The influence of patient portals on users' decision making is insufficiently investigated: A systematic methodological review

Patient online access to medical records in general practice: Perceived effects after one year follow-up

OBJECTIVE

Online access to medical records is expected to foster patient empowerment and patient-centred healthcare. However, data on actual experienced effects remain limited. We aimed to examine the development of effects patients perceive from online access.

METHODS

A nationwide online survey (N = 1769) evaluated Dutch patients' use of online access and beliefs about its effects on 16 outcomes at baseline and one-year follow-up. Analyses of Variance (ANOVA) were used to examine within-person belief changes across three user groups: patients who 1) used online access before the study, 2) started use during the study, and 3) did not use it at all.

RESULTS

There was a small decline in five beliefs around online access facilitating patient empowerment and participation in participants who started using online access during the study compared to at least one other user group. Most changes in beliefs did not differ between groups.

CONCLUSION

No evidence of benefits from online access was found. The findings might indicate inadequacies in the current system of online access. Possibly, the benefits of online access are contingent upon portal improvements and changes in documentation practices.

PRACTICE IMPLICATION

Records need to be easily accessible and comprehensible for patients. Consultation practices should enable patient participation.

From code to care: Clinician and researcher perspectives on an optimal therapeutic web portal for acute myeloid leukemia

BACKGROUND

Acute myeloid leukemia (AML), a rapidly progressing cancer of the blood and bone marrow, is the most common and fatal type of adult leukemia. Therapeutic web portals have great potential to facilitate AML research advances and improve health outcomes by increasing the availability of data, the speed and reach of new knowledge, and the communication between researchers and clinicians in the field. However, there is a need for stakeholder research regarding their optimal features, utility, and implementation.

METHODS

To better understand stakeholder perspectives regarding an ideal pan-Canadian web portal for AML research, semi-structured qualitative interviews were conducted with 17 clinicians, researchers, and clinician-researchers. Interview guides were inspired by De Laat's "fictive scripting", a method where experts are presented with scenarios about a future technology and asked questions about its implementation. Content analysis relied on an iterative process using themes extracted from both existing scientific literature and the data.

RESULTS

Participants described potential benefits of an AML therapeutic portal including facilitating data-sharing, communication, and collaboration, and enhancing clinical trial matchmaking for patients, potentially based on their specific genomic profiles. There was enthusiasm about researcher, clinician, and clinician-researcher access, but some disagreement about the nature of potential patient access to the portal. Interviewees also discussed two key elements they believed to be vital to the uptake and thus success of a therapeutic AML web portal: credibility and user friendliness. Finally, sustainability, security and privacy concerns were also documented.

CONCLUSIONS

This research adds to existing calls for digital platforms for researchers and clinicians to supplement extant modes of communication to streamline research and its dissemination, advance precision medicine, and ultimately improve patient prognosis and care. Findings are applicable to therapeutic web portals more generally, particularly in genomic and translational medicine, and will be of interest to portal end-users, developers, researchers, and policymakers.

How do opt-in versus opt-out settings nudge patients toward electronic health record adoption? An exploratory study of facilitators and barriers in Austria and France

BACKGROUND

Electronic health records (EHR) are becoming an integral part of the health system in many developed countries, though implementations and settings vary across countries. Some countries have adopted an opt-out policy, in which patients are enrolled in the EHR system following a default nudge, while others have applied an opt-in policy, where patients have to take action to opt into the system. While opt-in systems may exhibit lower levels of active user requests for access, this contrasts with opt-out systems where a notable percentage of users may passively retain access. Thus, our research endeavor aims to explore facilitators and barriers that contribute to explaining EHR usage (i.e., actively accessing the EHR system) in two countries with either an opt-in or opt-out setting, exemplified by France and Austria.

METHODS

A qualitative exploratory approach using a semi-structured interview guideline was undertaken in both countries: 1) In Austria, with four homogenously composed group discussions, and 2) in France, with 19 single patient interviews. The data were collected from October 2020 to January 2021.

RESULTS

Influencing factors were categorized into twelve subcategories. Patients have similar experiences in both countries with regard to all facilitating categories, for instance, the role of health providers, awareness of EHR and social norms. However, we highlighted important differences between the two systems regarding hurdles impeding EHR usage, namely, a lack of communication as well as transparency or information security about EHR.

