included Alerts/Requests (38%), Questions (31%), Statements of Thanks (24%), Response (1.2%), and Other (5%). We also identified 14 nonmutually exclusive message topics: Medication; Procedure/Treatment Plan; Schedule; Pain; Results; Diet; Discharge; Non-Medication Questions; Provider Requests; Symptoms; Custodial; Technical Issues; Potential Error; and Contact Information. Patient message topics most commonly discussed Symptoms (18%), Procedure/Treatment Plan (14%), or Pain (12%). CONCLUSION Our analysis of secure message content suggests certain message types and topics such as Alerts/Requests and Questions about symptoms and treatment plans are particularly important to patients. These findings demonstrate that both patients and family members utilize the secure messaging function to engage in the care process by posing questions, making requests, and alerting staff to problems. As this technology is implemented in additional facilities, future work should examine how use of secure messaging may be influenced by factors including patients' demographics, reasons for hospitalization, and length of stay.
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Affiliation(s)
- Cynthia J. Sieck
- 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, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - 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, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jennifer L. Hefner
- 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, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jaclyn Volney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Timothy R. Huerta
- 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, 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
| | - 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, 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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Tiase VL, Hull SC, Troseth M, Schnall R. Development and psychometric testing of the Readiness to Engage with Patient-Facing Health Information Technology Tools (RE-PHIT) scale. Int J Med Inform 2018; 118:1-4. [DOI: 10.1016/j.ijmedinf.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/26/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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17
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Stein JN, Klein JW, Payne TH, Jackson SL, Peacock S, Oster NV, Carpenter TP, Elmore JG. Communicating with Vulnerable Patient Populations: A Randomized Intervention to Teach Inpatients to Use the Electronic Patient Portal. Appl Clin Inform 2018; 9:875-883. [PMID: 30541152 PMCID: PMC6291377 DOI: 10.1055/s-0038-1676333] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/14/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations. OBJECTIVE This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals. METHODS Patients at a safety net hospital were randomly assigned to portal use education or usual care. Surveys assessed perceptions of discharge paperwork and the electronic portal. RESULTS Of the 202 prescreened eligible patients (e.g., deemed mentally competent, spoke English, and had a telephone), only 43% had working emails. Forty-four percent of participants did not remember receiving or reading discharge paperwork. Patients trained in portal use (n = 47) or receiving usual care (n = 23) preferred hospitals with online record access (85 and 83%, respectively), and felt that online access would increase their trust in doctors (85 and 87%) and satisfaction with care (91% each). Those who received training in portal use were more likely to register for the portal (48% vs. 11%; p < 0.01). CONCLUSION Patients had positive perceptions of portals, and education increased portal use. Lack of email access is a notable barrier to electronic communication with vulnerable patients.
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Affiliation(s)
- Jacob N. Stein
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Jared W. Klein
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Thomas H. Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Information Technology Services, University of Washington School of Medicine, Seattle, Washington, United States
| | - Sara L. Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Natalia V. Oster
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Trinell P. Carpenter
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Joann G. Elmore
- University of California, Los Angeles, California, United States
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Aljabri D, Dumitrascu A, Burton MC, White L, Khan M, Xirasagar S, Horner R, Naessens J. Patient portal adoption and use by hospitalized cancer patients: a retrospective study of its impact on adverse events, utilization, and patient satisfaction. BMC Med Inform Decis Mak 2018; 18:70. [PMID: 30053809 PMCID: PMC6062873 DOI: 10.1186/s12911-018-0644-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 06/26/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Portal use has been studied among outpatients, but its utility and impact on inpatients is unclear. This study describes portal adoption and use among hospitalized cancer patients and investigates associations with selected safety, utilization, and satisfaction measures. METHODS A retrospective review of 4594 adult hospitalized cancer patients was conducted between 2012 and 2014 at Mayo Clinic in Jacksonville, Florida, comparing portal adopters, who registered for a portal account prior to hospitalization, with nonadopters. Adopters were classified by their portal activity during hospitalization as active or inactive inpatient users. Univariate and several logistic and linear regression models were used for analysis. RESULTS Of total patients, 2352 (51.2%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Portal adoption was associated with patients who were young, female, married, with higher income, and had more frequent hospitalizations (P < .05). Active inpatient use was associated with patients who were young, married, nonlocals, with higher disease severity, and were hospitalized for medical treatment (P < .05). In univariate analyses, self-management knowledge scores were higher among adopters vs nonadopters (84.3 and 80.0, respectively; P = .01) and among active vs inactive inpatient users (87.0 and 83.3, respectively; P = .04). In regression models adjusted for age and disease severity, the association between portal behaviors and majority of measures were not significant (P > .05). CONCLUSIONS Over half of our cancer inpatients adopted a portal prior to hospitalization, with increased adoption associated with predisposing and enabling determinants (eg: age, sex, marital status, income), and increased inpatient use associated with need (eg: nonlocal residence and disease severity). Additional research and greater effort to expand the portal functionality is needed to impact inpatient outcomes.
