1
|
Owolo E, Petitt Z, Charles A, Baëta C, Poehlein E, Green C, Cook C, Sperber J, Chandiramani A, Roman M, Goodwin CR, Erickson M. The Association Between Sociodemographic Factors, Social Determinants of Health, and Spine Surgical Patient Portal Utilization. Clin Spine Surg 2023; 36:301-309. [PMID: 37081673 DOI: 10.1097/bsd.0000000000001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/09/2023] [Indexed: 04/22/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To examine patient portal use among the surgical spine patient population across different sociodemographic groups and assess the impact of patient portal use on clinical outcomes. SUMMARY OF BACKGROUND DATA Patient portals (PP) have been shown to improve outcomes and quality of care. Engaging them requires internet access, technological literacy, and dexterity, which may serve as access barriers. METHODS After exclusion criteria were applied, the study included data for 9211 encounters from 7955 patients. PP utilization was defined as having activated and used the Duke University Medical Center patient portal system, MyChart, at least once. Sociodemographic characteristics included urbanicity, age, race, ethnicity, language, employment, and primary insurer. Clinical outcomes included the length of hospital stay during the procedure, 30-day return to the emergency department, 30-day readmission, and being discharged somewhere other than home. RESULTS Being older than 65, non-White, unemployed, non-English-speaking, male, not-partnered, uninsured or publicly insured (Medicaid, Medicare and under 65 years of age, or other government insurance), and living in a rural environment were all risk factors for decreased PP utilization among surgical spine patients. A one-risk factor decrease in the number of social risk factors was associated with a 78% increase in the odds of PP utilization [odds ratio (OR): 1.78; 95% Confidence interval (CI): 1.69-1.87; P <0.001]. Patients not utilizing the portal at the time of their procedure had higher odds of 30-day readmission (OR: 1.59; 95% CI: 1.26-2.00), discharge somewhere other than home (OR: 2.41, 95% CI: 1.95-2.99), and an increased length of hospital stay (geometric mean ratio: 1.21; 95% CI: 1.12-1.30) compared with those who utilized it. CONCLUSIONS In patients undergoing spine procedures, PPs are not equally utilized among different sociodemographic groups. PP utilization is also associated with better outcomes. Interventions aimed at increasing PP uptake may improve care for certain patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Chad Cook
- Department of Biostatistics and Bioinformatics
| | | | - Anisha Chandiramani
- Division of General Internal Medicine; Department of Medicine
- Duke Health Technology Solutions
| | - Matthew Roman
- Duke Health Technology Solutions
- Duke Network Services
| | | | - Melissa Erickson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| |
Collapse
|
2
|
Baniulyte G, Rogerson N, Bowden J. Going paperless - Qualitative monitoring of staff morale during the transition from paper to electronic health records. Heliyon 2023; 9:e20645. [PMID: 37867851 PMCID: PMC10585231 DOI: 10.1016/j.heliyon.2023.e20645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
Background Organisational change is an important part of development and growth. Transitioning from paper-based hospital records to electronic health records improves efficiency and patient safety by streamlining data access and reducing the risk of errors, ultimately leading to enhanced patient care and outcomes. In October 2020, a large NHS trust underwent the transition from paper notes to a fully electronic health records system. Therefore, the purpose of this study was to monitor staff morale during this organisational change; to highlight any issues arising that may impact on the smooth transition; to encourage feedback. Methods A questionnaire was distributed to all members of the maxillofacial outpatients department on a regular basis. The qualitative responses were analysed using NVivo, following a framework analysis model. Results The analysis generated 1319 codes, which were placed into 68 groups. The three main themes were 'Transformational Advancements in Healthcare Delivery'; 'Obstacles to Seamless EHR Integration; 'Navigating the Transition and Evolving Perceptions'. Discussion Regular monitoring of morale and staff opinion allows for smoother transition in a large-scale organisational change. The results of this project will help future hospitals and trusts undergoing similar transitions.