CONCLUSION

Implementing additional safeguards to enhance privacy protection and supporting patients to improve their digital ability may help to diminish the perception of EHR-induced barriers and improve patients' health and commitment in the long term.

PRACTICAL IMPLICATIONS

Understanding the differences and similarities will help to develop practical implications to tackle the problem of low EHR usage rates in the long run. This problem is prevalent in countries with both types of EHR default settings.

The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study

BACKGROUND

Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested.

OBJECTIVE

This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients.

METHODS

A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders.

RESULTS

Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between -0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects.

CONCLUSIONS

Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality.

Developing the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) in primary care: A mixed-method survey of healthcare consumers and professionals

BACKGROUND

Evidence-based models are effective tools for informing quality improvement activities in health care. The Quality in Nutrition Care (QUINCE) model is an evidence-based model that describes quality nutrition care in the primary care setting but has not been applied to primary care dietetics. The present study comprised two phases. In the first phase, the study aimed to evaluate and compare healthcare consumers and professional perspectives on the importance of the 10 statements to understand their relevance for dietetics care. In the second phase, the study aimed to test and enhance the QUINCE model using healthcare consumer and professional responses to statements that were identified as relevant to primary care dietetics in the first phase.

METHODS

Quantitative and qualitative data were collected using an online survey comprising statements describing quality dietetic care adapted from the complexity literature. Quantitative data were analysed using descriptive statistical analysis to investigate statement importance as rated by participants using a six-point Likert scale. Qualitative content analysis was performed on the qualitative data using a deductive-inductive approach to identify patterns in the data. The QUINCE model was compared with identified patterns and modified as appropriate.

RESULTS

One hundred and fourteen consumers and 107 primary care professionals agreed on the importance of seven statements but expressed divergent views on the remaining three statements that addressed: (1) access to medical records; (2) access to performance and safety information; and (3) variation in care between dietitians. The QUINCE model was modified to produce the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) describing quality dietetic care in the primary care setting.

CONCLUSIONS

Consumers and professionals share views on some aspects of quality dietetic care but diverge on other aspects. The QUINCE-MOD is an evidence-based, complexity-informed model that describes components of quality relevant to primary care dietetics. The model should be applied at the practice level to reflect the unique perspective of quality at that level.

Patient online access to general practice medical records: A qualitative study on patients' needs and expectations

BACKGROUND

Patient online access to medical records is assumed to foster patient empowerment and advance patient-centred healthcare. Since July 2020, patients in the Netherlands have been legally entitled to electronically access their medical record in general practice. Experience from pioneering countries has shown that despite high patient interest, user rates often remain low. How to best support implementation depends on individual needs and expectations of patient populations, which are as yet unknown in the Dutch context.

OBJECTIVE

To understand Dutch patients' needs and expectations with regard to online access to their medical record in general practice.

METHOD

Twenty participants completed semi-structured individual interviews via video or telephone call. Transcripts of interviews underwent template analysis combining deductive and inductive coding using Atlas.ti software.

RESULTS

Patients' needs and expectations ranged across three overlapping areas: (i) prerequisites for getting online access; (ii) using online access; and (iii) the impact on interaction with healthcare providers. Patients expected benefits from online access such as better overview, empowerment and improved communication with their general practitioner but identified needs regarding technological difficulties, data privacy and complex medical language in their record.

CONCLUSION

The concerns and obstacles participants identified point towards the need for organisational changes in general practice, for example, adjusted documentation practices, and the key role of the general practitioner and staff in promoting and facilitating online access.

IMPLICATIONS

Implementation strategies addressing needs identified in this study may help to unlock the full potential of online access to achieve desired outcomes of patient involvement and satisfaction.

A Process Related View on the Usage of Electronic Health Records from the Patients' Perspective: A Systematic Review

BACKGROUND

In recent years, there has been an increasing interest in electronic health record (EHR) systems and various approaches of encouraging acceptance. Multiple methods of EHR acceptance have been proposed. However, a systematic review of patient's perspectives of their role and challenges in processing EHR remains lacking. Moreover, so far, there has been little discussion about barriers and facilitators of EHR system acceptance and usage from the patients' perspective.

METHODS

The study was reported according to the PRISMA statement. Six databases were systematically searched using keywords for articles from 2002-2020. We reviewed these data and used an inductive approach to analyse findings.

