1
|
Lee H, Lee S, Jo D. A Bedside Electronic Whiteboard System for Patient Care in Isolation Rooms: A Scenario-Based Preliminary Study. J Clin Nurs 2024. [PMID: 39313959 DOI: 10.1111/jocn.17461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024]
Abstract
AIM To assess a commercially available electronic whiteboard's usability and acceptability in isolation rooms, focusing on improving nurse-patient communication and supporting data input. DESIGN A cross-sectional study with quantitative and qualitative mixed methods. METHODS We evaluated the usability and acceptability of electronic whiteboards among nurses using scenarios in a virtual isolation room environment. RESULTS Nurses recognised the electronic whiteboard as a valuable tool for communication and error reductions in record-keeping but noted a learning curve for less tech-savvy users. Positive correlations were found between perceived usefulness, ease of use and adoption intent. Despite challenges, electronic whiteboards show promise for enhancing patient care, requiring comprehensive training and management systems. Time allocation in patient wards and nurse-patient interactions are crucial considerations. CONCLUSION Electronic whiteboards have usability and acceptability as a tool to improve nurse-patient communication. However, considering technical issues and staff resistance, a management system and user training are necessary. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses perceive electronic whiteboards as user-friendly and as facilitating data input. REPORTING METHOD TREND (Nonrandomised evaluations of behavioural and public health interventions). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Hyeongsuk Lee
- College of Nursing, Research Institute of AI and Nursing Science, Gachon University, Incheon, South Korea
| | - Seungmin Lee
- College of Nursing, Gachon University, Incheon, South Korea
| | - Dami Jo
- College of Nursing, Gachon University, Incheon, South Korea
| |
Collapse
|
2
|
Man C, Liu T, Yan S, Xie Q, Liu H. Research status and hotspots of patient engagement: A bibliometric analysis. PATIENT EDUCATION AND COUNSELING 2024; 125:108306. [PMID: 38669762 DOI: 10.1016/j.pec.2024.108306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/20/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This analysis aimed to examine current global trends in patient engagement research and identify critical focus areas. METHODS We searched the Web of Science Core Collection database for pertinent literature from January 1, 2000 to December 31, 2022. CiteSpace and VOSviewer were used for information analysis. RESULTS The bibliometric analysis covered 11,386 documents from 140 countries/regions, featuring contributions from 12,731 organizations and 45,489 authors. The United States and The University of Toronto were the most prolific country and institution. Leading researchers in publications and citations included Hibbard JH, Elwyn G, Legare F, and Street RL. Patient Education and Counseling led among journals. CONCLUSION Patient engagement research has experienced significant growth over the past two decades. The core of patient engagement research includes concepts, content, practical frameworks, impact assessment, and barriers. The current research focal points revolve around interventions for chronic disease patients, integrating digital health technologies to improve engagement, and incorporating patient-reported outcomes (PROs) into healthcare delivery. PRACTICE IMPLICATIONS This study unveils key trends and emphasizes global collaboration, strategic focus on chronic disease interventions, integration of digital health technologies, and the pivotal role of PROs. Embracing these insights promises to optimize healthcare practices and empower patients on a global scale.
Collapse
Affiliation(s)
- Chunxia Man
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Tiantian Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Suying Yan
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Qing Xie
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Hua Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| |
Collapse
|
3
|
Aitken SJ, James S, Lawrence A, Glover A, Pleass H, Thillianadesan J, Monaro S, Hitos K, Naganathan V. Codesign of health technology interventions to support best-practice perioperative care and surgical waitlist management. BMJ Health Care Inform 2024; 31:e100928. [PMID: 38471784 DOI: 10.1136/bmjhci-2023-100928] [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: 10/06/2023] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES This project aimed to determine where health technology can support best-practice perioperative care for patients waiting for surgery. METHODS An exploratory codesign process used personas and journey mapping in three interprofessional workshops to identify key challenges in perioperative care across four health districts in Sydney, Australia. Through participatory methodology, the research inquiry directly involved perioperative clinicians. In three facilitated workshops, clinician and patient participants codesigned potential digital interventions to support perioperative pathways. Workshop output was coded and thematically analysed, using design principles. RESULTS Codesign workshops, involving 51 participants, were conducted October to November 2022. Participants designed seven patient personas, with consumer representatives confirming acceptability and diversity. Interprofessional team members and consumers mapped key clinical moments, feelings and barriers for each persona during a hypothetical perioperative journey. Six key themes were identified: 'preventative care', 'personalised care', 'integrated communication', 'shared decision-making', 'care transitions' and 'partnership'. Twenty potential solutions were proposed, with top priorities a digital dashboard and virtual care coordination. DISCUSSION Our findings emphasise the importance of interprofessional collaboration, patient and family engagement and supporting health technology infrastructure. Through user-based codesign, participants identified potential opportunities where health technology could improve system efficiencies and enhance care quality for patients waiting for surgical procedures. The codesign approach embedded users in the development of locally-driven, contextually oriented policies to address current perioperative service challenges, such as prolonged waiting times and care fragmentation. CONCLUSION Health technology innovation provides opportunities to improve perioperative care and integrate clinical information. Future research will prototype priority solutions for further implementation and evaluation.
Collapse
Affiliation(s)
- Sarah Joy Aitken
- Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Camperdown, New South Wales, Australia
- Concord Institute of Academic Surgery, Sydney Local Health District, Concord West, New South Wales, Australia
| | - Sophie James
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Amy Lawrence
- Anaesthetics, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Anthony Glover
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Surgery and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Henry Pleass
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Janani Thillianadesan
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Geriatrics, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sue Monaro
- Clinical Excellence Commission, Sydney South, New South Wales, Australia
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Kerry Hitos
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Vasi Naganathan
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| |
Collapse
|
4
|
Kechagioglou P. Big Data in Oncology: The Electronic Patient Record Transformation Program. Semin Oncol Nurs 2023; 39:151430. [PMID: 37137769 DOI: 10.1016/j.soncn.2023.151430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES There is a vast amount of real-world data collected daily in oncology through diagnostic, therapeutic, and patient-reported outcome measures. The challenge arises with linking data together to create structured and meaningful databases, which are representative of the general population, free of bias, and of good quality to be able to draw meaningful conclusions. Real-world data that are linked together within trusted cancer research environments could represent the next generation of big data strategy in cancer. DATA SOURCES Patient and public involvement initiatives and expert opinion. CONCLUSION Collaboration among specialist cancer data analysts, academic researchers, and clinicians within cancer institutions is key to standardizing the design and evaluation of real-world databases. Digital transformation efforts must include implementation of integrated care records and patient-facing portals, in combination with training and education of clinicians in digital skills and health leadership. As part of the Electronic Patient Record Transformation Program, our experience with patient and public involvement in the development of a cancer patient-facing portal linked to an oncology electronic health record at University Hospitals Coventry and Warwickshire has given us useful insights into patient needs and priorities. IMPLICATIONS FOR NURSING PRACTICE The growth of electronic health records and patient portals is an opportunity to gather big data in oncology at a population level to help clinicians and researchers with the development of predictive and preventive algorithms and new models for personalized care.