Collapse
Affiliation(s)
- Gabriele Baniulyte
- Academic Clinical Fellow in Oral Surgery, Department of Oral and Maxillofacial Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK
| | - Norma Rogerson
- Speciality Doctor in Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK
| | - John Bowden
- Consultant in Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK
| |
Collapse
|
3
|
Forde-Johnston C, Butcher D, Aveyard H. An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse-patient interactions and communication. J Adv Nurs 2023; 79:48-67. [PMID: 36345050 PMCID: PMC10100205 DOI: 10.1111/jan.15484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
AIM To explore how nurses' use of electronic health records impacts on the quality of nurse-patient interactions and communication. DESIGN An integrative review. DATA SOURCES MEDLINE®, CINAHL®, PscyINFO, PubMed, BNI and Cochrane Library databases were searched for papers published between January 2005 and April 2022. REVIEW METHODS Following a comprehensive search, the studies were appraised using a tool appropriate to the study design. Data were extracted from the studies that met the inclusion criteria relating to sample characteristics, methods and the strength of evidence. Included empirical studies had to examine interactions or communication between a nurse and patient while electronic health records were being used in any healthcare setting. Findings were synthesized using a thematic approach. RESULTS One thousand nine hundred and twenty articles were initially identified but only eight met the inclusion criteria of this review. Thematic analysis revealed four key themes, indicating that EHR: impedes on face-to-face communication, promotes task-orientated and formulaic communication and impacts on types of communication patterns. CONCLUSION Research examining nurse-patient interactions and communication when nurses' use electronic health records is limited but evidence suggests that closed nurse-patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records, although some nurses were able to overcome logistical barriers and communicate more openly. Nurses' use of electronic health records impacts on the flow, nature and quality of communication between a nurse and patient. IMPACT The move to electronic health records has taken place largely without consideration of the impact that this might have on nurse-patient interaction and communication. There is evidence of impact but also evidence of how this might be mitigated. Nurses must focus future research on examining the impact that these systems have, and to develop strategies and practice that continue to promote the importance of nurse-patient interactions and communication. PATIENT OR PUBLIC CONTRIBUTION Studies examined within this review included patient participants that informed the analysis and interpretation of data.
Collapse
Affiliation(s)
- Carol Forde-Johnston
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dan Butcher
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| |
Collapse
|
4
|
McKee M, James TG, Helm KVT, Marzolf B, Chung DH, Williams J, Zazove P. Reframing Our Health Care System for Patients With Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3633-3645. [PMID: 35969852 PMCID: PMC9802570 DOI: 10.1044/2022_jslhr-22-00052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. METHOD A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. RESULTS These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. CONCLUSIONS The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.
Collapse
Affiliation(s)
- Michael McKee
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Tyler G. James
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Kaila V. T. Helm
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Brianna Marzolf
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Dana H. Chung
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - John Williams
- Department of Population Health Science, University of Mississippi Medical Center, Jackson
| | - Philip Zazove
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| |
Collapse
|
5
|
Lacambra VW. Developing and Implementing a Tablet-Based Health Information Technology Tool Training Program. Comput Inform Nurs 2021; 39:464-469. [PMID: 34495007 DOI: 10.1097/cin.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Kinney AP, Sankaranarayanan B. Effects of Patient Portal Use on Patient Satisfaction: Survey and Partial Least Squares Analysis. J Med Internet Res 2021; 23:e19820. [PMID: 34448712 PMCID: PMC8433860 DOI: 10.2196/19820] [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: 05/03/2020] [Revised: 09/15/2020] [Accepted: 07/13/2021] [Indexed: 01/26/2023] Open
Abstract
Background With digital delivery of health care services gaining prominence, patient portals have become a mainstay of many health care organizations. Despite the importance of patient portals, inconclusive data exist regarding the effect of patient portal use on patient satisfaction. Objective The aim of this study is to understand the relationship between the postadoptive use of patient portals and patient satisfaction outcomes. Methods Postadoptive use of patient portals has a positive relationship with the 3 dimensions of patient satisfaction, mediated by gratification, health self-awareness, and health perceptions. A total of 504 valid patient portal user responses were collected, and partial least squares analysis was performed to analyze the data. Results Patient satisfaction was captured using three dimensions: care team interaction, atmosphere, and instruction effectiveness. The results show that postadoptive use of patient portals has a positive influence on all 3 dimensions of patient satisfaction through the mediating variables of gratification, health self-awareness, and health perceptions. Specifically, postadoptive use had significant positive influence on gratification, health self-awareness, and health perceptions. Each of the 3 patient perceptions had significant positive influence on all 3 dimensions of patient satisfaction: care team interaction, atmosphere, and instruction effectiveness. Specifically, our model explained 31.8% of the care team interaction, 40.6% of the atmosphere, and 39.1% of the instruction effectiveness. Conclusions Our model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction.
