1
|
Nielsen MS, Steinsbekk A, Nøst TH. Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study. JMIR Ment Health 2024; 11:e57965. [PMID: 38860592 PMCID: PMC11185290 DOI: 10.2196/57965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 06/12/2024] Open
Abstract
Background In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. Objective The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals' digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. Methods A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Results Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. Conclusions A total of 17 recommendations related to key aspects of health care professionals' digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice.
Collapse
Affiliation(s)
- Martine Stecher Nielsen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, Clinical Research Facility, St. Olavs hospital, Trondheim, Norway
| |
Collapse
|
2
|
Sisk B, Antes AL, Bereitschaft C, Enloe M, Bourgeois F, DuBois J. Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators. JMIR Pediatr Parent 2024; 7:e49177. [PMID: 38466976 DOI: 10.2196/49177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/17/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents. OBJECTIVE We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care. METHODS We interviewed informatics administrators from US hospitals with ≥50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies. RESULTS We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent's health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators. CONCLUSIONS Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent's health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers.
Collapse
Affiliation(s)
- Bryan Sisk
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Alison L Antes
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
| | - Christine Bereitschaft
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Madi Enloe
- Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, MO, United States
| | - Fabienne Bourgeois
- Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - James DuBois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
| |
Collapse
|
3
|
Sethness JL, Golub S, Evans YN. Adolescent patient portals and concerns about confidentiality. Curr Opin Pediatr 2023; 35:430-435. [PMID: 37036289 DOI: 10.1097/mop.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
PURPOSE OF REVIEW To better understand confidentiality issues that arise from adolescent access to patient portals. RECENT FINDINGS Studies have evaluated the views of teens, parents, providers, and institutional leadership on adolescent patient portals and the risks they pose to adolescent privacy. Additional investigations have shown that teen portal accounts are often inappropriately accessed by parents. Guidelines are needed to better inform the creation of secure teen patient portals. Adolescent providers and other medical staff should be aware of the information available on portals, how to ensure portals are being accessed appropriately, and the potential for confidentiality breaches that come with portal use. Medical organizations that offer portal access need to provide resources to adolescents and their families to improve understanding around the importance of confidential care and how to maintain confidentiality while still engaging meaningfully with the healthcare system through patient portals. SUMMARY Adolescents realize the benefits portals may offer regarding improved understanding of their health conditions, communication with their providers, and autonomy in their healthcare decisions. However, confidentiality of patient portals is a major concern and a potential barrier to adolescent portal utilization. Adolescent providers should be aware of the limitations of portal systems and advocate for improved confidentiality functionality to ensure teens can access the benefits of patient portals without any harm.
Collapse
Affiliation(s)
- Janis L Sethness
- Division of Adolescent Medicine, Seattle Children's Hospital
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sarah Golub
- Division of Adolescent Medicine, Seattle Children's Hospital
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| |
Collapse
|
4
|
Sarabu C, Sharko M, Petersen C, Galvin H. Shifting into Action: from Data Segmentation to Equitable Interoperability for Adolescents (and Everyone Else). Appl Clin Inform 2023; 14:544-554. [PMID: 37467783 PMCID: PMC10356185 DOI: 10.1055/s-0043-1769924] [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: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Technological improvements and, subsequently, the federal 21st Century Cures Act have resulted in increased access to and interoperability of electronic protected health information (ePHI). These not only have many benefits, but also have created unique challenges for privacy and confidentiality for adolescent patients. The inability to granularly protect sensitive data and a lack of standards have resulted in limited confidentiality protection and inequitable access to health information. OBJECTIVES This study aimed to understand the challenges to safe, equitable access, and interoperability of ePHI for adolescents and to identify strategies that have been developed, ongoing needs, and work in progress. METHODS Shift, a national task force formalized in 2020, is a group of more than 200 expert stakeholder members working to improve functionality to standardize efforts to granularly identify and protect sensitive ePHI to promote equitable interoperability. RESULTS Shift has created high-priority clinical use cases and organized challenges into the areas of Standards and Terminology; Usability and Implementation; and Ethics, Legal, and Policy. CONCLUSION Current technical standards and value sets of terminology for sensitive data have been immature and inconsistent. Shift, a national diverse working group of stakeholders, is addressing challenges inherent in the protection of privacy and confidentiality for adolescent patients. The diversity of expertise and perspectives has been essential to identify and address these challenges.