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Affiliation(s)
- Duaa Aljabri
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL USA
| | - Adrian Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - M. Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - Launia White
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL USA
| | - Mahmud Khan
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - James Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
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Hefner JL, Sieck CJ, McAlearney AS. Training to Optimize Collaborative Use of an Inpatient Portal. Appl Clin Inform 2018; 9:558-564. [PMID: 30045386 DOI: 10.1055/s-0038-1666993] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Inpatient portals are an emerging technology that can facilitate collaborative interactions between patients and care teams, but little is known about how organizations attempt to implement and facilitate inpatient portal use for their providers. METHODS We held in-person, semistructured interviews with care team members and information technology (IT) staff and conducted rigorous thematic analysis of transcripts. RESULTS Interviews with 220 care team members and 4 IT staff identified 3 new areas of training needed to optimize inpatient portal implementation and use that extend beyond training to use other technologies: (1) teaching staff to train patients about tool use; (2) training about how to promote tool use to patients; and (3) training about optimal use of secure messaging. DISCUSSION Our findings show that inpatient portals are implemented within a collaborative multistakeholder context. Training efforts must consider the importance of this collaborative context to help providers learn to both incorporate the technology into their workflow and assist patients with portal use.
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Affiliation(s)
- Jennifer L Hefner
- 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 in Health Services and Implementation Science Research (Catalyst), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Cynthia J Sieck
- 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 in Health Services and Implementation Science Research (Catalyst), 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 in Health Services and Implementation Science Research (Catalyst), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, 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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20
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Framework for Evaluating and Implementing Inpatient Portals: a Multi-stakeholder Perspective. J Med Syst 2018; 42:158. [DOI: 10.1007/s10916-018-1009-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/02/2018] [Indexed: 01/06/2023]
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21
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Grossman LV, Feiner SK, Mitchell EG, Masterson Creber RM. Leveraging Patient-Reported Outcomes Using Data Visualization. Appl Clin Inform 2018; 9:565-575. [PMID: 30068012 PMCID: PMC6070388 DOI: 10.1055/s-0038-1667041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Health care organizations increasingly use patient-reported outcomes (PROs) to capture patients' health status. Although federal policy mandates PRO collection, the challenge remains to better engage patients in PRO surveys, and ensure patients comprehend the surveys and their results. OBJECTIVE This article identifies the design requirements for an interface that assists patients with PRO survey completion and interpretation, and then builds and evaluates the interface. METHODS We employed a user-centered design process that consisted of three stages. First, we conducted qualitative interviews and surveys with 13 patients and 11 health care providers to understand their perceptions of the value and challenges associated with the use of PRO measures. Second, we used the results to identify design requirements for an interface that collects PROs, and designed the interface. Third, we conducted usability testing with 12 additional patients in a hospital setting. RESULTS In interviews, patients and providers reported that PRO surveys help patients to reflect on their symptoms, potentially identifying new opportunities for improved care. However, 6 out of 13 patients reported significant difficultly in understanding PRO survey questions, answer choices and results. Therefore, we identified aiding comprehension as a key design requirement, and incorporated visualizations into our interface design to aid comprehension. In usability testing, patients found the interface highly usable. CONCLUSION Future interfaces designed to collect PROs may benefit from employing strategies such as visualization to aid comprehension and engage patients with surveys.