Collapse
Affiliation(s)
- Penny Kechagioglou
- Consultant Clinical Oncologist, Chief Clinical Information Officer, and Deputy Chief Medical Officer, University Hospitals Coventry and Warwickshire, Clifford Bridge road, Coventry, CV2 2DX.
| |
Collapse
|
5
|
Samal L, Khasnabish S, Foskett C, Zigmont K, Faxvaag A, Chang F, Clements M, Rossetti SC, Dalal AK, Leone K, Lipsitz S, Massaro A, Rozenblum R, Schnock KO, Yoon C, Bates DW, Dykes PC. Comparison of a Voluntary Safety Reporting System to a Global Trigger Tool for Identifying Adverse Events in an Oncology Population. J Patient Saf 2022; 18:611-616. [PMID: 35858480 PMCID: PMC9391281 DOI: 10.1097/pts.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a lack of research on adverse event (AE) detection in oncology patients, despite the propensity for iatrogenic harm. Two common methods include voluntary safety reporting (VSR) and chart review tools, such as the Institute for Healthcare Improvement's Global Trigger Tool (GTT). Our objective was to compare frequency and type of AEs detected by a modified GTT compared with VSR for identifying AEs in oncology patients in a larger clinical trial. METHODS Patients across 6 oncology units (from July 1, 2013, through May 29, 2015) were randomly selected. Retrospective chart reviews were conducted by a team of nurses and physicians to identify AEs using the GTT. The VSR system was queried by the department of quality and safety of the hospital. Adverse event frequencies, type, and harm code for both methods were compared. RESULTS The modified GTT detected 0.90 AEs per patient (79 AEs in 88 patients; 95% [0.71-1.12] AEs per patient) that were predominantly medication AEs (53/79); more than half of the AEs caused harm to the patients (41/79, 52%), but only one quarter were preventable (21/79; 27%). The VSR detected 0.24 AEs per patient (21 AEs in 88 patients; 95% [0.15-0.37] AEs per patient), a large plurality of which were medication/intravenous related (8/21); more than half did not cause harm (70%). Only 2% of the AEs (2/100) were detected by both methods. CONCLUSIONS Neither the modified GTT nor the VSR system alone is sufficient for detecting AEs in oncology patient populations. Further studies exploring methods such as automated AE detection from electronic health records and leveraging patient-reported AEs are needed.
Collapse
Affiliation(s)
- Lipika Samal
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Srijesa Khasnabish
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Cathy Foskett
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Katherine Zigmont
- Academic Medical Center, Patient Safety Organization, Boston, Massachusetts, USA
| | - Arild Faxvaag
- Department of Neuromedicine and Movement Science & Department of Rheumatology, St. Olavs University Hospital, Trondheim, Norway
| | - Frank Chang
- Information Systems/Clinical, Partners Healthcare, Somerville, Massachusetts, USA
| | | | - Sarah Collins Rossetti
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
| | - Anuj K Dalal
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Leone
- Department of Nursing, Brigham and Women’s Faulkner Hospital, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Massaro
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ronen Rozenblum
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kumiko O. Schnock
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine Yoon
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - David W. Bates
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia C. Dykes
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Salas M, Petracek J, Yalamanchili P, Aimer O, Kasthuril D, Dhingra S, Junaid T, Bostic T. The Use of Artificial Intelligence in Pharmacovigilance: A Systematic Review of the Literature. Pharmaceut Med 2022; 36:295-306. [PMID: 35904529 DOI: 10.1007/s40290-022-00441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Artificial intelligence through machine learning uses algorithms and prior learnings to make predictions. Recently, there has been interest to include more artificial intelligence in pharmacovigilance of products already in the market and pharmaceuticals in development. OBJECTIVE The aim of this study was to identify and describe the uses of artificial intelligence in pharmacovigilance through a systematic literature review. METHODS Embase and MEDLINE database searches were conducted for articles published from January 1, 2015 to July 9, 2021 using search terms such as 'pharmacovigilance,' 'patient safety,' 'artificial intelligence,' and 'machine learning' in the title or abstract. Scientific articles that contained information on the use of artificial intelligence in all modalities of patient safety or pharmacovigilance were reviewed and synthesized using a pre-specified data extraction template. Articles with incomplete information and letters to editor, notes, and commentaries were excluded. RESULTS Sixty-six articles were identified for evaluation. Most relevant articles on artificial intelligence focused on machine learning, and it was used in patient safety in the identification of adverse drug events (ADEs) and adverse drug reactions (ADRs) (57.6%), processing safety reports (21.2%), extraction of drug-drug interactions (7.6%), identification of populations at high risk for drug toxicity or guidance for personalized care (7.6%), prediction of side effects (3.0%), simulation of clinical trials (1.5%), and integration of prediction uncertainties into diagnostic classifiers to increase patient safety (1.5%). Artificial intelligence has been used to identify safety signals through automated processes and training with machine learning models; however, the findings may not be generalizable given that there were different types of data included in each source. CONCLUSION Artificial intelligence allows for the processing and analysis of large amounts of data and can be applied to various disease states. The automation and machine learning models can optimize pharmacovigilance processes and provide a more efficient way to analyze information relevant to safety, although more research is needed to identify if this optimization has an impact on the quality of safety analyses. It is expected that its use will increase in the near future, particularly with its role in the prediction of side effects and ADRs.