Collapse
Affiliation(s)
- Chethan Sarabu
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Marianne Sharko
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, United States
| | - Carolyn Petersen
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Hannah Galvin
- Department of Information Technology, Cambridge Health Alliance, Tufts University School of Medicine, Cambridge, Massachusetts, United States
| |
Collapse
|
5
|
Sampson A, Block R, Lake PW, Gagliardi J, Augusto B, Santiago-Datil W, Sutter M, Schabath MB, Vadaparampil S, Quinn GP. "No one size fits all" A Multi-Method Survey of Oncology Allied Health Professionals Experiences with Lesbian, Gay, Bisexual, Transgender/Queer Questioning Adolescent, and Young Adult Patients with Cancer and Reproductive and Sexual Health". J Adolesc Young Adult Oncol 2023; 12:250-258. [PMID: 35731000 PMCID: PMC10124174 DOI: 10.1089/jayao.2021.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To assess training needs for providers who care for adolescent and young adult (AYA) lesbian, gay, bisexual, transgender/queer questioning (LGBTQ) cancer patients, we conducted a mixed-method survey. During their cancer care experience, AYA cancer patients experience physical, psychosocial, and reproductive health challenges. In addition to these challenges, AYA LGBTQ individuals are a diverse and medically underserved population who experience unique challenges and disparities in medical care. Methods: Health care providers (n = 351) who participated in our reproductive health in cancer training program completed a survey with 28 quantitative items and 4 open-ended items assessing knowledge, confidence discussing reproductive health, and confidence in knowledge specific to reproductive needs and general health needs among AYA LGBTQ patients. Results: Confidence discussing and confidence in knowledge of reproductive and general health needs are lower regarding transgender and nonbinary patients. Nearly half of providers (45%) demonstrated low knowledge, while 38% and 17% demonstrated moderate and high knowledge, respectively. Open comments indicated providers desired more training around the needs of Trans and nonbinary patients, and creating welcoming environments. Conclusions: The majority of our participants demonstrate low or moderate knowledge regarding factors that can influence AYA LGBTQ patient care, suggesting that this is a key area for improvement. Furthermore, improving provider knowledge may subsequently improve confidence in general and reproductive needs of LGBTQ patients, resulting in improved patient-centered care. Improving provider knowledge and confidence may then ultimately help reduce disparities in cancer care among this patient population.
Collapse
Affiliation(s)
- Amani Sampson
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, New York, USA
| | | | - Paige W. Lake
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Community Outreach Engagement, & Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Julia Gagliardi
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, New York, USA
| | - Bianca Augusto
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Community Outreach Engagement, & Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Waleska Santiago-Datil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Community Outreach Engagement, & Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Megan Sutter
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, New York, USA
| | - Matthew B. Schabath
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Community Outreach Engagement, & Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Community Outreach Engagement, & Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
6
|
Hagström J, Blease C, Haage B, Scandurra I, Hansson S, Hägglund M. Views, Use, and Experiences of Online Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review (Preprint). J Med Internet Res 2022; 24:e40328. [DOI: 10.2196/40328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
|
7
|