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Affiliation(s)
- Lisa V. Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
- College of Physicians and Surgeons, Columbia University, New York, New York, United States
| | - Steven K. Feiner
- Department of Computer Science, Columbia University, New York, New York, United States
| | - Elliot G. Mitchell
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
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22
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Grossman LV, Creber RM, Restaino S, Vawdrey DK. Sharing Clinical Notes with Hospitalized Patients via an Acute Care Portal. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:800-809. [PMID: 29854146 PMCID: PMC5977594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Though several institutions offer hospitalized patients access to their medical records through acute care patient portals, no studies have assessed the potential impact of patients' access to physicians' notes through these systems. We employed a mixed-methods approach, including patient surveys, system usage log analysis, and qualitative interviews, to describe patients' perspectives on receiving their clinical notes and usage of the clinical notes feature in an acute care patient portal. Patients visited the clinical notes feature more frequently and for longer durations than any other feature. In qualitative interviews, patients reported improved access to information, better insight into their conditions, decreased anxiety, increased appreciation for clinicians, improvements in health behaviors, and more engagement in care. Our results suggest that sharing notes with hospitalized patients is feasible and beneficial, although further studies should investigate the magnitude of benefit and explore the unintended negative consequences associated with increased transparency of clinical information.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY
| | | | - Susan Restaino
- Department of Medicine, Columbia University, New York, NY
| | - David K Vawdrey
- Value Institute, NewYork-Presbyterian Hospital, New York, NY
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23
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Grossman LV, Choi SW, Collins S, Dykes PC, O’Leary KJ, Rizer M, Strong P, Yen PY, Vawdrey DK. Implementation of acute care patient portals: recommendations on utility and use from six early adopters. J Am Med Inform Assoc 2018; 25:370-379. [PMID: 29040634 PMCID: PMC7646852 DOI: 10.1093/jamia/ocx074] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 02/02/2023] Open
Abstract
Objective To provide recommendations on how to most effectively implement advanced features of acute care patient portals, including: (1) patient-provider communication, (2) care plan information, (3) clinical data viewing, (4) patient education, (5) patient safety, (6) caregiver access, and (7) hospital amenities. Recommendations We summarize the experiences of 6 organizations that have implemented acute care portals, representing a variety of settings and technologies. We discuss the considerations for and challenges of incorporating various features into an acute care patient portal, and extract the lessons learned from each institution's experience. We recommend that stakeholders in acute care patient portals should: (1) consider the benefits and challenges of generic and structured electronic care team messaging; (2) examine strategies to provide rich care plan information, such as daily schedule, problem list, care goals, discharge criteria, and post-hospitalization care plan; (3) offer increasingly comprehensive access to clinical data and medical record information; (4) develop alternative strategies for patient education that go beyond infobuttons; (5) focus on improving patient safety through explicit safety-oriented features; (6) consider strategies to engage patient caregivers through portals while remaining cognizant of potential Health Insurance Portability and Accountability Act (HIPAA) violations; (7) consider offering amenities to patients through acute care portals, such as information about navigating the hospital or electronic food ordering.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Sung W Choi
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sarah Collins
- Partners Healthcare System, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patricia C Dykes
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kevin J O’Leary
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Milisa Rizer
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | | | - Po-Yin Yen
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- Value Institute, NewYork–Presbyterian Hospital, New York, NY, USA
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24
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Yen PY, Walker DM, Smith JMG, Zhou MP, Menser TL, McAlearney AS. Usability evaluation of a commercial inpatient portal. Int J Med Inform 2018; 110:10-18. [DOI: 10.1016/j.ijmedinf.2017.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/20/2017] [Accepted: 11/12/2017] [Indexed: 10/18/2022]
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25
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Grossman LV, Restaino S, Vawdrey D. Should Hospital Patients Have Bedside Access to Their Complete Medical Records? J Particip Med 2017; 9:e11. [PMID: 36262010 PMCID: PMC8080438 DOI: 10.2196/jopm.8844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Robinson JR, Davis SE, Cronin RM, Jackson GP. Use of a Patient Portal During Hospital Admissions to Surgical Services. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2017; 2016:1967-1976. [PMID: 28269956 PMCID: PMC5333326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patient portal research has focused on medical outpatient settings, with little known about portal use during hospitalizations or by surgical patients. We measured portal adoption among patients admitted to surgical services over two years. Surgical services managed 37,025 admissions of 31,310 unique patients. One-fourth of admissions (9,362, 25.3%) involved patients registered for the portal. Registration rates were highest for admissions to laparoscopic/gastrointestinal (55%) and oncology/endocrine (50%) services. Portal use occurred during 1,486 surgical admissions, 4% of all and 16% of those registered at admission. Inpatient portal use was associated with patients who were white, male, and had longer lengths of stay (p < 0.01). Viewing health record data and secure messaging were the most commonly used functions, accessed in 4,836 (72.9%) and 1,626 (24.5%) user sessions. Without specific encouragement, hospitalized surgical patients are using our patient portal. The surgical inpatient setting may provide opportunities for patient engagement using patient portals.
