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Hughes M, Doyle M, Moroney D, Fennelly O. Designing an interoperable patient portal to augment an Advanced Nurse Practitioner service for Children with hydrocephalus. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100223. [PMID: 39131241 PMCID: PMC11315161 DOI: 10.1016/j.ijnsa.2024.100223] [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: 03/04/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 08/13/2024] Open
Abstract
Background Children's Health Ireland (CHI), who govern and operate acute paediatric services for the greater Dublin area, are also the client for the new children's hospital project which will be Ireland's first fully digital hospital. Design, development and implementation of digital solutions has been prioritised by the National Strategy for Children's Nursing to transform and accelerate nurse-led services. Aim The aim of this phase of a larger study was to explore the perspectives and opinions of key stakeholders on the requirements, benefits, and challenges for a bespoke patient portal, with a specific focus on the ANP-led Neurosurgical Service and children and young people with hydrocephalus. Methods Interviews and focus groups were held online, and data were recorded and transcribed verbatim. Twenty-three participants across eight sites were interviewed including parents, healthcare professionals, experts and management/administrators. Data were analysed using Braun and Clarke's (2006) framework. Results Four key findings and considerations were identified in relation to patient portals in general and their interoperability with Electronic Health Records, as well as a bespoke patient portal for children and young people with hydrocephalus. Conclusions The availability of a patient portal for children and young people with hydrocephalus would be hugely advantageous to their parents, the ANP led nursing service, and healthcare professionals in both the neurosurgical service at CHI and at regional healthcare organisations as well as for administration, research, and reports. More timely access to health data as well as a consistent log of information and communications between patients and healthcare professionals, would be more efficient and effective than current practices.The augmented ANP-led Neurosurgical Nursing Service at CHI will act as a pilot project from which other nurse-led digital patient services can learn from. Study Registration This study was conducted between September 2022 and June 2023. It was registered in Trinity College Dublin, Ireland. Twitter Abstract A study exploring requirements, benefits, & challenges for an interoperable patient portal in an ANP led Service for children with hydrocephalus.
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Affiliation(s)
- Mary Hughes
- Trinity School of Nursing and Midwifery, Dublin Ireland
| | - Michelle Doyle
- Neurosurgery Team, Children's Health Ireland at Temple Street, Dublin 1
| | | | - Orna Fennelly
- Trinity School of Nursing and Midwifery, Dublin Ireland
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Durocher K, Shin HD, Jackson KT, Strudwick G. Women's experiences of using patient portals in healthcare settings: a rapid review. BMC Womens Health 2024; 24:449. [PMID: 39118081 PMCID: PMC11308597 DOI: 10.1186/s12905-024-03292-9] [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] [Received: 05/22/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The integration of patient portals into health systems has the potential to increase access for women. For example, within a mental health context, women are at a higher risk of developing anxiety and depression but may experience barriers in accessing care. Therefore, the aim of this rapid review was to understand what is currently known about patient portal use among women. The objectives were (1) To discover pertinent facilitators for women when using patient portals; (2) To discern if women face individual barriers to accessing patient portals; and (3) To explore the potential role of patient portals for women's mental health care. METHODS A rapid review methodology was implemented using the Cochrane Rapid Reviews Methods Group, as well as a grey literature scan. Inclusion criteria included articles that focused on women's use of patient portals within healthcare settings. Four databases were searched, including Embase, MEDLINE (Ovid), CINAHL and PsycINFO in September 2023. Two independent reviewers performed screening, data extraction, and analysis. RESULTS This search resulted in screening 1385 titles and abstracts, and 82 articles for full-text eligibility. 15 articles were included in the review. Data were extracted and analyzed, guided by the research objectives. Facilitators to patient portal use included processes that enhanced user engagement, the provision of portal tools, and management of health care features. Barriers included health equity factors and use of medical jargon. Applications to mental health care included how use of portals eased women's anxiety and increased their sense of internal control. CONCLUSIONS The results of this review indicate that interrelated factors influence women's experiences with using patient portals. By understanding facilitators and barriers to portal use, and applications for mental health care, we can understand how to improve women's use of portals in the future.
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Affiliation(s)
- Keri Durocher
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Hwayeon Danielle Shin
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, 1151 Richmond Street, London, ON, Canada
| | - Gillian Strudwick
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada
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Badr J, Motulsky A, Denis JL. Digital health technologies and inequalities: A scoping review of potential impacts and policy recommendations. Health Policy 2024; 146:105122. [PMID: 38986333 DOI: 10.1016/j.healthpol.2024.105122] [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: 10/19/2023] [Revised: 05/17/2024] [Accepted: 06/29/2024] [Indexed: 07/12/2024]
Abstract
Digital health technologies hold promises for reducing health care costs, enhancing access to care, and addressing labor shortages. However, they risk exacerbating inequalities by disproportionately benefitting a subset of the population. Use of digital technologies accelerated during the Covid-19 pandemic. Our scoping review aimed to describe how inequalities related to their use were conceptually assessed during and after the pandemic and understand how digital strategies and policies might support digital equity. We used the PRISMA Extension for scoping reviews, identifying 2055 papers through an initial search of 3 databases in 2021 and complementary search in 2022, of which 41 were retained. Analysis was guided by the eHealth equity framework. Results showed that digital inequalities were reported in the U.S. and other high-income countries and were mainly assessed through differences in access and use according to individual sociodemographic characteristics. Health disparities related to technology use and the interaction between context and technology implementation were more rarely documented. Policy recommendations stressed the adoption of an equity lens in strategy development and multilayered and intersectoral collaboration to align interventions with the needs of specific subgroups. Finally, findings suggested that evaluations of health and wellbeing distribution related to the use of digital technologies should inform digital strategies and health policies.