Ford CA, Bourgeois F, Buckelew SM, Emans SJ, English A, Evans YN, Irwin CE, Richardson LP, Sherer S, Short S, Sieving RE, Simpson T, Tanaka D, White K. Twenty-First Century Cures Act Final Rule and Adolescent Health Care: Leadership Education in Adolescent Health (LEAH) Program Experiences. J Adolesc Health 2021; 69:873-877. [PMID: 34666958 DOI: 10.1016/j.jadohealth.2021.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Carol A Ford
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Fabienne Bourgeois
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Sara M Buckelew
- Department of Pediatrics, University of California at San Francisco/Benioff Children's Hospitals, San Francisco, California
| | - S Jean Emans
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Abigail English
- Center for Adolescent Health & the Law, Chapel Hill, North Carolina
| | - Yolanda N Evans
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Charles E Irwin
- Department of Pediatrics, University of California at San Francisco/Benioff Children's Hospitals, San Francisco, California
| | - Laura P Richardson
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Sara Sherer
- Department of Pediatrics, University of Southern California/Children's Hospital of Los Angeles, Los Angeles, California
| | - Sonja Short
- Department of Medical Informatics, University of Minnesota/Fairview Health System, Eagan, Minnesota
| | - Renee E Sieving
- School of Nursing and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Tina Simpson
- Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Diane Tanaka
- Department of Pediatrics, University of Southern California/Children's Hospital of Los Angeles, Los Angeles, California
| | - Krishna White
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
8
|
Ip W, Yang S, Parker J, Powell A, Xie J, Morse K, Aikens RC, Lee J, Gill M, Vundavalli S, Huang Y, Huang J, Chen JH, Hoffman J, Kuelbs C, Pageler N. Assessment of Prevalence of Adolescent Patient Portal Account Access by Guardians. JAMA Netw Open 2021; 4:e2124733. [PMID: 34529064 PMCID: PMC8446820 DOI: 10.1001/jamanetworkopen.2021.24733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Importance Patient portals can be configured to allow confidential communication for adolescents' sensitive health care information. Guardian access of adolescent patient portal accounts could compromise adolescents' confidentiality. Objective To estimate the prevalence of guardian access to adolescent patient portals at 3 academic children's hospitals. Design, Setting, and Participants A cross-sectional study to estimate the prevalence of guardian access to adolescent patient portal accounts was conducted at 3 academic children's hospitals. Adolescent patients (aged 13-18 years) with access to their patient portal account with at least 1 outbound message from their portal during the study period were included. A rule-based natural language processing algorithm was used to analyze all portal messages from June 1, 2014, to February 28, 2020, and identify any message sent by guardians. The sensitivity and specificity of the algorithm at each institution was estimated through manual review of a stratified subsample of patient accounts. The overall proportion of accounts with guardian access was estimated after correcting for the sensitivity and specificity of the natural language processing algorithm. Exposures Use of patient portal. Main Outcome and Measures Percentage of adolescent portal accounts indicating guardian access. Results A total of 3429 eligible adolescent accounts containing 25 642 messages across 3 institutions were analyzed. A total of 1797 adolescents (52%) were female and mean (SD) age was 15.6 (1.6) years. The percentage of adolescent portal accounts with apparent guardian access ranged from 52% to 57% across the 3 institutions. After correcting for the sensitivity and specificity of the algorithm based on manual review of 200 accounts per institution, an estimated 64% (95% CI, 59%-69%) to 76% (95% CI, 73%-88%) of accounts with outbound messages were accessed by guardians across the 3 institutions. Conclusions and Relevance In this study, more than half of adolescent accounts with outbound messages were estimated to have been accessed by guardians at least once. These findings have implications for health systems intending to rely on separate adolescent accounts to protect adolescent confidentiality.