Collapse
Affiliation(s)
- Maribel Salas
- Daiichi Sankyo, Inc. & Center for Real-World Effectiveness and Safety of Therapeutics (CREST), University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 211 Mount Airy Rd, Basking Ridge, NJ, USA
| | - Jan Petracek
- Institute of Pharmacovigilance, Hvezdova 2b, 14000, Prague, Czech Republic
| | - Priyanka Yalamanchili
- Daiichi Sankyo, Inc. & Rutgers University, 211 Mount Airy Rd, Basking Ridge, NJ, USA.
| | | | | | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | | | - Tina Bostic
- PPD, part of Thermo Fisher Scientific, Wilmington, NC, USA
| |
Collapse
|
7
|
Abraham J, Kandasamy M, Huggins A. Articulation of postsurgical patient discharges: coordinating care transitions from hospital to home. J Am Med Inform Assoc 2022; 29:1546-1558. [PMID: 35713640 DOI: 10.1093/jamia/ocac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cardiac surgery patients are at high risk for readmissions after hospital discharge- few of these readmissions are preventable by mitigating barriers underlying discharge care transitions. An in-depth evaluation of the nuances underpinning the discharge process and the use of tools to support the process, along with insights on patient and clinician experiences, can inform the design of evidence-based strategies to reduce preventable readmissions. OBJECTIVE The study objectives are 3-fold: elucidate perceived factors affecting the postsurgical discharge care transitions of cardiac surgery patients going home; highlight differences among clinician and patient perceptions of the postsurgical discharge experiences, and ascertain the impact of these transitions on patient recovery at home. METHODS We conducted a prospective multi-stakeholder study using mixed methods, including general observations, patient shadowing, chart reviews, clinician interviews, and follow-up telephone patient and caregiver surveys/interviews. We followed thematic and content analyses. FINDINGS Participants included 49 patients, 6 caregivers, and 27 clinicians. We identified interdependencies between the predischarge preparation, discharge education, and postdischarge follow-up care phases that must be coordinated for effective discharge care transitions. We identified several factors that could lead to fragmented discharges, including limited preoperative preparation, ill-defined discharge education, and postoperative plans. To address these, clinicians often performed behind-the-scenes work, including offering informal preoperative preparation, tailoring discharge education, and personalizing postdischarge follow-up plans. As a result, majority of patients reported high satisfaction with care transitions and their positive impact on their home recovery. DISCUSSION AND CONCLUSIONS Articulation work by clinicians (ie, behind the scenes work) is critical for ensuring safety, care continuity, and overall patient experience during care transitions. We discuss key evidence-based considerations for re-engineering postsurgical discharge workflows and re-designing discharge interventions.
Collapse
Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Madhumitha Kandasamy
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ashley Huggins
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
8
|
Abstract
Clinical informatics can support quality improvement and patient safety in the pediatric intensive care unit (PICU) in several ways including data extraction, analysis, and decision support enabled by electronic health records (EHRs), and databases and registries. Clinical decision support (CDS), embedded in EHRs, now an integral part of the workflow in the PICU, includes several tools and is increasingly leveraging artificial intelligence (AI). Understanding the opportunities and challenges can improve the engagement of clinicians with the design, validation, and implementation of CDS, improve satisfaction with CDS, and improve patient safety, care quality, and value.
Collapse
|
9
|
Gaughan AA, Walker DM, Sova LN, Vink S, Moffatt-Bruce SD, McAlearney AS. Improving Provisioning of an Inpatient Portal: Perspectives from Nursing Staff. Appl Clin Inform 2022; 13:355-362. [PMID: 35419788 PMCID: PMC9008224 DOI: 10.1055/s-0042-1743561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Inpatient portals are recognized to provide benefits for both patients and providers, yet the process of provisioning tablets to patients by staff has been difficult for many hospitals. OBJECTIVE Our study aimed to identify and describe practices important for provisioning an inpatient portal from the perspectives of nursing staff and provide insight to enable hospitals to address challenges related to provisioning workflow for the inpatient portal accessible on a tablet. METHODS Qualitative interviews were conducted with 210 nursing staff members across 26 inpatient units in six hospitals within The Ohio State University Wexner Medical Center (OSUWMC) following the introduction of tablets providing access to an inpatient portal, MyChart Bedside (MCB). Interviews asked questions focused on nursing staffs' experiences relative to MCB tablet provisioning. Verbatim interview transcripts were coded using thematic analysis to identify factors associated with tablet provisioning. Unit provisioning performance was established using data stored in the OSUWMC electronic health record about provisioning status. Provisioning rates were divided into tertiles to create three levels of provisioning performance: (1) higher; (2) average; and (3) lower. RESULTS Three themes emerged as critical strategies contributing to MCB tablet provisioning success on higher-performing units: (1) establishing a feasible process for MCB provisioning; (2) having persistent unit-level MCB tablet champions; and (3) having unit managers actively promote MCB tablets. These strategies were described differently by staff from the higher-performing units when compared with characterizations of the provisioning process by staff from lower-performing units. CONCLUSION As inpatient portals are recognized as a powerful tool that can increase patients' access to information and enhance their care experience, implementing the strategies we identified may help hospitals' efforts to improve provisioning and increase their patients' engagement in their health care.
Collapse
Affiliation(s)
- Alice A Gaughan
- The 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
| | - Daniel M Walker
- The 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 Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Lindsey N Sova
- The 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
| | - Shonda Vink
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | | | - Ann Scheck McAlearney
- The 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 Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Zoe Fritz
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge
| | | | | |
Collapse
|
11
|
Newman B, Joseph K, Chauhan A, Seale H, Li J, Manias E, Walton M, Mears S, Jones B, Harrison R. Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety. Health Expect 2021; 24:1905-1923. [PMID: 34432339 PMCID: PMC8628590 DOI: 10.1111/hex.13343] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness. METHODS A systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane-Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible; two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted. RESULTS Twenty-six papers reporting on twenty-seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of 'patient engagement' varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user-friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care. CONCLUSIONS Agency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient-provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information. PATIENT OR PUBLIC CONTRIBUTION Review progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).
Collapse
Affiliation(s)
- Bronwyn Newman
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kathryn Joseph
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Ashfaq Chauhan
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Holly Seale
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jiadai Li
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Merrilyn Walton
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Mears
- Hunter New England Health Libraries, John Hunter Hospital, HRMC, Newcastle, New South Wales, Australia
| | - Benjamin Jones
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Lipschultz E, Danahey K, Truong TM, Schierer E, Volchenboum SL, Ratain MJ, O’Donnell PH. Creation of a pharmacogenomics patient portal complementary to an existing institutional provider-facing clinical decision support system. JAMIA Open 2021; 4:ooab067. [PMID: 34458686 PMCID: PMC8390782 DOI: 10.1093/jamiaopen/ooab067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background Applied pharmacogenomics presents opportunities for improving patient care through precision medicine, particularly when paired with appropriate clinical decision support (CDS). However, a lack of patient resources for understanding pharmacogenomic test results may hinder shared decision-making and patient confidence in treatment. We sought to create a patient pharmacogenomics education and results delivery platform complementary to a CDS system to facilitate further research on the relevance of patient education to pharmacogenomics. Methods We conceptualized a model that extended the data access layer of an existing institutional CDS tool to allow for the pairing of decision supports offered to providers with patient-oriented summaries at the same level of phenotypic specificity. We built a two-part system consisting of a secure portal for patient use and an administrative dashboard for patient summary creation. The system was built in an ASP.NET and AngularJS architecture, and all data was housed in a HIPAA-compliant data center, with PHI secure in transit and at rest. Results The YourPGx Patient Portal was deployed on the institutional network in June 2019. Fifty-eight unique patient portal summaries have been written so far, which can provide over 4500 results modules to the pilot population of 544 patients. Patient behavior on the portal is being logged for further research. Conclusions To our knowledge, this is the first automated system designed and deployed to provide detailed, personalized patient pharmacogenomics education complementary to a clinical decision support system. Future work will expand upon this system to allow for telemedicine and patient notification of new or updated results.