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Affiliation(s)
- Janine Badr
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada.
| | - Aude Motulsky
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada
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Wolff JL, Wec A, Peereboom D, Gleason KT, Amjad H, Burgdorf JG, Cassidy J, DesRoches CM, Fabius CD, Green AR, Lin CT, Nothelle SK, Powell DS, Riffin CA, Smith J, Lum HD. Care partners and consumer health information technology: A framework to guide systems-level initiatives in support of digital health equity. Learn Health Syst 2024; 8:e10408. [PMID: 38883870 PMCID: PMC11176584 DOI: 10.1002/lrh2.10408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Consumer-oriented health information technologies (CHIT) such as the patient portal have a growing role in care delivery redesign initiatives such as the Learning Health System. Care partners commonly navigate CHIT demands alongside persons with complex health and social needs, but their role is not well specified. Methods We assemble evidence and concepts from the literature describing interpersonal communication, relational coordination theory, and systems-thinking to develop an integrative framework describing the care partner's role in applied CHIT innovations. Our framework describes pathways through which systematic engagement of the care partner affects longitudinal work processes and multi-level outcomes relevant to Learning Health Systems. Results Our framework is grounded in relational coordination, an emerging theory for understanding the dynamics of coordinating work that emphasizes role-based relationships and communication, and the Systems Engineering Initiative for Patient Safety (SEIPS) model. Cross-cutting work systems geared toward explicit and purposeful support of the care partner role through CHIT may advance work processes by promoting frequent, timely, accurate, problem-solving communication, reinforced by shared goals, shared knowledge, and mutual respect between patients, care partners, and care team. We further contend that systematic engagement of the care partner in longitudinal work processes exerts beneficial effects on care delivery experiences and efficiencies at both individual and organizational levels. We discuss the utility of our framework through the lens of an illustrative case study involving patient portal-mediated pre-visit agenda setting. Conclusions Our framework can be used to guide applied embedded CHIT interventions that support the care partner role and bring value to Learning Health Systems through advancing digital health equity, improving user experiences, and driving efficiencies through improved coordination within complex work systems.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Aleksandra Wec
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Danielle Peereboom
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Kelly T Gleason
- Johns Hopkins University School of Nursing Baltimore Maryland USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Julia G Burgdorf
- Center for Home Care Policy & Research Visiting Nurse Service of New York New York New York USA
| | - Jessica Cassidy
- School of Social Work University of Texas at Arlington Arlington Texas USA
| | | | - Chanee D Fabius
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ariel R Green
- Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - C T Lin
- University of Colorado Aurora Colorado USA
| | - Stephanie K Nothelle
- Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Danielle S Powell
- Department of Hearing & Speech Sciences University of Maryland College Park Maryland USA
| | - Catherine A Riffin
- Division of Geriatrics and Palliative Medicine Weill Cornell Medical Center New York New York USA
| | - Jamie Smith
- Johns Hopkins School of Nursing Baltimore Maryland USA
| | - Hillary D Lum
- Division of Geriatric Medicine University of Colorado School of Medicine Aurora Colorado USA
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Coetzer JA, Loukili I, Goedhart NS, Ket JCF, Schuitmaker-Warnaar TJ, Zuiderent-Jerak T, Dedding C. The potential and paradoxes of eHealth research for digitally marginalised groups: A qualitative meta-review. Soc Sci Med 2024; 350:116895. [PMID: 38710135 DOI: 10.1016/j.socscimed.2024.116895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
Whilst the transformation towards digital healthcare is accelerating, there is still a substantial risk of excluding people with a distance to the online world. Groups like people with a low socioeconomic position, people with a migrant background or the elderly, who are already most at risk of experiencing health inequalities, are simultaneously experiencing increased digital exclusion. Researchers play a role in determining how eHealth access is framed and can thus impact how the barriers to its use are addressed. This qualitative meta-review critically evaluates the way researchers (as authors) discuss eHealth use in digitally marginalised groups. Specifically, it seeks to understand how eHealth is framed to address existing health systems problems; how the barriers to eHealth use are presented and which solutions are provided in response; and who authors suggest should be responsible for making eHealth work. The results of this review found four paradoxes in how current literature views eHealth use. Firstly, that health systems problems are complex and nuanced, yet eHealth is seen as a simple answer. Secondly, that there are many political, social and health systems-based solutions suggested to address eHealth use, however most of the identified barriers are individually framed. This focus on personal deficits results in misallocating responsibility for making these systemic improvements. Thirdly, although eHealth is meant to simplify the tasks of patients and healthcare workers, these are the groups most often burdened with the responsibility of ensuring its success. Lastly, despite tailoring eHealth to the user being the most suggested solution, researchers generally speak about groups as a homogenous entity - thus rendering tailoring difficult. Ultimately, this review finds that a shift to focus research on addressing systemic issues on a systems level is necessary to prevent further exacerbating existing health inequalities.
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Affiliation(s)
- Jessica A Coetzer
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Ibrahim Loukili
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Nicole S Goedhart
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Johannes C F Ket
- VUmc, Medische Bibliotheek, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | | | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Christine Dedding
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
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Benjamins J, de Vet E, de Mortier CA, Haveman-Nies A. The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents. J Particip Med 2024; 16:e50092. [PMID: 38652532 PMCID: PMC11077414 DOI: 10.2196/50092] [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: 07/10/2023] [Revised: 12/11/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports. OBJECTIVE This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client's perspective. METHODS We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal. RESULTS Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting. CONCLUSIONS Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence.