Collapse
Affiliation(s)
- Wui Ip
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Information Services, Stanford Children's Health, Palo Alto, California
| | - Samuel Yang
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Hospital Medicine, The Ohio State University College of Medicine, Columbus
| | - Jacob Parker
- Information Management Division, Rady Children's Hospital, San Diego, California
| | - Austin Powell
- Information Services, Stanford Children's Health, Palo Alto, California
| | - James Xie
- Information Services, Stanford Children's Health, Palo Alto, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Keith Morse
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Information Services, Stanford Children's Health, Palo Alto, California
| | - Rachael C. Aikens
- Department of Biomedical Informatics, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Lee
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Manjot Gill
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Hospital Medicine, The Ohio State University College of Medicine, Columbus
| | - Shravani Vundavalli
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Yungui Huang
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jeannie Huang
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Jonathan H. Chen
- Center for Biomedical Informatics Research, Stanford University, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey Hoffman
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Cynthia Kuelbs
- Information Management Division, Rady Children's Hospital, San Diego, California
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Natalie Pageler
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Information Services, Stanford Children's Health, Palo Alto, California
| |
Collapse
|
9
|
Mueller EL, Cochrane AR, Moore CM, Miller AD, Wiehe SE. Title: The Children's Oncology Planning for Emergencies (COPE) Tool: Prototyping with Caregivers of Children with Cancer. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:896-905. [PMID: 33936465 PMCID: PMC8075434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As part of a larger project to co-design and create a mHealth tool to support caregivers of children with cancer, we performed a pilot, qualitative study. For this portion of the project, we engaged with caregivers of children with cancer to co-create and refine a low-fidelity prototype of the Children's Oncology Planning for Emergencies mHealth tool. Testing was accomplished through recorded semi-structured interviews with each caregiver as they interacted with a low-fidelity wireframe using Adobe Xd. Through the engagement of our key stakeholders, we were able to refine the COPE tool to provide the key elements they desired including pertinent patient medical information, checklist for planning when seeking urgent care, and coordination of care with the medical team and other caregivers.
Collapse
Affiliation(s)
- Emily L Mueller
- Indiana University, Indianapolis, IN
- Riley Hospital for Children, Indianapolis, IN
| | - Anneli R Cochrane
- Indiana University, Indianapolis, IN
- Riley Hospital for Children, Indianapolis, IN
| | | | | | - Sarah E Wiehe
- Indiana University, Indianapolis, IN
- Riley Hospital for Children, Indianapolis, IN
| |
Collapse
|
10
|
Weis A, Pohlmann S, Poss-Doering R, Strauss B, Ullrich C, Hofmann H, Ose D, Winkler EC, Szecsenyi J, Wensing M. Caregivers' role in using a personal electronic health record: a qualitative study of cancer patients and caregivers in Germany. BMC Med Inform Decis Mak 2020; 20:158. [PMID: 32660600 PMCID: PMC7358207 DOI: 10.1186/s12911-020-01172-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/29/2020] [Indexed: 11/27/2022] Open
Abstract
Background Particularly in the context of severe diseases like cancer, many patients wish to include caregivers in the planning of treatment and care. Many caregivers like to be involved but feel insufficiently enabled. This study aimed at providing insight into patients’ and caregivers’ perspectives on caregivers’ roles in managing the patient portal of an electronic personal health record (PHR). Methods A descriptive qualitative study was conducted comprising two study phases: (1) Usability tests and interviews with patients with cancer and caregivers (2) additional patient interviews after a 3-month-pilot-testing of the PHR. For both study parts, a convenience sample was selected, focusing on current state of health and therapy process and basic willingness to participate and ending up with a mixed sample as well as saturation of data. All interviews were audio-recorded, pseudonymized, transcribed verbatim and qualitatively analyzed. Results Two main categories emerged from qualitative data: ‘Caregivers’ role’ and ‘Graduation of access rights’ – consisting of four subcategories each. The interviewed patients (n = 22) and caregivers (n = 9) felt that the involvement of caregivers is central to foster the acceptance of a PHR for cancer patients. However, their role varied from providing technical support to representing patients, e.g. if the patient’s state of health made this necessary. Heterogeneous opinions emerged regarding the question whether caregivers should receive full or graduated access on a patient’s PHR. Conclusions In order to support the patient and to participate in the care process, caregivers need up-to-date information on the patient’s health and treatment. Nevertheless, some patients do not want to share all medical data with caregivers, which might strain the patient-caregiver relationship. This needs to be considered in development and implementation of personal health records. Generally, in the debate on patient portals of a personal health record, paying attention to the role of caregivers is essential. By appreciating the important relationship between patients and caregivers right from the beginning, implementation, of a PHR would be enhanced. Trial registration ISRCTN85224823. Date of registration: 23/12/2015 (retrospectively registered).