Collapse
Affiliation(s)
- Elizabeth Lipschultz
- Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
| | - Keith Danahey
- Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
| | - Tien M Truong
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Emily Schierer
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
| | | | - Mark J Ratain
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Peter H O’Donnell
- Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
- Corresponding Author: Peter H. O’Donnell, M.D., University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL 60637-1447, USA ()
| |
Collapse
|
13
|
Pollack AH, Mishra SR, Apodaca C, Khelifi M, Haldar S, Pratt W. Different roles with different goals: Designing to support shared situational awareness between patients and clinicians in the hospital. J Am Med Inform Assoc 2021; 28:222-231. [PMID: 33150394 PMCID: PMC7883969 DOI: 10.1093/jamia/ocaa198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Team situational awareness helps to ensure high-quality care and prevent errors in the complex hospital environment. Although extensive work has examined factors that contribute to breakdowns in situational awareness among clinicians, patients’ and caregivers’ roles have been neglected. To address this gap, we studied team-based situational awareness from the perspective of patients and their caregivers. Materials and Methods We utilized a mixed-methods approach, including card sorting and semi-structured interviews with hospitalized patients and their caregivers at a pediatric hospital and an adult hospital. We analyzed the results utilizing the situational awareness (SA) theoretical framework, which identifies 3 distinct stages: (1) perception of a signal, (2) comprehension of what the signal means, and (3) projection of what will happen as a result of the signal. Results A total of 28 patients and 19 caregivers across the 2 sites participated in the study. Our analysis uncovered how team SA helps patients and caregivers ensure that their values are heard, their autonomy is supported, and their clinical outcomes are the best possible. In addition, our participants described both barriers—such as challenges with communication—and enablers to facilitating shared SA in the hospital. Discussion Patients and caregivers possess critical knowledge, expertise, and values required to ensure successful and accurate team SA. Therefore, hospitals need to incorporate tools that facilitate patients and caregivers as key team members for effective SA. Conclusions Elevating patients and caregivers from passive recipients to equal contributors and members of the healthcare team will improve SA and ensure the best possible outcomes.
Collapse
Affiliation(s)
- Ari H Pollack
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sonali R Mishra
- Information School, University of Washington, Seattle, Washington, USA
| | - Calvin Apodaca
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Maher Khelifi
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Shefali Haldar
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| |
Collapse
|
14
|
Masterson Creber R, Turchioe MR. Returning Cardiac Rhythm Data to Patients: Opportunities and Challenges. Card Electrophysiol Clin 2021; 13:555-567. [PMID: 34330381 PMCID: PMC8328196 DOI: 10.1016/j.ccep.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spurred by federal legislation, professional organizations, and patients themselves, patient access to data from electronic cardiac devices is increasingly transparent. Patients can collect data through consumer devices and access data traditionally shared only with health care providers. These data may improve screening, self-management, and shared decision-making for cardiac arrhythmias, but challenges remain, including patient comprehension, communication with providers, and sustained engagement. Ways to address these challenges include leveraging visualizations that support comprehension, involving patients in designing and developing patient-facing digital tools, and establishing clear practices and goals for data exchange with health care providers.
Collapse
Affiliation(s)
- Ruth Masterson Creber
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA.
| | - Meghan Reading Turchioe
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA
| |
Collapse
|
15
|
Haldar S, Mishra SR, Kim Y, Hartzler A, Pollack AH, Pratt W. Use and impact of an online community for hospital patients. J Am Med Inform Assoc 2021; 27:549-557. [PMID: 31986197 PMCID: PMC7075532 DOI: 10.1093/jamia/ocz212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/08/2019] [Accepted: 12/04/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Although patient-peer support technologies have demonstrated effectiveness in a variety of health contexts-including diabetes, weight loss, and cancer-less is known about how hospitalized patients can benefit from this support. We investigated the nature of peer support in the hospital and the impact this support had on patients' hospital stays. MATERIALS AND METHODS We created a technology, resembling an online health community, in which patients could exchange advice about their hospitalization. We deployed it at 1 pediatric hospital and 1 adult hospital. With 30 participants, we conducted bedside interviews, observed how they used the technology during their hospitalization, and completed follow-up phone interviews. RESULTS Participants shared advice about several topics, including adjusting to the hospital and building relationships with providers. Contrary to concerns that such a system would primarily serve as a place for patients to "complain," sentiment analysis showed that 23 of 36 (64%) of the shared advice reflected positive sentiment. Patients also reported positive impacts to their quality, safety, and hospital experience due to the inpatient peer support community. DISCUSSION Participants benefited from peer support that transcended diagnoses and individual health conditions. The shared experience of being in the hospital was sufficient to yield valuable and practical peer support. Participants who did not contribute their own advice still experienced benefits from reading their peers' advice. CONCLUSIONS Our study demonstrated the positive nature of peer advice exchanged, and the benefits of this advice on patients' hospital stays. Inpatient peer support technologies could be an additional resource for patients to engage in their care.
Collapse
Affiliation(s)
- Shefali Haldar
- Division of Biomedical and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Sonali R Mishra
- Information School, University of Washington, Seattle, Washington, USA
| | - Yoojung Kim
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Andrea Hartzler
- Division of Biomedical and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Ari H Pollack
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| |
Collapse
|
16
|
Choudhury A, Renjilian E, Asan O. Use of machine learning in geriatric clinical care for chronic diseases: a systematic literature review. JAMIA Open 2020; 3:459-471. [PMID: 33215079 PMCID: PMC7660963 DOI: 10.1093/jamiaopen/ooaa034] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/26/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives Geriatric clinical care is a multidisciplinary assessment designed to evaluate older patients’ (age 65 years and above) functional ability, physical health, and cognitive well-being. The majority of these patients suffer from multiple chronic conditions and require special attention. Recently, hospitals utilize various artificial intelligence (AI) systems to improve care for elderly patients. The purpose of this systematic literature review is to understand the current use of AI systems, particularly machine learning (ML), in geriatric clinical care for chronic diseases. Materials and Methods We restricted our search to eight databases, namely PubMed, WorldCat, MEDLINE, ProQuest, ScienceDirect, SpringerLink, Wiley, and ERIC, to analyze research articles published in English between January 2010 and June 2019. We focused on studies that used ML algorithms in the care of geriatrics patients with chronic conditions. Results We identified 35 eligible studies and classified in three groups: psychological disorder (n = 22), eye diseases (n = 6), and others (n = 7). This review identified the lack of standardized ML evaluation metrics and the need for data governance specific to health care applications. Conclusion More studies and ML standardization tailored to health care applications are required to confirm whether ML could aid in improving geriatric clinical care.