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Affiliation(s)
- Janine Benjamins
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- Icare JGZ, Meppel, Netherlands
- Stichting Jeugd Noord Veluwe, Nunspeet, Netherlands
| | - Emely de Vet
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- University Collega Tilburg, Tilburg University, Tilburg, Netherlands
| | - Chloe A de Mortier
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Knowledge Instiute of Medical Specialists, Utrecht, Netherlands
| | - Annemien Haveman-Nies
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- GGD Noord-en Oost Gelderland, Warnsveld, Netherlands
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Antonio MG, Veinot TC. From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses. J Am Med Inform Assoc 2024; 31:674-691. [PMID: 38134954 PMCID: PMC10873853 DOI: 10.1093/jamia/ocad234] [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] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Investigate how people with chronic obstructive pulmonary disease (COPD)-an example of a progressive, potentially fatal illness-are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness. MATERIALS AND METHODS A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages. RESULTS Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity. DISCUSSION AND CONCLUSION We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. "Quality of life informatics" should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.
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Affiliation(s)
- Marcy G Antonio
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- School of Health Information Science, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
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Yoon E, Hur S, Opsasnick L, Huang W, Batio S, Curtis LM, Benavente JY, Lewis-Thames MW, Liebovitz DM, Wolf MS, Serper M. Disparities in Patient Portal Use Among Adults With Chronic Conditions. JAMA Netw Open 2024; 7:e240680. [PMID: 38421645 PMCID: PMC10905301 DOI: 10.1001/jamanetworkopen.2024.0680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Disparities in patient access and use of health care portals have been documented. Limited research has evaluated disparities in portal use during and after the COVID-19 pandemic. Objective To assess prevalence of health care portal use before, during, and after the most restrictive phase of the pandemic (2019-2022) among the COVID-19 & Chronic Conditions (C3) cohort and to investigate any disparities in use by sociodemographic factors. Design, Setting, and Participants This cohort study uses data from the C3 study, an ongoing, longitudinal, telephone-based survey of participants with multiple chronic conditions. Participants were middle aged and older-adult primary care patients who had an active portal account, recruited from a single academic medical center in Chicago, Illinois, between 2019 and 2022. Data were analyzed between March and June 2022. Main Outcomes and Measures Outcomes of portal use (ie, number of days of portal login by year) were recorded for all study participants by the electronic data warehouse. All parent studies had uniform sociodemographic data and measures of social support, self-efficacy, health literacy, and health activation. Results Of 536 participants (mean [SD] age, 66.7 [12.0] years; 336 [62.7%] female), 44 (8.2%) were Hispanic or Latinx, 142 (26.5%) were non-Hispanic Black, 322 (60.1%) were non-Hispanic White, and 20 individuals (3.7%) identified as other race, including Asian, Native American or Alaskan Native, and self-reported other race. In multivariable analyses, portal login activity was higher during the 3 years of the COVID-19 pandemic compared with the 2019 baseline. Higher portal login activity was associated with adequate health literacy (incidence rate ratio [IRR], 1.51; 95% CI, 1.18-1.94) and multimorbidity (IRR, 1.38; 95% CI, 1.17-1.64). Lower portal activity was associated with older age (≥70 years: IRR, 0.69; 95% CI, 0.55-0.85) and female sex (IRR, 0.77; 95% CI, 0.66-0.91). Compared with non-Hispanic White patients, lower portal activity was observed among Hispanic or Latinx patients (IRR, 0.66; 95% CI, 0.49-0.89), non-Hispanic Black patients (IRR, 0.68; 95% CI, 0.56-0.83), and patients who identified as other race (IRR, 0.42; 95% CI, 0.28-0.64). Conclusions and Relevance This cohort study using data from the C3 study identified changes in portal use over time and highlighted populations that had lower access to health information. The COVID-19 pandemic was associated with an increase in portal use. Sociodemographic disparities by sex and age were reduced, although disparities by health literacy widened. A brief validated health literacy measure may serve as a useful digital literacy screening tool to identify patients who need further support.
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Affiliation(s)
- Esther Yoon
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Supportive Oncology, Rush University Cancer Center, Chicago, Illinois
| | - Scott Hur
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wei Huang
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie Batio
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laura M. Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Julia Yoshinso Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marquita W. Lewis-Thames
- Department of Medical Social Science, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Michael S. Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Dang P, Chavez A, Pham C, Tipton M, Woodard LD, Adepoju OE. Proxy use of patient portals on behalf of children: Federally Qualified Health Centers as a case study. Digit Health 2024; 10:20552076231224073. [PMID: 38205036 PMCID: PMC10777763 DOI: 10.1177/20552076231224073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Objective This study examined the proxy use of patient portals for children in a large Federally Qualified Health Centers (FQHC) network in Texas. Methods We used de-identified individual-level data of patients, 0-18 years, who had 1+ visits between December 2018 and November 2020. Logistic regression was used to examine patient-, clinic-, and geographic-level factors associated with portal usage by an assumed proxy (i.e. parent or guardian). Results The proxy portal usage rate increased from 28% in the pre-pandemic months (November 2018-February 2020) to 34% in the pandemic months (March-Nov 2020). Compared to patients 0-5 years, patients aged 6 to 18 years had lower odds of portal usage (6-10 OR: 0.77, p < 0.001; 11-14 OR: 0.62, p < 0.001; 15-18 OR: 0.51, p < 0.001). Minoritized groups had significantly lower odds of portal usage when compared to their non-Hispanic White counterparts (non-Hispanic Black OR: 0.78, p < 0.001; Hispanic OR 0.63, p < 0.001; Asian OR: 0.69, p < 0.001). Having one chronic condition was associated with portal usage (OR: 1.57, p < 0.001); however, there were no significant differences in portal usage between those with none or multiple chronic conditions. Portal usage also varied by service lines, with obstetrics and gynecology (OR: 1.84, p < 0.001) and behavioral health (OR 1.82, p < 0.001) having the highest odds of usage when compared to pediatrics. Having a telemedicine visit was the strongest predictor of portal usage (OR: 2.30, p < 0.001), while residence in zip codes with poor broadband internet access was associated with lower odds of portal usage (OR: 0.97, p < 0.001). Conclusion While others have reported portal usage rates as high as 64% in pediatric settings, our analysis suggests proxy portal usage rates of 30% in pediatric FQHC settings, with race/ethnicity, age group, and chronic disease status being significant drivers of portal non-usage. These findings highlight the need for appropriate and responsive health information technology approaches for vulnerable populations receiving care in low-resource settings.