RESULTS

A total of 36 studies met the inclusion criteria. Our systematic literature review results reveal a wide range of barriers and facilitators assigned to four distinct stages of EHR system usage: awareness, adoption, behaviour and perception, and consequences. Results were described in a narrative synthesis of the included empirical studies.

DISCUSSION

Results underline the necessity to put a particular emphasis - but not exclusively - on the initial stage of awareness in the future. Further research in the field is therefore strongly recommended in order to develop tailored mediated communication to foster EHR system usage in the long run.

A preliminary study of further attempt at the development, testing and application of an independent primary screening stool card

Stool characteristics are of great value to assess diseases, but patients knew little. E-learning applied in health popularization and patient education is booming. In China, WeChat applets has advantages of abundant users, convenient access and low cost, which may be a great media in patient education on stool. This preliminary study aims to develop and evaluate a stool card WeChat applet. We collected stools images during 2020 to 2022 in the Department of Gastroenterology and Hepatology in the Second Affiliated Hospital of Harbin Medical University, constructed a stool card applet named the Doctor Friend Primary Screening Stool Card (DFPSSC) and evaluated it. Eligible participants were divided into the applet, traditional paper media and control group. We implement a series of tests to evaluate the effectiveness. 20 clinicians and participants using the DFPSSC completed a questionnaire to evaluate the usability. We developed the DFPSSC for an E-learning approach. Of 108 volunteers, 97 completed the DFPSSC learning. No significant pretest differences were found among the three groups (P = 0.303). Applet group had significantly higher posttest scores than pretest scores in intervention (P < 0.001, d = 1.68) and simulation (P = 0.006) test, and it had higher scores than other two group (P < 0.001). 63% participants and 59% clinicians strongly agree or agree to the usability of DFSSC. This preliminary study verified that the DFPSSC can effectively improve participants' knowledge of feces, making it an effective clinical tool for patient education and the avoidance of treatment delay.

Assessing patient readiness for a patient portal implementation in the UAE

Purpose

This paper proposes a Web-based patient portal based on the electronic medical record. Such a portal can allow patients to manage their own health care, reduce health-care visits and significantly improve the quality of their health care.

Design/methodology/approach

A patient portal prototype and an accompanying online survey were distributed to assess the adoption readiness among a group of people in the United Arab Emirates (UAE).

Findings

The results from 470 survey participants demonstrated an enhanced awareness of this technology, and support the study hypotheses indicating that both intrinsic and extrinsic factors are important when considering the implementation of a patient portal in the UAE.

Originality/value

This study adds value to the few research studies undertaken in the Middle East discussing online health information technology and its adoption and usage among the population at large. The extended technology acceptance model, which contains two additional constructs, had not been previously validated in terms of a patient portal in the UAE, according to the author’s knowledge, adding more value. The UAE’s health-care system must use the benefits from the available IT infrastructure to provide a user-friendly online portal to encourage patients to manage their health care and health information.

Ready for Prime Time? Using Normalization Process Theory to Evaluate Implementation Success of Personal Health Records Designed for Decision Making

Personal health records designed for shared decision making (SDM) have the potential to engage patients and provide opportunities for positive health outcomes. Given the limited number of published interventions that become normal practice, this preimplementation evaluation of an integrated SDM personal health record system (e-PHR) was underpinned by Normalization Process Theory (NPT). The theory provides a framework to analyze cognitive and behavioral mechanisms known to influence implementation success. A mixed-methods investigation was utilized to explain the work required to implement e-PHR and its potential to integrate into practice. Patients, care providers, and electronic health record (EHR) and clinical leaders (n = 27) offered a rich explanation of the implementation work. Reliability tests of the NPT-based instrument negated the use of scores for two of the four mechanisms. Participants indicated that e-PHR made sense as explained by two qualitative themes: game-changing technology and sensibility of change. Participants appraised e-PHR as explained by two themes: reflecting on value and monitoring and adapting. The combined qualitative and quantitative results for the other two NPT mechanisms corroborated. Participants strongly agreed (score = 4.6/5) with processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (score = 3.6/5) was observed with processes requiring an investment in effort, explained by one theme: uncovering the challenge of building collective action, and three subthemes: assessing fit, adapting to change together, and investing in the change. Finally, participants strongly agreed (score = 4.5/5) that e-PHR would positively affect engagement in self-management decision-making in two themes: care is efficient, and care is patient-centered. Overall, successful integration of e-PHR will only be attained when systemic effort is invested to enact it. Additional investigation is needed to explore the collective action gaps to inform priorities and approaches for future implementation success. This research has implications for patients, care providers, EHR vendors, and the healthcare system for improving the effectiveness and efficiency of patient-centric services. Findings confirm the usefulness of NPT for planning and understanding implementation success of PHRs.