Collapse
Affiliation(s)
- Aaron P Kinney
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, United States
| | - Balaji Sankaranarayanan
- Department of Information Technology and Supply Chain Management, College of Business and Economics, University of Wisconsin - Whitewater, Whitewater, WI, United States
| |
Collapse
|
7
|
Allard CT, Krasowski MD. Data on the activation and utilization of an electronic health record patient portal in an adult inpatient population at an academic medical center. Data Brief 2021; 35:106806. [PMID: 33604427 PMCID: PMC7875813 DOI: 10.1016/j.dib.2021.106806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022] Open
Abstract
Electronic health record patient portals allow patients to access their own health data online and interact with the healthcare team. Many studies have focused on use of patient portals in the outpatient setting. Relatively less is known about use of patient portals for hospitalized patients. The data in this article include analysis of patient portal activation and utilization for adults hospitalized in 2018 at an academic medical center in a Midwestern state in the United States. Activation was assessed by percentage of patients who had activated their patient portal by the time of data review. Utilization of the patient portal was determined by whether patients or their legal proxies accessed one or more reports from diagnostic testing ordered during inpatient encounter(s) in 2018. The data include 826,843 diagnostic tests on 40,640 unique patients. Patient characteristics include sex, age, whether outpatient diagnostic tests were also performed in 2018, preferred language (English or non-English), health insurance status (private, public, or uninsured), self-declared race (White or non-White), and whether there was a legal proxy for the patient. Association of these covariates with patient portal activation and utilization were analyzed.
Collapse
Affiliation(s)
- Corey T Allard
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| |
Collapse
|
8
|
Christian ZK, Aoun SG, Afuwape O, Adeyemo E, Barrie U, Badejo O, Dosselman LJ, Pernik MN, Hall K, Reyes VP, El Ahmadieh TY, Al Tamimi M, Bagley CA. Electronic Communication Patterns Could Reflect Preoperative Anxiety and Serve as an Early Complication Warning in Elective Spine Surgery Patients with Affective Disorders: A Retrospective Analysis of a Cohort of 1199 Elective Spine Patients. World Neurosurg 2020; 141:e888-e893. [PMID: 32561492 DOI: 10.1016/j.wneu.2020.06.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The analysis of perioperative electronic patient portal (EPP) communication may provide risk stratification and insight for complication prevention in patients with affective disorders (ADs). We aimed to understand how patterns of EPP communication in patients with AD relate to preoperative narcotic use, surgical outcomes, and readmission rates. METHODS The records of adult patients who underwent elective spinal surgery between January 2010 and August 2017 at a single institution were retrospectively reviewed for analysis. Primary outcomes included preoperative narcotic use, the number of perioperative EPP messages sent, rates of perioperative complications, hospital length of stay, emergency department (ED) visits within 6 weeks, and readmissions within 30 days after surgery. RESULTS A total of 1199 patients were included in the analysis. Patients with an AD were more likely to take narcotics before surgery (51.69% vs. 41%, P < 0.001) and to have active EPP accounts (75.36% vs. 69.75%, P = 0.014) compared with controls. They were also more likely to send postoperative messages (38.89% vs. 32.75%, P = 0.030) and tended to send more messages (0.67 vs. 0.48, P = 0.034). The AD group had higher rates of postoperative complications (8.21% vs. 3.98%, P = 0.001), ED visits (4.99% vs. 2.43%, P = 0.009), and readmissions postoperatively (2.49% vs. 1.38%, P = 0.049). CONCLUSIONS AD patients have specific patterns of perioperative EPP communication. They are at a higher risk of postoperative complications. Addressing these concerns early may prevent more serious morbidity and avoid unnecessary ED visits and readmissions, thus reducing costs and improving patient care.
Collapse
Affiliation(s)
- Zachary K Christian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Olusoji Afuwape
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanuel Adeyemo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Olatunde Badejo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luke J Dosselman
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark N Pernik
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Valery Peinado Reyes
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mazin Al Tamimi
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
9
|
McAlearney AS, Hefner JL, MacEwan SR, Gaughan A, DePuccio M, Walker DM, Hogan CT, Fareed N, Sieck CJ, Huerta TR. Care Team Perspectives About an Inpatient Portal: Benefits and Challenges of Patients' Portal Use During Hospitalization. Med Care Res Rev 2020; 78:537-547. [PMID: 32552351 DOI: 10.1177/1077558720925296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While current research about inpatient portals has focused largely on the patient perspective, it is also critical to consider the care team point of view, as support from these individuals is essential to successful portal implementation and use. We held brief in-person interviews with 433 care team members across a six-hospital health system to explore opinions about patients' use of an inpatient portal as perceived by care team members. Using the Inpatient Portal Evaluation Framework, we characterized benefits and challenges of portal use that care team members reported affected patients, themselves, and the collaborative work of these care teams with their patients. Interviewees noted inpatient portals can improve patient care and experience and also indicated room for improvement in portal use for hospitalized patients. Further understanding of the care team perspective is critical to inform approaches to inpatient portal implementation that best benefit both patients and providers.