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27
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Prey JE, Qian M, Restaino S, Hibbard J, Bakken S, Schnall R, Rothenberg G, Vawdrey DK, Masterson Creber R. Reliability and validity of the patient activation measure in hospitalized patients. PATIENT EDUCATION AND COUNSELING 2016; 99:2026-2033. [PMID: 27422339 PMCID: PMC5121059 DOI: 10.1016/j.pec.2016.06.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/24/2016] [Accepted: 06/26/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The purposes of this paper are to describe the internal consistency reliability and construct validity of the PAM-13 for hospitalized cardiology and oncology patients and to examine the predictors of low patient activation in the same population. METHODS We evaluated the internal consistency reliability of the PAM-13 in the inpatient setting. Construct validity of the PAM-13 was then assessed using two approaches: expected known-groups differences between patients with planned and unplanned admissions PAM-13 levels and convergence of PAM-13 levels with other measures. RESULTS The PAM demonstrated adequate internal consistency overall (Cronbach α=0.81). Patients with unplanned admissions were more likely to have low activation than patients with planned admissions (adjusted OR=5.7, p=0.008). The PAM-13 was modestly correlated (p<0.001) with each of the PROMIS Global Health components used in this study (global, physical and mental health). CONCLUSION This study demonstrates the PAM-13 is a reliable and valid measure for use in the inpatient hospital setting and that type of admission (planned versus unplanned) is an important predictor of patient activation. PRACTICE IMPLICATIONS By measuring patient activation with the PAM-13, clinicians and researchers can provide tailored communication and care strategies to meet patient's needs.
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Affiliation(s)
- Jennifer E Prey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.
| | - Min Qian
- Department of Biostatistics, Columbia University, New York, NY, USA
| | | | - Judith Hibbard
- Institute for Policy Research and Innovation, University of Oregon, Eugene, OR, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; School of Nursing, Columbia University, New York, NY, USA
| | | | | | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA
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28
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Patmon FL, Gee PM, Rylee TL, Readdy NL. Using Interactive Patient Engagement Technology in Clinical Practice: A Qualitative Assessment of Nurses' Perceptions. J Med Internet Res 2016; 18:e298. [PMID: 27836817 PMCID: PMC5124111 DOI: 10.2196/jmir.5667] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/01/2016] [Accepted: 10/30/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research has shown patients who are more engaged in their care are likely to have better health outcomes and reduced health care costs. Health care organizations are now focusing their efforts in finding ways to improve patient engagement. At the forefront of this movement are patient engagement technology systems. In this paper, these emerging systems are described as interactive patient engagement technologies (iPET). OBJECTIVE The objective of this descriptive study was to gain an understanding of the perceptions of nurses who are integrating these iPET systems into their daily clinical practice. METHODS The research team interviewed 38 nurses from 2 California-based hospitals using a focused rapid ethnographic evaluation methodology to gather data. RESULTS The study participants reported that using iPET systems may enhance clinical nursing practice. The 4 key findings of iPET were that it (1) is effective for distraction therapy, (2) has functionality that affects both patients and nurses, (3) has implications for clinical practice, and (4) may require additional training to improve usage. CONCLUSIONS With sufficient training on the iPET system, nurses believed they could use these technologies as an enhancement to their clinical practice. Additionally, nurses perceived these systems served as distraction therapy for patients. Initial findings suggest that iPET is beneficial, but more research is required to examine the usefulness of iPET systems in the inpatient settings.
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Affiliation(s)
- Frances L Patmon
- Nursing Research and Analytics, Dignity Health, Phoenix, AZ, United States
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Perry M Gee
- Nursing Research and Analytics, Dignity Health, Phoenix, AZ, United States
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Tina L Rylee
- Nursing Research and Analytics, Dignity Health, Phoenix, AZ, United States
- Department of Psychology, California State University, Sacramento, CA, United States
| | - Noriann L Readdy
- Patient Care Services, Dignity Health, San Francisco, CA, United States
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