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Affiliation(s)
- Patrick Dang
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - Arlette Chavez
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - Cecilia Pham
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Mary Tipton
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - LeChauncy D Woodard
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Omolola E Adepoju
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
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Iyamu I, Kassam R, Worthington C, Grace D, Pedersen H, Haag D, Bondyra M, Salmon A, Koehoorn M, Gilbert M. Missed opportunities to provide sexually transmitted and blood-borne infections testing in British Columbia: An interpretive description of users' experiences of Get Checked Online's design and implementation. Digit Health 2024; 10:20552076241277653. [PMID: 39233893 PMCID: PMC11372858 DOI: 10.1177/20552076241277653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024] Open
Abstract
Background Digital testing services for sexually transmitted and blood-borne infections (STBBIs), such as GetCheckedOnline, experience significant user drop-offs. For example, 32% of GetCheckedOnline users needing testing at account creation do not test, constituting missed opportunities. We explored the influence of users' expectations and experiences of GetCheckedOnline's web design and implementation on missed opportunities. Methods This interpretive description purposively sampled 14 GetCheckedOnline users who created accounts between April 2022 and February 2023, indicated needed testing at account creation but did not test. We conducted semi-structured interviews and cognitive walkthroughs of GetCheckedOnline on Zoom, exploring participants' expectations and experiences, including problems using the service. Interviews were audio recorded, transcribed verbatim, and analyzed using reflexive thematic analyses. Results Three themes were identified: (a) transitioning between GetCheckedOnline and laboratory services is a major testing barrier; (b) users' appraisal of their health and social contexts is a determinant of testing through GetCheckedOnline; and (c) tailoring GetCheckedOnline's design and implementation to accommodate varying user needs can promote equitable testing. Health equity issues occurred along sociodemographic gradients as the GetCheckedOnline-laboratory transition was more onerous for older users. Users' appraisal of their testing needs which varied by age and gender, and their assessment of time, and travel requirements for testing in remote communities influenced testing. Learning about GetCheckedOnline from healthcare providers improved testing compared with learning about the service through Google search which raised trust concerns regarding GetCheckedOnline's authenticity. Suggested improvements to promote health equity include personalized education, mail-in testing options, and simpler seamless web experiences. Conclusions To promote equitable access to digital STBBI testing services such as GetCheckedOnline, we can adapt web-design and implementation to suit user needs and contexts, ensuring simplicity and options for testing that reduce user burdens.
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Affiliation(s)
- Ihoghosa Iyamu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control (BCCDC), Vancouver, Canada
| | - Rosemin Kassam
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Daniel Grace
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | - Devon Haag
- BC Centre for Disease Control (BCCDC), Vancouver, Canada
| | - Mark Bondyra
- BC Centre for Disease Control (BCCDC), Vancouver, Canada
| | - Amy Salmon
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control (BCCDC), Vancouver, Canada
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Bignell CA, Petrovskaya O. Understanding the role and impact of electronic health records in labor and delivery nursing practice: A scoping review protocol. Digit Health 2024; 10:20552076241249271. [PMID: 38665885 PMCID: PMC11044773 DOI: 10.1177/20552076241249271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background Electronic health records have a significant impact on nursing practice, particularly in specializations such as labor and delivery, or acute care maternity nursing practice. Although primary studies on the use of electronic health records in labor and delivery have been done, no reviews on this topic exist. Moreover, the topic of labor and delivery nurses' organizing work in the electronic health record-enabled context has not been addressed. Objective To (a) synthesize research on electronic health record use in labor and delivery nursing and (b) map how labor and delivery nursing organizing work is transformed by the electronic health record (as described in the reviewed studies). Methods The scoping review will be guided by a modified methodology based on selected recommendations from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted in the following databases: CINAHL Complete, MEDLINE, Academic Search Complete, Web of Science, Scopus and Dissertations and Theses Abstracts and Indexes. Included sources will be primary research, dissertations, or theses that address the use of electronic health records in labor and delivery nursing practice in countries with high levels of electronic health record adoption. Data extracted from included sources will be analyzed thematically. Further analysis will theorize labor and delivery nurses' organizing work in the context of electronic health record use by utilizing concepts from Davina Allen's Translational Mobilization Theory. Findings will be presented in tabular and descriptive formats. Conclusion The findings of this review will help understand transformations of nursing practice in the electronic health record-enabled labor and delivery context and identify areas of future research. We will propose an extension of the Translational Mobilization Theory and theorize nurses' organizing work involving the use of the electronic health record.