Sustaining Patient Portal Continuous Use Intention and Enhancing Deep Structure Usage: Cognitive Dissonance Effects of Health Professional Encouragement and Security Concerns

Sustaining patient portal use is a major problem for many healthcare organizations and providers. If this problem can be successfully addressed, it could have a positive impact on various stakeholders. Through the lens of cognitive dissonance theory, this study investigates the role of health professional encouragement as well as patients' security concerns in influencing continuous use intention and deep structure usage among users of a patient portal. The analysis of data collected from 177 patients at a major medical center in the Midwestern region of the United States shows that health professional encouragement helps increase the continuous use intention and deep structure usage of the patient portal, while security concerns impede them. Interestingly, health professional encouragement not only has a direct positive influence on continuous use intention and deep structure usage but also lowers the negative impact of security concerns on them. The research model explains a substantial variance in continuous use intention (i.e., 40%) and deep structure usage (i.e., 32%). The paper provides theoretical implications as well as practical implications to healthcare managers and providers to improve patient portal deep structure usage and sustained use for user retention.

An Internet-Based Intervention for Cardiovascular Disease Management Integrated With Primary Care Electronic Health Records: Mixed Methods Evaluation of Implementation Fidelity and User Engagement

Background

Growing evidence supports the benefits of eHealth interventions to increase patient engagement and improve outcomes for a range of conditions. However, ineffective program delivery and usage attrition limit exposure to these interventions and may reduce their effectiveness.

Objective

This study aims to evaluate the delivery fidelity of an eHealth intervention, describe use patterns, compare outcomes between low and high users, and identify mediating factors on intervention delivery and receipt.

Methods

This is a mixed methods study of an internet-based intervention being evaluated for effectiveness in a randomized controlled trial (RCT). The intervention comprised medication and cardiovascular disease (CVD) risk data uploaded from the primary care electronic health record (EHR); interactive, personalized CVD risk score estimation; goal setting and self-monitoring; an interactive social forum; and optional receipt of heart health messages. Fidelity was assessed over 12 months. Trial outcomes were compared between low and high users. Data sources included program delivery records, web log data, trial data, and thematic analysis of communication records.

Results

Most participants in the intervention group (451/486, 93%) had an initial training session conducted by telephone (413/447, 92.4% of participants trained), with a mean duration of 44 minutes (range 10-90 minutes). Staff conducted 98.45% (1776/1804) of the expected follow-ups, mostly by telephone or email. Of the 451 participants who commenced log-ins, 46.8% (211) were categorized as low users (defined as at least one log-in in 3 or fewer months of follow-up), 40.4% (182) were categorized as high users (at least one log-in in more than 3 months of follow-up), and 12.8% (58) were nonadopters (no log-ins after their training session). The mean log-in frequency was 3-4 per month in ongoing users. There was no significant difference between the groups in the primary trial outcome of adherence to guideline-recommended medications (P=.44). In unadjusted analyses, high users had significantly greater eHealth literacy scores (P=.003) and were more likely to meet recommended weekly targets for fruit (P=.03) and fish (P=.004) servings; however, the adjusted findings were not significant. Interactive screen use was highest for goal tracking and lowest for the chat forum. Screens with EHR-derived data held only an early interest for most users. Fidelity measures (reach, content, dose delivered, and dose received) were influenced by the facilitation strategies used by staff, invisible qualities of staff-participant communication, and participants’ responsiveness to intervention attributes.

Conclusions

A multifeature internet-based intervention was delivered with high fidelity to the RCT protocol and was regularly used by 40.4% (182/451) of users over 12 months. Higher log-in frequency as an indicator of greater intervention exposure was not associated with statistically significant improvements in eHealth literacy scores, lifestyle changes, or clinical outcomes. Attributes of the intervention and individualized support influenced initial and ongoing use.