Collapse
Affiliation(s)
- Avishek Choudhury
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | - Emily Renjilian
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, USA
| |
Collapse
|
17
|
Fritz Z, Schlindwein A, Slowther AM. Patient engagement or information overload: patient and physician views on sharing the medical record in the acute setting. Clin Med (Lond) 2020; 19:386-391. [PMID: 31530686 DOI: 10.7861/clinmed.2019-0079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patient and professional views about the impact of providing full real-time access to the medical record in the in-hospital setting are unknown. METHODS Likert-scale and free-text validated questionnaire survey of physicians and patients from acute medical units in two hospitals. The questionnaire explored recent experiences; views on the formation of trust, and views on sharing either the entire medical record or a summary. RESULTS Two-hundred and forty-eight patient questionnaires (62% response rate) and 32 physician questionnaires (21% response rate) were returned. Twenty-seven per cent of patients did not recall being told their diagnosis. Doctors and patients differed on what practices that they believed built trust.Eighty-one per cent of patients supported the idea of having access to the full medical record (for empowerment; the right to information about oneself; as an aide-memoire for discussion). Doctors feared it might provoke anxiety and change the nature of what was written. A written lay summary record was preferred by doctors and patients. CONCLUSIONS The current system of providing information verbally to patients is inadequate. Patients want more information and are less concerned than physicians about potential negative effects of real-time access to their records. Patient access to medical records (in both full and summary forms) should be evaluated.
Collapse
Affiliation(s)
- Zoë Fritz
- Wellcome fellow in society and ethics, The Healthcare Improvement Studies (THIS) Institute, Cambridge, UK and Warwick Medical School, Coventry, UK
| | | | | |
Collapse
|
18
|
Choudhury A, Asan O. Role of Artificial Intelligence in Patient Safety Outcomes: Systematic Literature Review. JMIR Med Inform 2020; 8:e18599. [PMID: 32706688 PMCID: PMC7414411 DOI: 10.2196/18599] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/26/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Artificial intelligence (AI) provides opportunities to identify the health risks of patients and thus influence patient safety outcomes. OBJECTIVE The purpose of this systematic literature review was to identify and analyze quantitative studies utilizing or integrating AI to address and report clinical-level patient safety outcomes. METHODS We restricted our search to the PubMed, PubMed Central, and Web of Science databases to retrieve research articles published in English between January 2009 and August 2019. We focused on quantitative studies that reported positive, negative, or intermediate changes in patient safety outcomes using AI apps, specifically those based on machine-learning algorithms and natural language processing. Quantitative studies reporting only AI performance but not its influence on patient safety outcomes were excluded from further review. RESULTS We identified 53 eligible studies, which were summarized concerning their patient safety subcategories, the most frequently used AI, and reported performance metrics. Recognized safety subcategories were clinical alarms (n=9; mainly based on decision tree models), clinical reports (n=21; based on support vector machine models), and drug safety (n=23; mainly based on decision tree models). Analysis of these 53 studies also identified two essential findings: (1) the lack of a standardized benchmark and (2) heterogeneity in AI reporting. CONCLUSIONS This systematic review indicates that AI-enabled decision support systems, when implemented correctly, can aid in enhancing patient safety by improving error detection, patient stratification, and drug management. Future work is still needed for robust validation of these systems in prospective and real-world clinical environments to understand how well AI can predict safety outcomes in health care settings.
Collapse
Affiliation(s)
- Avishek Choudhury
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| |
Collapse
|
19
|
Casillas A, Cemballi AG, Abhat A, Lemberg M, Portz JD, Sadasivaiah S, Ratanawongsa N, Semere W, Brown A, Lyles CR. An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net. J Med Internet Res 2020; 22:e18466. [PMID: 32706709 PMCID: PMC7400036 DOI: 10.2196/18466] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. Objective Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. Methods We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.
Collapse
Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Anupama Gunshekar Cemballi
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Anshu Abhat
- Los Angeles County Department of Health Services, Harbor-UCLA Medical Center, Los Angeles, CA, United States
| | - Miya Lemberg
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Jennifer D Portz
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Shobha Sadasivaiah
- Office of Health Informatics, San Francisco Health Network, San Francisco, CA, United States
| | - Neda Ratanawongsa
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Wagahta Semere
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Courtney Rees Lyles
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| |
Collapse
|
20
|
Ochoa C, Baron-Lee J, Popescu C, Busl KM. Electronic patient portal utilization by neurology patients and association with outcomes. Health Informatics J 2020; 26:2751-2761. [PMID: 32674698 PMCID: PMC9215314 DOI: 10.1177/1460458220938533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Existing literature on electronic patient portals demonstrates mixed findings for portal user demographic patterns and relationships between portal usage and clinical outcomes. This study sought to determine characteristics of portal users specific to a neurology patient population and examine whether usage predicted decreased clinic visits and risk of hospitalization. A cross-sectional analysis on 13,483 patients seen at a tertiary neurology outpatient clinic over a 1-year period found significant associations between demographics, and interactions between age, sex, and race. Black and Hispanic patients were less likely to be portal users. While females had higher odds of portal usage overall, their probability decreased with increasing age. Portal users had higher rates of clinic utilization but no difference in hospitalization risk. These results highlight demographics that may need strategic targeting to increase portal uptake and the need for other interventions for populations more likely to experience health events resulting in hospitalization.
Collapse
|
21
|
Zayas-Cabán T, White PJ. The national health information technology human factors and ergonomics agenda. APPLIED ERGONOMICS 2020; 86:103109. [PMID: 32342896 DOI: 10.1016/j.apergo.2020.103109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 08/08/2019] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
Health information technology (IT) implementation has encompassed much of the United States health care system over the past decade, and user frustration with health IT has steadily increased. Human factors and ergonomics (HFE) methods and approaches can improve the design, implementation, and use of health IT for clinicians and consumers. To better understand the effect of federal HFE in health IT research funding, the authors conducted a review of several key, specific initiatives. The review focused on the goals and accomplishments of these initiatives. Findings to date show that HFE is improving the usefulness of health IT, but additional research and new methods are needed. Corresponding research funding and policy priorities are identified. New HFE work and innovative approaches are needed to capitalize on HFE knowledge, principles, and methods to improve the design, implementation, and use of health IT at a broader scale.