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12
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Iyamu I, Sierra-Rosales R, Estcourt CS, Salmon A, Koehoorn M, Gilbert M. Differential uptake and effects of digital sexually transmitted and bloodborne infection testing interventions among equity-seeking groups: a scoping review. Sex Transm Infect 2023; 99:554-560. [PMID: 37402569 PMCID: PMC10715539 DOI: 10.1136/sextrans-2023-055749] [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] [Received: 01/17/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Digital sexually transmitted and bloodborne infection (STBBI) testing interventions have gained popularity. However, evidence of their health equity effects remains sparse. We conducted a review of the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects. METHODS We followed Arksey and O'Malley's framework for scoping reviews (2005) integrating adaptations by Levac et al (2010). We searched OVID Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar and health agency websites for peer-reviewed articles and grey literature comparing uptake of digital STBBI testing with in-person models and/or comparing uptake of digital STBBI testing among sociodemographic strata, published in English between 2010 and 2022. We extracted data using the Place of residence, Race, Occupation, Gender/Sex, Religion, Education, Socioeconomic status (SES), Social capital and other disadvantaged characteristics (PROGRESS-Plus) framework, reporting differences in uptake of digital STBBI testing by these characteristics. RESULTS We included 27 articles from 7914 titles and abstracts. Among these, 20 of 27 (74.1%) were observational studies, 23 of 27 (85.2%) described web-based interventions and 18 of 27 (66.7%) involved postal-based self-sample collection. Only three articles compared uptake of digital STBBI testing with in-person models stratified by PROGRESS-Plus factors. While most studies demonstrated increased uptake of digital STBBI testing across sociodemographic strata, uptake was higher among women, white people with higher SES, urban residents and heterosexual people. Co-design, representative user recruitment, and emphasis on privacy and security were highlighted as factors contributing to health equity in these interventions. CONCLUSION Evidence of health equity effects of digital STBBI testing remains limited. While digital STBBI testing interventions increase testing across sociodemographic strata, increases are lower among historically disadvantaged populations with higher prevalence of STBBIs. Findings challenge assumptions about the inherent equity of digital STBBI testing interventions, emphasising the need to prioritise health equity in their design and evaluation.
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Affiliation(s)
- Ihoghosa Iyamu
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Rodrigo Sierra-Rosales
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Claudia S Estcourt
- Department of Nursing and Community Health, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Amy Salmon
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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13
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Petrovskaya O, Karpman A, Schilling J, Singh S, Wegren L, Caine V, Kusi-Appiah E, Geen W. Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review. J Med Internet Res 2023; 25:e43765. [PMID: 37856174 PMCID: PMC10623227 DOI: 10.2196/43765] [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: 10/24/2022] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.
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Affiliation(s)
| | - Albina Karpman
- Faculty of Nursing, MacEwan University, Edmonton, AB, Canada
| | | | - Simran Singh
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Larissa Wegren
- South Health Campus, Women's Health, Calgary, AB, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Willow Geen
- School of Nursing, University of Victoria, Victoria, BC, Canada
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14
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Bharmal N, Rennick A, Shideler A, Blazel M, Jones R, Wilson C, Pfoh ER. Health-Related Social Needs: Which Patients Respond to Screening and Who Receives Resources? J Gen Intern Med 2023; 38:2695-2702. [PMID: 36932266 PMCID: PMC10506999 DOI: 10.1007/s11606-023-08135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Health systems are screening patients for health-related social needs (HRSN) but the optimal approach is unknown. OBJECTIVE To describe the variation in responding to an HRSN questionnaire delivered via patient portal, and whether referral to and resources provided by social workers differed by response status. DESIGN Retrospective observational study. PARTICIPANTS Primary care patients with a visit between June 2020 and January 2022. INTERVENTION HRSN questionnaire MAIN MEASURES: We identified each patient's index visit (e.g., date of their first questionnaire response for responders or their first visit within the study period for non-responders). Through the EHR, we identified patients' demographic characteristics. We linked the area deprivation index (ADI) to each patient and grouped patients into quintiles. We used multilevel logistic regressions to identify characteristics associated with responding to the questionnaire and, for responders, reporting a need. We also determined if responder status was associated with receiving a social worker referral or receiving a resource. We included patient demographics and ADI quintile as fixed variables and practice site as a random variable. KEY RESULTS Our study included 386,997 patients, of which 51% completed at least one HRSN questionnaire question. Patients with Medicaid insurance (AOR: 0.62, 95%CI: 0.61, 0.64) and those who lived in higher ADI neighborhoods had lower adjusted odds of responding (AOR: 0.76, 95% CI: 0.75, 0.78 comparing quintile 5 to quintile 1). Of responders, having Medicaid insurance (versus private) increased the adjusted odds of reporting each of the HRSN needs by two- to eightfold (p < 0.01). Patients who completed a questionnaire (versus non-responders) had similar adjusted odds of receiving a referral (AOR: 0.91, 95% CI: 0.80, 1.02) and receiving a resource from a SW (AOR: AOR: 1.18, 95%CI: 0.79, 1.77). CONCLUSION HRSN questionnaire responses may not accurately represent the needs of patients, especially when delivered solely via patient portal.
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Affiliation(s)
- Nazleen Bharmal
- Community Health & Partnerships, Cleveland Clinic Community Care, Community Health, Cleveland, OH, USA.
- Department of Internal Medicine, Cleveland Clinic Lerner College of Medicine at CWRU, Cleveland, OH, USA.
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA.