A Study on the Relationship between Usability of GUIs and Power Consumption of a PC: The Case of PHRs

Usability is key to achieve quality in software products. The client applications with a high score in usability might impact on the power consumption when they are run in a PC. For this reason, energy savings turn to be critical in green software systems. In this paper the relationship between the usability evaluations of the GUIs and the power consumption measurements of the main components of a PC were analysed. A set of 5 web-based personal health records (PHRs) were selected as a case study. The usability assessment was performed by an expert, employing the 14 principles of design by Alan Dix as heuristics. They were scored on a Likert scale after performing a collection of common tasks in the PHRs. At the same time, an equipment to measure the energy consumption of hard disk drive, graphics card, processor, monitor and power supply was used. Spearman’s index was studied for the correlations between the usability assessments and the power consumption measurements. As a results, some weak relationships were found. A total of 5 usability heuristics were observed to may influence energy consumption when they were considered in the implementation of the PHRs. These heuristics were the following ones: consistency, task migratability, observability, recoverability and responsiveness. Based on the results, the usability principles of design cannot always be related to lower energy consumption. Future research should focus on the tradeoffs between usability and power consumption of client applications when they are used in a computer.

Patient Portal, Patient-Generated Images, and Medical Decision-Making in a Pediatric Ambulatory Setting

BACKGROUND

Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images, and videos generated by families can be sent to providers securely. With the widespread use of smart phones, there has been an increase in patient-generated images (PGI) sent to providers via patient portals. There are few studies that have evaluated the role of PGI in medical decision-making.

OBJECTIVES

The study aimed to characterize PGI sent to providers via a patient portal, determine how often PGI-affected medical decision-making, and determine the rate of social PGI sent via patient portal.

METHODS

A retrospective chart review of PGI uploaded to a children's hospital's ambulatory patient portal from January 2011 to December 2017 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image-affected medical decision-making. Images were classified as medical related (e.g., blood glucose readings and skin rashes), nonmedical or administrative related (e.g., medical clearance or insurance forms), and social (e.g., self-portraits and camp pictures).

RESULTS

One hundred forty-three individuals used the portal a total of 358 times, sending 507 images over the study period. Mean (standard deviation) patient age was 9.5 (5.9) years, 50% were females, 89% were White, and 64% had private insurance. About 9% of images were sent directly by patients and the rest by parents/guardians. A total of 387 (76%) images were sent for medical related reasons, 20% for nonmedical, and 4% were deemed social images. Of the 387 medical related images, 314 (81%) affected medical decision-making.

CONCLUSION

PGI-affected medical decision-making in most cases. Additional studies are needed to characterize use of PGI in the pediatric population.

The State of Evidence in Patient Portals: Umbrella Review

Background

Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time.

Objective

This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption.

Methods

For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence.

Results

Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews.

Conclusions

Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

Patients' compliance behavior in a personalized mobile patient education system (PMPES) setting: Rational, social, or personal choices?

OBJECTIVE

With the advancement of mobile technologies, patients can access medical and patient educational information anytime and anywhere. Computer-aided patient education has been advocated as a key means of interventions for improving patient knowledge and compliance (i.e., adherence). However, evidence of the efficacy of computer-aided patient education remains relatively limited. For example, little is known about how the latest mobile technologies influence patients' compliance intention and their actual compliance behavior. The objective of this study is to investigate patients' compliance intention and behavior using a personalized mobile patient education system (PMPES) as a novel technological intervention for patients based on rational choice theory (RCT) and the theory of planned behavior (TPB).

MATERIALS AND METHODS

We conducted a field survey with 125 actual patients in U.S. who obtained their patient education through PMPES while seeking medical treatment advice from their doctors. We used partial least squares (PLS) regression path modeling to test our model.

RESULTS

We found that, based on RCT, the benefits of compliance and cost/threat of noncompliance positively influenced intention toward treatment compliance; in contrast, costs of compliance negatively influenced intention toward treatment compliance. However, the benefits of noncompliance had no effect on intention toward treatment compliance. The results also indicated that intention toward treatment compliance, response efficacy, and self-efficacy related to TPB jointly influenced the degree of actual compliance behaviors. Social influence factors including subjective norms and descriptive norms had no influence on patients' actual treatment compliance behavior.