Collapse
Affiliation(s)
- Teresa Zayas-Cabán
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, 330 C Street, SW, Floor 7, Washington, DC, 20201, USA.
| | - P Jon White
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| |
Collapse
|
22
|
Lyles CR, Nelson EC, Frampton S, Dykes PC, Cemballi AG, Sarkar U. Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices. Ann Intern Med 2020; 172:S123-S129. [PMID: 32479176 PMCID: PMC7800164 DOI: 10.7326/m19-0876] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.
Collapse
Affiliation(s)
- Courtney R Lyles
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Eugene C Nelson
- Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (E.C.N.)
| | | | - Patricia C Dykes
- Center for Patient Safety, Research, and Practice, Brigham and Women's Hospital, Boston, Massachusetts (P.C.D.)
| | - Anupama G Cemballi
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Urmimala Sarkar
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| |
Collapse
|
23
|
D'Costa SN, Kuhn IL, Fritz Z. A systematic review of patient access to medical records in the acute setting: practicalities, perspectives and ethical consequences. BMC Med Ethics 2020; 21:18. [PMID: 32122332 PMCID: PMC7053049 DOI: 10.1186/s12910-020-0459-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process. Methods This study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed. Results 3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients – almost exclusively verbally – is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated. Conclusions The review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated.
Collapse
Affiliation(s)
- Stephanie N D'Costa
- Gonville and Caius College, Cambridge University, Trinity Street, Cambridge, CB2 1TA, UK
| | - Isla L Kuhn
- THIS Institute (The Healthcare Improvement Studies Institute), Cambridge University, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Zoë Fritz
- THIS Institute (The Healthcare Improvement Studies Institute), Cambridge University, Clifford Allbutt Building, Cambridge, CB2 0AH, UK.
| |
Collapse
|
24
|
Greysen SR, Magan Y, Rosenthal J, Jacolbia R, Auerbach AD, Harrison JD. Patient Recommendations to Improve the Implementation of and Engagement With Portals in Acute Care: Hospital-Based Qualitative Study. J Med Internet Res 2020; 22:e13337. [PMID: 31934868 PMCID: PMC6996719 DOI: 10.2196/13337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background The inclusion of patient portals into electronic health records in the inpatient setting lags behind progress in the outpatient setting. Objective The aim of this study was to understand patient perceptions of using a portal during an episode of acute care and explore patient-perceived barriers and facilitators to portal use during hospitalization. Methods We utilized a mixed methods approach to explore patient experiences in using the portal during hospitalization. All patients received a tablet with a brief tutorial, pre- and postuse surveys, and completed in-person semistructured interviews. Qualitative data were coded using thematic analysis to iteratively develop 18 codes that were integrated into 3 themes framed as patient recommendations to hospitals to improve engagement with the portal during acute care. Themes from these qualitative data guided our approach to the analysis of quantitative data. Results We enrolled 97 participants: 53 (53/97, 55%) women, 44 (44/97, 45%) nonwhite with an average age of 48 years (19-81 years), and the average length of hospitalization was 6.4 days. A total of 47 participants (47/97, 48%) had an active portal account, 59 participants (59/97, 61%) owned a smartphone, and 79 participants (79/97, 81%) accessed the internet daily. In total, 3 overarching themes emerged from the qualitative analysis of interviews with these patients during their hospital stay: (1) hospitals should provide both access to a device and bring-your-own-device platform to access the portal; (2) hospitals should provide an orientation both on how to use the device and how to use the portal; and (3) hospitals should ensure portal content is up to date and easy to understand. Conclusions Patients independently and consistently identified basic needs for device and portal access, education, and usability. Hospitals should prioritize these areas to enable successful implementation of inpatient portals to promote greater patient engagement during acute care. Trial Registration ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT01970852
Collapse
Affiliation(s)
- S Ryan Greysen
- Section of Hospital Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Yimdriuska Magan
- School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jamie Rosenthal
- School of Medicine, Boston University, Boston, MA, United States
| | - Ronald Jacolbia
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - James D Harrison
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
25
|
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
|
26
|
Chaar D, Shin JY, Mazzoli A, Vue R, Kedroske J, Chappell G, Hanauer DA, Barton D, Hassett AL, Choi SW. A Mobile Health App (Roadmap 2.0) for Patients Undergoing Hematopoietic Stem Cell Transplant: Qualitative Study on Family Caregivers' Perspectives and Design Considerations. JMIR Mhealth Uhealth 2019; 7:e15775. [PMID: 31651402 PMCID: PMC6913725 DOI: 10.2196/15775] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 01/26/2023] Open
Abstract
Background Hematopoietic stem cell transplantation (HCT), also referred to as blood and marrow transplantation (BMT), is a high-risk, but potentially curative therapy for a number of cancer and noncancer conditions. BMT Roadmap (Roadmap 1.0) is a mobile health app that was developed as a family caregiver–facing tool to provide informational needs about the health status of patients undergoing inpatient HCT. Objective This study explored the views and perceptions of family caregivers of patients undergoing HCT and their input regarding further technology development and expansion of BMT Roadmap into the outpatient setting (referred to as Roadmap 2.0). Methods Semistructured qualitative interviews were conducted among 24 family caregivers. Questions were developed from existing literature coupled with prior in-depth observations and interviews in hospital-based settings to explore the study objectives. Participants were recruited during routine outpatient clinic appointments of HCT patients, and all interviews were conducted in the participants’ homes, the setting in which Roadmap 2.0 is intended for use. A thematic analysis was performed using a consistent set of codes derived from our prior research. New emerging codes were also included, and the coding structure was refined with iterative cycles of coding and data collection. Results Four major themes emerged through our qualitative analysis: (1) stress related to balancing caregiving duties; (2) learning and adapting to new routines (resilience); (3) balancing one’s own needs with the patient’s needs (insight); and (4) benefits of caregiving. When caregivers were further probed about their views on engagement with positive activity interventions (ie, pleasant activities that promote positive emotions and well-being such as expressing gratitude or engaging in activities that promote positive thoughts, emotions, and behaviors), they preferred a “menu” of positive activities to help support caregiver health and well-being. Conclusions This study involved family caregivers as participants in the development of new components for Roadmap 2.0. Our research provided a further understanding of the many priorities that hematopoietic stem cell transplant family caregivers face while maintaining balance in their lives. Their schedules can often be unpredictable, even more so once the patient is discharged from the hospital. Our findings suggest that expanding Roadmap 2.0 into the outpatient setting may provide critical caregiver support and that HCT caregivers are interested in and willing to engage in positive activities that may enhance well-being and attenuate the stress associated with caregiving. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.4918
Collapse