| | - Alex Rennick
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Shideler
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robert Jones
- Department of Internal Medicine, Cleveland Clinic Lerner College of Medicine at CWRU, Cleveland, OH, USA
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
| | - Chi' Wilson
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth R Pfoh
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
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15
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Durocher K, Shin HD, Lo B, Chen S, Ma C, Strudwick G. Understanding the Role of Patient Portals in Fostering Interprofessional Collaboration Within Mental Health Care Settings: Mixed Methods Study. JMIR Hum Factors 2023; 10:e44747. [PMID: 37467024 PMCID: PMC10398557 DOI: 10.2196/44747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Patient portals are web-based systems through which patients can access their personal health information and communicate with their clinicians. The integration of patient portals into mental health care settings has been evolving over the past decade, as cumulated research to date has highlighted the potential role of portals in facilitating positive health outcomes. However, it is currently unknown whether portal use can foster interprofessional collaboration between clinicians and patients or whether the portal is a tool to support an already established collaborative relationship. OBJECTIVE This mixed methods study aimed to understand how the use of a patient portal within mental health settings can impact the level of interprofessional collaboration between clinicians and patients. METHODS This study was conducted in a large mental health care organization in Ontario, Canada. A convergent mixed methods design was used, where the primary data collection methods included questionnaires and semistructured interviews with patients who had experience using a portal for their mental health care. For the quantitative strand, participants completed the Health Care Communication Questionnaire and the Self-Empowerment subscale of the Mental Health Recovery Measure at 3 time points (baseline, 3 months of use, and 6 months of use) to measure changes in scores over time. For the qualitative strand, semistructured interviews were conducted at the 3-month time point to assess the elements of interprofessional collaboration associated with the portal. RESULTS For the quantitative strand, 113 participants completed the questionnaire. For the Health Care Communication Questionnaire scores, the raw means of the total scores at the 3 time points were as follows: baseline, 43.01 (SD 7.28); three months, 43.19 (SD 6.65); and 6 months, 42.74 (SD 6.84). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.70). For the Mental Health Recovery Measure scores, the raw mean total scores at the 3 time points were as follows: baseline, 10.77 (SD 3.63); three months, 11.09 (SD 3.81); and 6 months, 11.10 (SD 3.33). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.34). For the qualitative strand, 10 participants were interviewed and identified various elements of how interprofessional collaboration can be supplemented through the use of a patient portal, including improved team functioning, communication, and conflict resolution. CONCLUSIONS Although the quantitative data produced nonsignificant findings in interprofessional collaboration scores over time, the patients' narrative accounts described how the portal can support various interprofessional collaboration concepts, such as communication, leadership, and conflict resolution. This provides useful information for clinicians to support the interprofessional relationship when using a portal within a mental health setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-025508.
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Affiliation(s)
- Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
- School of Health, Community Services, and Creative Design, Lambton College, Sarnia, ON, Canada
| | - Hwayeon Danielle Shin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement Ma
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Woolley KE, Bright D, Ayres T, Morgan F, Little K, Davies AR. Mapping Inequities in Digital Health Technology Within the World Health Organization's European Region Using PROGRESS PLUS: Scoping Review. J Med Internet Res 2023; 25:e44181. [PMID: 37115613 PMCID: PMC10182469 DOI: 10.2196/44181] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits. OBJECTIVE This scoping review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains. METHODS We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization's European region. Extracted data were mapped against Cochrane's PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity. RESULTS In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence. CONCLUSIONS Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed.
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Affiliation(s)
- Katherine E Woolley
- Research and Evaluation Division, Public Health Wales, Cardiff, United Kingdom
- National Centre for Population Health and Well-being Research, Wales, United Kingdom
| | - Diana Bright
- Research and Evaluation Division, Public Health Wales, Cardiff, United Kingdom
| | - Toby Ayres
- Evidence Service, Public Health Wales, Cardiff, United Kingdom
| | - Fiona Morgan
- Evidence Service, Public Health Wales, Cardiff, United Kingdom
| | - Kirsty Little
- Evidence Service, Public Health Wales, Cardiff, United Kingdom
| | - Alisha R Davies
- Research and Evaluation Division, Public Health Wales, Cardiff, United Kingdom
- National Centre for Population Health and Well-being Research, Wales, United Kingdom
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17
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Lui F, Lewicka M, Bao GC, Moyer A, Boyce L, Leng J. A systematic review and meta-analysis of psychosocial interventions for immigrant and limited English proficient cancer patients. Psychooncology 2023; 32:516-557. [PMID: 36792931 PMCID: PMC10410571 DOI: 10.1002/pon.6110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Immigrants, particularly those who are less acculturated and limited English proficient (LEP), often lack access to culturally and linguistically appropriate psychosocial care in cancer survivorship. We sought to determine what psychosocial interventions are available for immigrant and/or LEP cancer patients and to assess treatment and patient factors that may correlate with better psychosocial outcomes for this population. METHODS We conducted a systematic review and meta-analysis of studies published through August 2022 of interventions conducted with immigrant and/or LEP cancer patients aimed at improving psychosocial outcomes (i.e., quality of life, depression, cancer-related distress, and anxiety). Using Covidence, a software program for systematic review management, four independent raters screened 16,123 records with a systematic process for reconciling disagreement, yielding 48 articles (45 studies) for systematic review and 21 studies for meta-analysis. RESULTS Most studies were conducted with Spanish-speaking patients with breast cancer. Study participants (N = 5400) were primarily middle-aged (mean = 53 years old), female (90.0%), and Hispanic (67.0%). The weighted average effect size (g) across studies was 0.14 (95% CI 0.03-0.26) for quality of life (18 studies), 0.04 (95% CI -0.08 to 0.17) for depression (8 studies), 0.14 (95% CI -0.03 to 0.31) for cancer-related distress (6 studies), and 0.03 (95% CI -0.11 to 0.16) for anxiety (5 studies). CONCLUSION The interventions under review had small but beneficial effects on psychosocial outcomes for immigrant and LEP cancer patients. Notably, effect sizes were smaller than those found in previous meta-analyses of psychosocial interventions conducted in majority U.S.-born, non-Hispanic White, English-speaking cancer patient samples. More research is needed to identify key components and adaptations of interventions that benefit immigrant and LEP cancer patients to strengthen their effects for this growing yet underserved population.