CONCLUSION

Overall, the research model explains 69.2 % of the variance in patients' actual compliance behavior. We find our model robust in using RCT as a key theoretical lens for the assessment of patients' compliance intention to follow medical recommendations enabled by the PMPES and delivered to mobile devices. The factors associated with RCT and TPB jointly influence patients' actual compliance behavior. Future mobile patient education programs should consider patients' age groups, mixed-gender groups, different medical settings, and cross-cultural contexts.

Personal electronic healthcare records: What influences consumers to engage with their clinical data online? A literature review

Background:

Online electronic records such as patient portals and personally controlled electronic health records (PEHRs) have been widely viewed as a key component to modernising the delivery of healthcare but the uptake of such systems has been slow.

Objective:

The purpose of this literature review was to determine what influences consumers to engage and interact with their clinical data online.

Method:

A scoping literature review following PRISMA guidelines was completed. Electronic patient record research published between January 2009 and December 2018 was included. Following screening and full-text reviews, a total of 64 records were included in this review.

Results:

Three key areas of influence on consumer engagement with their clinical data online emerged: demographic factors affecting consumer interaction with PEHRs; consumers’ perceived benefits and detriments of PEHR use; and the influence of PEHR use on consumer empowerment and responsibility.

Discussion:

Consumer motivation and readiness for engaging with their clinical data online and their long-term ongoing use of these systems requires further exploration.

Conclusion:

As worldwide rates of consumer interactions with individual online clinical data remain low, what influences consumer engagement with a PEHR remains unknown. Further research into the consumer perspective of, and interaction with, a PEHR, needs to be undertaken to determine if factors such as frequent usage of the system by consumers leads to improved clinical outcomes.

How do patients value and prioritize patient portal functionalities and usage factors? A conjoint analysis study with chronically ill patients

BACKGROUND

Patient portal use can be a stimulant for patient engagement. Yet, the heterogeneous landscape of tethered patient portals, is a major barrier to further portal development and implementation. A variety in portal access means, functionalities, usability and usefulness exists; without having accurate sight on patient perspectives. We aimed to get insights on possible coherence between patients' preferred usage factors of portals and patients' prioritization of functionalities, within the complexity of their disease management across different healthcare organizations.

METHODS

A conjoint analysis questionnaire was sent to patient panels of two large patient associations in The Netherlands, centered on heart and vascular diseases and lung diseases.

RESULTS

Of 1294 patient respondents, 81% were 55+ years old and 49% were 65+ years old. Overall respondents significantly prioritized user-friendly access to a portal, via a laptop or desktop. Patients aged < 65 were less negative about using tablets to access a portal compared to the total respondents. Patients had no preference for a digital interoperable export functionality; most respondents preferred to create printable overviews. Built-in publication delay of two weeks for medical information was not preferred. Our results show no significant preference of patients between 'instant publication' versus 'publication after new information has been explained by a healthcare provider'. Overall respondents and experienced portal users had a strong preference to be able to communicate with their provider via a portal and to use a portal providing information from multiple providers. Lung patients preferred information from one provider and did not require the possibility to ask online questions.

CONCLUSIONS

Heart and vascular patients as well as lung patients prefer similar technical patient portal aspects, independent of their medical condition. Yet, in current portals consistency on this matter is lacking. It is highly assumable that offering a more consistent user-experience across the variety of patient portals could help increase patient portal acceptance, ultimately helping to stimulate patient engagement via patient portal use. We further affirm the need for customization on medical information publication and sharing information of various providers through patient portals, where information provision can be adapted to preferences of patients related to their medical condition(s).

How standards and user involvement can improve app quality: A lifecycle approach

Health apps have great potential to improve the quality of care and reduce costs, but this has not yet been achieved. Unfortunately, there are many low-quality, unsafe health apps, resulting in different types of risks. This Perspective addresses the current failure to adopt standards for the development and implementation of health apps. For each theoretical stage of the app development lifecycle we discuss problems, examples, reasons, and solutions. We believe that adapted versions of existing professional and technical standards and tools developed for clinical information systems, medical devices and medicines could help mitigate risks throughout the health app lifecycle. Adapted standards should bring more effective user involvement and cooperation amongst stakeholders. We argue that these efforts will ultimately provide users with a wider choice of higher-quality health apps, give healthcare providers access to better quality data, and allow developers to innovate without unnecessary time-consuming restrictions.