Affiliation(s)
- Dima Chaar
- University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
| | - Ji Youn Shin
- Michigan State University, College of Communication Arts and Sciences, Department of Media and Information, East Lansing, MI, United States
| | - Amanda Mazzoli
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Rebecca Vue
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Jacob Kedroske
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Grant Chappell
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - David A Hanauer
- University of Michigan, Medical School, Michigan Institute for Clinical and Health Research, Ann Arbor, MI, United States
| | - Debra Barton
- University of Michigan, School of Nursing, Ann Arbor, MI, United States
| | - Afton L Hassett
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, United States
| | - Sung Won Choi
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Schnock KO, Snyder JE, Fuller TE, Duckworth M, Grant M, Yoon C, Lipsitz S, Dalal AK, Bates DW, Dykes PC. Acute Care Patient Portal Intervention: Portal Use and Patient Activation. J Med Internet Res 2019; 21:e13336. [PMID: 31322123 PMCID: PMC6670280 DOI: 10.2196/13336] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 01/21/2023] Open
Abstract
Background Patient-facing health information technology (HIT) tools, such as patient portals, are recognized as a potential mechanism to facilitate patient engagement and patient-centered care, yet the use of these tools remains limited in the hospital setting. Although research in this area is growing, it is unclear how the use of acute care patient portals might affect outcomes, such as patient activation. Objective The aim of this study was to describe the use of an acute care patient portal and investigate its association with patient and care partner activation in the hospital setting. Methods We implemented an acute care patient portal on 6 acute care units over an 18-month period. We investigated the characteristics of the users (patients and their care partners) of the patient portal, as well as their use of the portal. This included the number of visits to each page, the number of days used, the length of the user’s access period, and the average percent of days used during the access period. Patient and care partner activation was assessed using the short form of the patient activation measure (PAM-13) and the caregiver patient activation measure (CG-PAM). Comparisons of the activation scores were performed using propensity weighting and robust weighted linear regression. Results Of the 2974 randomly sampled patients, 59.01% (1755/2974) agreed to use the acute care patient portal. Acute care patient portal enrollees were younger, less sick, less likely to have Medicare as their insurer, and more likely to use the Partners Healthcare enterprise ambulatory patient portal (Patient Gateway). The most used features of the acute care patient portal were the laboratory test results, care team information, and medication list. Most users accessed the portal between 1 to 4 days during their hospitalization, and the average number of days used (logged in at least once per day) was 1.8 days. On average, users accessed the portal 42.69% of the hospital days during which it was available. There was significant association with patient activation on the neurology service (P<.001) and medicine service (P=.01), after the introduction of HIT tools and the acute care patient portal, but not on the oncology service. Conclusions Portal users most often accessed the portal to view their clinical information, though portal usage was limited to only the first few days of enrollment. We found an association between the use of the portal and HIT tools with improved levels of patient activation. These tools may help facilitate patient engagement and improve outcomes when fully utilized by patients and care partners. Future study should leverage usage metrics to describe portal use and assess the impact of HIT tools on specific outcome measures in the hospital setting.
Collapse
Affiliation(s)
- Kumiko O Schnock
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Julia E Snyder
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Theresa E Fuller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Megan Duckworth
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Maxwell Grant
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Catherine Yoon
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Stuart Lipsitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Anuj K Dalal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| |
Collapse
|
29
|
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.
Collapse
|
30
|
Dendere R, Slade C, Burton-Jones A, Sullivan C, Staib A, Janda M. Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review. J Med Internet Res 2019; 21:e12779. [PMID: 30973347 PMCID: PMC6482406 DOI: 10.2196/12779] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 12/21/2022] Open
Abstract
Background Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. Objective The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. Methods A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). Results The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. Conclusions While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.
Collapse
Affiliation(s)
- Ronald Dendere
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Christine Slade
- Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Australia
| | - Andrew Burton-Jones
- School of Business, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia.,Metro North Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Australia
| | - Andrew Staib
- Metro South Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Australia.,University of Queensland School of Medicine, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| |
Collapse
|
31
|
Sadasivaiah S, Lyles CR, Kiyoi S, Wong P, Ratanawongsa N. Disparities in Patient-Reported Interest in Web-Based Patient Portals: Survey at an Urban Academic Safety-Net Hospital. J Med Internet Res 2019; 21:e11421. [PMID: 30912747 PMCID: PMC6454341 DOI: 10.2196/11421] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/05/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Offering hospitalized patients' enrollment into a health system's patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. Patient portal disparities exist and may lead to differences in access or outcomes. As such, it is important to study upstream factors in a typical hospital workflow that could lead to those disparities in safety-net settings. OBJECTIVE The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system's portal among hospitalized patients and reasons for no interest. METHODS Nurses assessed interest in a Web-based patient portal, expressed by the patient as "yes" or "no," as part of the admission nursing assessment among patients at an academic urban safety-net hospital and recorded responses in the electronic health record (EHR), including reasons for no interest. We extracted patient responses from the EHR. RESULTS Among 23,994 hospitalizations over a 2-year period, 35.90% (8614/ 23,994) reported an interest in a Web-based portal. Reasons for no interest included the following: not interested/other reason 41.68% (6410/15,380), no ability to use/access computers/internet 29.59% (4551/15,380), doesn't speak English 11.15% (1715/15,380), physically or mentally unable 8.70% (1338/15,380), does not want to say 8.70% (1338/15,380), security concerns 0.03% (4/15,380), and not useful 0.16% (24/15,380). Among the 16,507 unique patients included in this sample, portal interest was lower in older, African American, non-English speaking, and homeless patient populations. CONCLUSIONS In a safety-net system, patient interest at the time of hospitalization in a Web-based enterprise portal-a required step before enrollment-is low with significant disparities by sociodemographic characteristics. To avoid worsening the digital divide, new strategies are needed and should be embedded within routine workflows to engage vulnerable safety-net patients in the use of Web-based health technologies.