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Affiliation(s)
- Florence Lui
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Psychiatry, Weill Cornell Medical College
| | - Malwina Lewicka
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - George C. Bao
- Department of Medicine, Weill Cornell Medical College
| | - Anne Moyer
- Department of Psychology, Stony Brook University
| | - Lindsay Boyce
- Medical Library, Memorial Sloan Kettering Cancer Center
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Healthcare Policy and Research, Weill Cornell Medical College
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18
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Antonio MG, Williamson A, Kameswaran V, Beals A, Ankrah E, Goulet S, Wang Y, Macias G, James-Gist J, Brown LK, Davis S, Pillai S, Buis L, Dillahunt T, Veinot TC. Targeting Patients' Cognitive Load for Telehealth Video Visits Through Student-Delivered Helping Sessions at a United States Federally Qualified Health Center: Equity-Focused, Mixed Methods Pilot Intervention Study. J Med Internet Res 2023; 25:e42586. [PMID: 36525332 PMCID: PMC9897309 DOI: 10.2196/42586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/19/2022] [Accepted: 12/01/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The task complexity involved in connecting to telehealth video visits may disproportionately impact health care access in populations already experiencing inequities. Human intermediaries can be a strategy for addressing health care access disparities by acting as technology helpers to reduce the cognitive load demands required to learn and use patient-facing telehealth technologies. OBJECTIVE We conducted a cognitive load theory-informed pilot intervention involving warm accompaniment telehealth helping sessions with patients at a Federally Qualified Health Center (FQHC). We demonstrate how to design and report recruitment methods, reach, delivery process, and the preliminary impact of a novel equity-focused intervention. METHODS Early into the COVID-19 pandemic a telehealth helping session was offered to patients at FQHC via phone. Graduate students led the sessions on conducting a telehealth video test run or helping with patient portal log-in. They systematically recorded their recruitment efforts, intervention observations, and daily reflection notes. Following the intervention, we asked the intervention participants to participate in an interview and all patients who had telehealth visits during and 4 weeks before and after the intervention period to complete a survey. Electronic health records were reviewed to assess telehealth visit format changes. Descriptive and inferential statistical analyses of the recruitment records, electronic health record data, and surveys were performed. Through integrative analysis, we developed process-related themes and recommendations for future equity-focused telehealth interventions. RESULTS Of the 239 eligible patients, 34 (14.2%) completed the intervention and 3 (1.2%) completed subsequent interviews. The intervention participants who completed the survey (n=15) had lower education and less technological experience than the nonintervention survey participants (n=113). We identified 3 helping strategies for cognitive load reduction: providing step-by-step guidance for configuring and learning, building rapport to create confidence while problem-solving, and being on the same page to counter informational distractions. Intervention participants reported increased understanding but found that learning the video visit software was more difficult than nonintervention participants. A comparison of visit experiences did not find differences in difficulty (cognitive load measure) using telehealth-related technologies, changes to visit modality, or reported technical problems during the visit. However, the intervention participants were significantly less satisfied with the video visits. CONCLUSIONS Although a limited number of people participated in the intervention, it may have reached individuals more likely to need technology assistance. We postulate that significant differences between intervention and nonintervention participants were rooted in baseline differences between the groups' education level, technology experience, and technology use frequency; however, small sample sizes limit conclusions. The barriers encountered during the intervention suggest that patients at FQHC may require both improved access to web-based technologies and human intermediary support to make telehealth video visits feasible. Future large, randomized, equity-focused studies should investigate blended strategies to facilitate video visit access.
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Affiliation(s)
- Marcy G Antonio
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Alicia Williamson
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Ashley Beals
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth Ankrah
- Department of Informatics, University of California Irvine, Irvine, CA, United States
| | - Shannon Goulet
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Yucen Wang
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Grecia Macias
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Jade James-Gist
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lindsay K Brown
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sage Davis
- Covenant Community Care, Detroit, MI, United States
| | | | - Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tawanna Dillahunt
- School of Information and College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany C Veinot
- Department of Health Behavior and Health Education, School of Information and School of Public Health, University of Michigan, Ann Arbor, MI, United States
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19
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Mavragani A, Schoonman GG, Maat B, Habibović M, Krahmer E, Pauws S. Patients Managing Their Medical Data in Personal Electronic Health Records: Scoping Review. J Med Internet Res 2022; 24:e37783. [PMID: 36574275 PMCID: PMC9832357 DOI: 10.2196/37783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/31/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients' medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR. OBJECTIVE This scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients' health and health care services. METHODS We searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query. RESULTS Of the 182 eligible papers, 37 (20%) provided sufficient information about patients' data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients' passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction. CONCLUSIONS The findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.
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Affiliation(s)
| | - Guus G Schoonman
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Barbara Maat
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Remote Patient Management & Connected Care, Philips Research, Eindhoven, Netherlands
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20
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Gleason KT, Peereboom D, Wec A, Wolff JL. Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations: A Scoping Review. JAMA Netw Open 2022; 5:e2248696. [PMID: 36576738 PMCID: PMC9857556 DOI: 10.1001/jamanetworkopen.2022.48696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Family and other unpaid care partners may bridge accessibility challenges in interacting with the patient portal, but the extent and nature of this involvement is not well understood. OBJECTIVE To inform an emerging research agenda directed at more purposeful inclusion of care partners within the context of digital health equity by (1) quantifying care partners' uptake and use of the patient portal in adolescent and adult patients, (2) identifying factors involving care partners' portal use across domains of the System Engineering Initiative for Patient Safety model, and (3) assessing evidence of perceived or actual outcomes of care partners' portal use. EVIDENCE REVIEW Following Arksey and O'Malley's methodologic framework, a scoping review of manuscripts published February 1 and March 22, 2022, was conducted by hand and a systematic search of PubMed, PsycInfo, Embase, and Web of Science. The search yielded 278 articles; 125 were selected for full-text review and 41 were included. FINDINGS Few adult patient portal accounts had 1 or more formally registered care partners (<3% in 7 of 7 articles), but care partners commonly used the portal (8 of 13 contributing articles reported >30% use). Care partners less often authored portal messages with their own identity credentials (<3% of portal messages in 3 of 3 articles) than with patient credentials (20%-60% of portal messages in 3 of 5 articles). Facilitators of care partner portal use included markers of patient vulnerability (13 articles), care partner characteristics (15 articles; being female, family, and competent in health system navigation), and task-based factors pertaining to ease of information access and care coordination. Environmental (26 articles) and process factors (19 articles, eg, organizational portal registration procedures, protection of privacy, and functionality) were identified as influential to care partner portal use, but findings were nuanced and precluded reporting on effects. Care partner portal use was identified as contributing to both patient and care partner insight into patient health (9 articles), activation (7 articles), continuity of care (8 articles), and convenience (6 articles). CONCLUSIONS AND RELEVANCE In this scoping review, care partners were found to be infrequently registered for the patient portal and more often engaged in portal use with patient identity credentials. Formally registering care partners for the portal was identified as conferring potential benefits for patients, care partners, and care quality.