Collapse
|
10
|
Wood KE, Krasowski MD. Academic E-Mail Overload and the Burden of "Academic Spam". Acad Pathol 2020; 7:2374289519898858. [PMID: 32010761 PMCID: PMC6974753 DOI: 10.1177/2374289519898858] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023] Open
Abstract
This article presents an editorial perspective on the challenges associated with e-mail
management for academic physicians. We include 2-week analysis of our own e-mails as
illustrations of the e-mail volume and content. We discuss the contributors to high e-mail
volumes, focusing especially on unsolicited e-mails from medical/scientific conferences
and open-access journals (sometimes termed “academic spam emails”), as these e-mails
comprise a significant volume and are targeted to physicians and scientists. Our 2-person
sample is consistent with studies showing that journals that use mass e-mail advertising
have low rates of inclusion in recognized journal databases/resources. Strategies for
managing e-mail are discussed and include unsubscribing, blocking senders or domains,
filtering e-mails, managing one’s inbox, limiting e-mail access, and e-mail etiquette.
Academic institutions should focus on decreasing the volume of unsolicited e-mails,
fostering tools to manage e-mail overload, and educating physicians including trainees
about e-mail practices, predatory journals, and scholarly database/resources.
Collapse
Affiliation(s)
- Kelly E Wood
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Jackson GP, Robinson JR, Ingram E, Masterman M, Ivory C, Holloway D, Anders S, Cronin RM. A technology-based patient and family engagement consult service for the pediatric hospital setting. J Am Med Inform Assoc 2019; 25:167-174. [PMID: 29016789 DOI: 10.1093/jamia/ocx067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/06/2017] [Indexed: 01/09/2023] Open
Abstract
Objective The Vanderbilt Children's Hospital launched an innovative Technology-Based Patient and Family Engagement Consult Service in 2014. This paper describes our initial experience with this service, characterizes health-related needs of families of hospitalized children, and details the technologies recommended to promote engagement and meet needs. Materials and Methods We retrospectively reviewed consult service documentation for patient characteristics, health-related needs, and consultation team recommendations. Needs were categorized using a consumer health needs taxonomy. Recommendations were classified by technology type. Results Twenty-two consultations were conducted with families of patients ranging in age from newborn to 15 years, most with new diagnoses or chronic illnesses. The consultation team identified 99 health-related needs (4.5 per consultation) and made 166 recommendations (7.5 per consultation, 1.7 per need). Need categories included 38 informational needs, 26 medical needs, 23 logistical needs, and 12 social needs. The most common recommendations were websites (50, 30%) and mobile applications (30, 18%). The most frequent recommendations by need category were websites for informational needs (39, 50%), mobile applications for medical needs (15, 40%), patient portals for logistical needs (12, 44%), and disease-specific support groups for social needs (19, 56%). Discussion Families of hospitalized pediatric patients have a variety of health-related needs, many of which could be addressed by technology recommendations from an engagement consult service. Conclusion This service is the first of its kind, offering a potentially generalizable and scalable approach to assessing health-related needs, meeting them with technologies, and promoting patient and family engagement in the inpatient setting.
Collapse
Affiliation(s)
- Gretchen P Jackson
- Department of Pediatric Surgery, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA.,Department of Biomedical Informatics, VUMC, Nashville, TN, USA.,Department of Pediatrics, VUMC, Nashville, TN, USA
| | - Jamie R Robinson
- Department of Pediatric Surgery, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA.,Department of Biomedical Informatics, VUMC, Nashville, TN, USA
| | - Ebone Ingram
- Department of Psychiatry, VUMC, Nashville, TN, USA
| | - Mary Masterman
- Department of Family Medicine, University of Kansas, Kansas City, KS, USA
| | - Catherine Ivory
- Department of Biomedical Informatics, VUMC, Nashville, TN, USA.,Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, USA
| | | | - Shilo Anders
- Department of Pediatric Surgery, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA.,Department of Anesthesiology, VUMC, Nashville, TN, USA
| | - Robert M Cronin
- Department of Biomedical Informatics, VUMC, Nashville, TN, USA.,Department of Pediatrics, VUMC, Nashville, TN, USA.,Department of Medicine, VUMC, Nashville, TN, USA
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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]
|
17
|
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]
|