Collapse
Affiliation(s)
- Shobha Sadasivaiah
- Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Stephen Kiyoi
- Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States
| | - Piera Wong
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Neda Ratanawongsa
- Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
32
|
Tai-Seale M, Downing NL, Jones VG, Milani RV, Zhao B, Clay B, Sharp CD, Chan AS, Longhurst CA. Technology-Enabled Consumer Engagement: Promising Practices At Four Health Care Delivery Organizations. Health Aff (Millwood) 2019; 38:383-390. [DOI: 10.1377/hlthaff.2018.05027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ming Tai-Seale
- Ming Tai-Seale is a professor in the Department of Family Medicine and Public Health at the University of California San Diego (UCSD) School of Medicine, director of outcomes analysis and scholarship at UC San Diego Health, and director of research at UCSD Health Sciences International, in La Jolla
| | - N. Lance Downing
- N. Lance Downing is a clinical assistant professor of medicine at the Stanford School of Medicine and program director for the Stanford Program in AI-Assisted Care, both in Palo Alto, California
| | - Veena Goel Jones
- Veena Goel Jones is medical director of digital patient experience and a pediatric hospitalist at Sutter Health and an adjunct clinical assistant professor of pediatrics at the Stanford School of Medicine
| | - Richard V. Milani
- Richard V. Milani is chief clinical transformation officer at Ochsner Health System in New Orleans, Louisiana
| | - Beiqun Zhao
- Beiqun Zhao is a National Library of Medicine/National Institutes of Health biomedical informatics fellow and a general surgery resident at UC San Diego Health
| | - Brian Clay
- Brian Clay is a chief medical information officer at UC San Diego Health and a clinical professor of medicine at the UCSD School of Medicine
| | - Christopher Demuth Sharp
- Christopher Demuth Sharp is chief medical information officer at Stanford Health Care and a clinical associate professor at the Stanford School of Medicine
| | - Albert Solomon Chan
- Albert Solomon Chan is chief of digital patient experience and an investigator at Sutter Health and an adjunct professor at the Stanford Center for Biomedical Informatics Research, Stanford School of Medicine
| | - Christopher A. Longhurst
- Christopher A. Longhurst is chief information officer and associate chief medical officer at UC San Diego Health, and a clinical professor of medicine and pediatrics at the UCSD School of Medicine
| |
Collapse
|
33
|
McAlearney AS, Fareed N, Gaughan A, MacEwan SR, Volney J, Sieck CJ. Empowering Patients during Hospitalization: Perspectives on Inpatient Portal Use. Appl Clin Inform 2019; 10:103-112. [PMID: 30759491 DOI: 10.1055/s-0039-1677722] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Patients have demonstrated an eagerness to use portals to access their health information and connect with care providers. While outpatient portals have been extensively studied, there is a recognized need for research that examines inpatient portals. OBJECTIVE We conducted this study to improve our understanding about the role of a portal in the context of inpatient care. Our study focused on a large sample of the general adult inpatient population and obtained perspectives from both patients and care team members about inpatient portal use. METHODS We interviewed patients (n = 120) who used an inpatient portal during their hospitalization at 15 days or 6 months after discharge to learn about their portal use. We also interviewed care team members (n = 331) 4 weeks, 6 months, and 12 months after inpatient portal implementation to collect information about their ongoing perspectives about patients' use of the portal. RESULTS The perspectives of patients and care team members generally converged on their views of the inpatient portal. Three features-(1) ordering meals, (2) looking up health information, and (3) viewing the care team-were most commonly used; the secure messaging feature was less commonly used and of some concern to care team members. The inpatient portal benefited patients in four main ways: (1) promoted independence, (2) reduced anxiety, (3) informed families, and (4) increased empowerment. CONCLUSION Inpatient portals are recognized as a tool that can enhance the delivery of patient-centered care. In addition to empowering patients by increasing their sense of control, inpatient portals can support family members and caregivers throughout the hospital stay. Given the consistency of perspectives about portal use across patients and care team members, our findings suggest that inpatient portals may facilitate shifts in organizational culture that increase the patient centeredness of care and improve patient experience in the hospital context.
Collapse
Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,CATALYST, 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
| | - Naleef Fareed
- CATALYST, 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
| | - Alice Gaughan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jaclyn Volney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, 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.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
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
|
36
|
Haldar S, Mishra SR, Khelifi M, Pollack AH, Pratt W. Exploring the Design of an Inpatient Peer Support Tool: Views of Adult Patients. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1282-1291. [PMID: 30815170 PMCID: PMC6371245] [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
Despite wide recognition of the value, expertise, and support that patient-peers provide in a variety of health contexts, mechanisms to design and enable peer support in the inpatient setting have not been sufficiently explored. To better understand the opportunities for an inpatient peer support tool, we surveyed 100 adult patients and caregivers, and conducted follow-up, semi-structured interviews with 15 adult patients. In this paper, we describe five key peer support needs that our adult patient participants expressed: (1) adjusting to the hospital environment, (2) understanding and normalizing medical care, (3) communicating with providers, (4) reporting and preventing medical errors, and (5) empowering peers. In addition, we identify privacy concerns, situational impairments, and communication mode as barriers to, and preferences for, interacting with peers. Based on our findings, we discuss intelligent peer matching and aggregating peer data as design recommendations for future inpatient peer support tools.
Collapse
Affiliation(s)
| | | | | | - Ari H Pollack
- University of Washington, Seattle, WA
- Seattle Children's Hospital, Seattle, WA
| | | |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Walker DM, Menser T, Yen PY, McAlearney AS. Optimizing the User Experience: Identifying Opportunities to Improve Use of an Inpatient Portal. Appl Clin Inform 2018; 9:105-113. [PMID: 29444536 DOI: 10.1055/s-0037-1621732] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Patient portals specifically designed for the inpatient setting have significant potential to improve patient care. However, little is known about how the users of this technology, the patients, may interact with the inpatient portals. As a result, hospitals have limited ability to design approaches that support patient use of the portal. OBJECTIVES This study aims to evaluate the user experience associated with an inpatient portal. METHODS We used a Think-Aloud protocol to study user interactions with a commercially available inpatient portal-MyChart Bedside (MCB). Study participants included 19 English-speaking adults over the age of 18 years. In one-on-one sessions, participants narrated their experience using the MCB application and completing eight specific tasks. Recordings were transcribed and coded into three dimensions of the user experience: physical, cognitive, and sociobehavioral. RESULTS Our analysis of the physical experience highlighted the navigational errors and technical challenges associated with the use of MCB. We also found that issues associated with the cognitive experience included comprehension problems that spurred anxiety and uncertainty. Analysis of the sociobehavioral experience suggested that users have different learning styles and preferences for learning including self-guided, handouts, and in-person training. CONCLUSION Inpatient portals may be an effective tool to improve the patient experience in the hospital. Moreover, making this technology available to inpatients may help to foster ongoing use of technology across the care continuum. However, deriving the benefits from the technology requires appropriate support. We identified multiple opportunities for hospital management to intervene. In particular, teaching patients to use the application by making a variety of instructional materials available could help to reduce several identified barriers to use. Additionally, hospitals should be prepared to manage patient anxiety and increased questioning arising from the availability of information in the inpatient portal application.
Collapse
|