Collapse
Affiliation(s)
- Aline Weis
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Sabrina Pohlmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Beate Strauss
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Helene Hofmann
- Ethics and Patient-Oriented Care, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Dominik Ose
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Eva C Winkler
- Ethics and Patient-Oriented Care, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| |
Collapse
|
11
|
Carlson JL, Goldstein R, Buhr T, Buhr N. Teenager, Parent, and Clinician Perspectives on the Electronic Health Record. Pediatrics 2020; 145:peds.2019-0193. [PMID: 32024749 DOI: 10.1542/peds.2019-0193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jennifer L Carlson
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California; and
| | - Rachel Goldstein
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California; and
| | - Tyler Buhr
- Lucile Packard Children's Hospital, Palo Alto, California
| | - Nancy Buhr
- Lucile Packard Children's Hospital, Palo Alto, California
| |
Collapse
|
12
|
Steitz BD, Wong JIS, Cobb JG, Carlson B, Smith G, Rosenbloom ST. Policies and procedures governing patient portal use at an Academic Medical Center. JAMIA Open 2019; 2:479-488. [PMID: 32025645 PMCID: PMC6994003 DOI: 10.1093/jamiaopen/ooz039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/28/2019] [Accepted: 08/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patient portal use has increased over the last two decades in response to consumer demand and government regulation. Despite growing adoption, few guidelines exist to direct successful implementation and governance. We describe the policies and procedures that have governed over a decade of continuous My Health at Vanderbilt (MHAV) patient portal use. METHODS We examined MHAV usage data between May 2007 and November 2017. We classified patient portal activity into eight functional categories: Appointment, Billing, Document Access, Genetics, Health Result, Immunization, Medication, and Messaging. We describe our operating policies and measure portal uptake, patient account activity, and function use over time. RESULTS By the end of the study period, there were 375 517 registered accounts. Policies made MHAV available to competent adults and adolescents 13 and over. Patients signed up for a limited access account online, which could be upgraded to a full-access account after identity verification. Patients could assign proxy accounts to family and caregivers, which permitted nonpatient access to select MHAV functions. Laboratory and radiology results were accessible via MHAV. Results were classified into three groups based on sensitivity, which govern the length of delay before results appeared in MHAV. DISCUSSION AND CONCLUSION Patient portals offer significant opportunity to engage patients in their healthcare. However, there remains a need to understand how policies can promote uptake and use. We anticipate that other institutions can apply concepts from our policies to support meaningful patient portal engagement.
Collapse
Affiliation(s)
- Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jared G Cobb
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian Carlson
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gaye Smith
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center
| |
Collapse
|
13
|
Abstract
BACKGROUND Nurses providing 24-h care for the primary caregiver role have a number of significant roles to play in potential problems or conflicts associated with patient privacy and confidentiality. RESEARCH OBJECTIVES The objective of the study is to determine the prevailing attitudes towards gossip and the patient privacy practices of nurses working in paediatric units. RESEARCH DESIGN A descriptive and cross-sectional design was used. A Descriptive Characteristics Form, a Gossip and Rumour Attitude Scale and a Patient Privacy Scale were used to collect data. PARTICIPANTS AND RESEARCH CONTEXT A total of 112 paediatric nurses working in Turkey were included in the study. The response rate was 79.43%. ETHICAL CONSIDERATIONS Permission to conduct the study was obtained from the university's ethics committee. The participants were informed of the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them. FINDINGS It was observed that nurses who had a higher education level, who were educated about patient privacy and who had read the patient rights regulations were more concerned about patient privacy. Negative correlations were found between the attitudes towards gossiping and the average scores on the patient confidentiality scale. Nurses who negatively defined gossip were more concerned about patient confidentiality. DISCUSSION Privacy is important for securing and protecting the personal, physical and psychological things that are important and special for patients. It is argued that obstacles to maintaining the privacy of hospitalized children and adolescents are a tolerant attitude towards gossiping, a lack of education about patient privacy and insufficient information about patient's rights regulations and the Convention on the Rights of the Child. CONCLUSION A nurse's knowledge about the provision of patient confidentiality affects their privacy practices. For this reason, regular training sessions are recommended in hospitals.
Collapse
|