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Affiliation(s)
| | | | - Aleksandra Wec
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L. Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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21
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Moore A, Chavez C, Fisher MP. Factors Enhancing Trust in Electronic Communication Among Patients from an Internal Medicine Clinic: Qualitative Results of the RECEPT Study. J Gen Intern Med 2022; 37:3121-3127. [PMID: 35048293 PMCID: PMC8768442 DOI: 10.1007/s11606-021-07345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Electronic health records are now the norm in US healthcare. Bidirectional patient portals allow frequent communication between patients and their healthcare team. Many studies have examined the importance of patient engagement and trust between patients and their healthcare team, typically in the context of face-to-face interactions. Little is known about how patient trust and engagement are built or enhanced through electronic communications. COVID-19 provided a unique time in history for this novel exploration. OBJECTIVE Our objective was to learn how patients experience trust formation through electronic communication (patient messaging and video visits) with their healthcare team. DESIGN Our research was guided by grounded theory methodology. Qualitative interviews were conducted between February and December 2020 with patients or their caregivers from an internal medicine clinic in Colorado. PARTICIPANTS Fifty-one participants were recruited by age group and gender to represent the clinic's adult ambulatory care demographics. Seven were patients' caregivers who were purposefully recruited. Average age was 53 with an educated, middle class, and largely white predominance in our eventual sample. APPROACH Thirty-minute semi-structured interviews were conducted using an interview guide informed by a validated physician-patient trust scale. Interviews were conducted by telephone, recorded via Zoom, and transcribed. Results were analyzed and coded in ATLAS.ti utilizing the constant comparative method, with two coders. KEY RESULTS Patients experienced enhanced trust in their healthcare team through electronic communications. Interpersonal and system factors contributed to trust formation. Promptness of reply was the most salient factor in trust formation with a majority desiring same day response. CONCLUSIONS Patients now rely on electronic communication with their healthcare team. Opportunities exist to leverage this to improve health outcomes. Important research in expanded demographic groups, along with ambulatory healthcare redesign, will be necessary to optimize benefits of electronic communication with patients and meet patient expectations.
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Affiliation(s)
- Annie Moore
- Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,University of Colorado School of Medicine, Aurora, USA.
| | - Catia Chavez
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael P Fisher
- Department of Health Sciences, Towson University, Towson, MD, USA
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22
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Zaidi M, Amante DJ, Anderson E, Ito Fukunaga M, Faro JM, Frisard C, Sadasivam RS, Lemon SC. Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study. JMIR Cancer 2022; 8:e34745. [PMID: 35943789 PMCID: PMC9399875 DOI: 10.2196/34745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied. OBJECTIVE The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients' self-efficacy in health information-seeking. METHODS We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5-derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information-seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods. RESULTS A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information-seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use. CONCLUSIONS Increased frequency of patient portal use was associated with higher PCC, and an individual's health information-seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.
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Affiliation(s)
- Maryum Zaidi
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Ekaterina Anderson
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Jamie M Faro
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
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23
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Jelinek R, Pandita D, Linzer M, Engoang JBBN, Rodin H. An Evidence-Based Roadmap for the Provision of More Equitable Telemedicine. Appl Clin Inform 2022; 13:612-620. [PMID: 35675839 DOI: 10.1055/s-0042-1749597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE During the coronavirus disease 2019 pandemic, as a safety-net organization with a substantial percentage of patients of color and with limited English proficiency (LEP), we were wary of furthering health disparities in our community. We analyzed gaps in telemedicine (telephone and video) delivery in our communities, quantified the effects of our tests of change, and began the process of accumulating evidence to create a road map for other organizations. METHODS We leveraged Lean problem-solving strategies to identify modifiable gaps across multiple domains that could inhibit equity in telemedicine. We implemented tests of change across domains of community engagement, technology, education, and access. We observed the proportion of telemedicine encounters across races and languages between April and November, 2020. Regression analyses tested the impact of race and language on telemedicine controlling for age, gender, insurance, and time. RESULTS Several rounds of changes and enhancements were associated with changes in telemedicine use of +5.5% (p < 0.0001) for Hispanic, +4.0% (p < 0.0001) for Spanish-speaking, -2.1% for Black (p < 0.05), and -4.4% for White patients (p < 0.001). African-American, Hispanic, and non-English-speaking patients had between 2.3 and 4.6 times the odds of preferring telephone to video encounters (p < 0.0001), with increases in preferences for video use over time (p < 0.05). CONCLUSION Our roadmap to improve equitable delivery of telemedicine was associated with a significant improvement in telemedicine use among certain minority populations. Most populations of color used telephone more often than video. This preference changed over time and with equity-focused changes in telemedicine delivery.
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Affiliation(s)
- Ryan Jelinek
- Department of Medicine, Hennepin Healthcare, and University of Minnesota, Minneapolis, Minnesota, United States
| | - Deepti Pandita
- Department of Medicine, Hennepin Healthcare, and University of Minnesota, Minneapolis, Minnesota, United States
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, and University of Minnesota, Minneapolis, Minnesota, United States
| | | | - Holly Rodin
- Analytics Center of Excellence, Hennepin Healthcare, Minneapolis, Minnesota, United States
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24
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Lawrence K, Chong S, Krelle H, Roberts T, Thorpe L, Trinh-Shevrin C, Yi S, Kwon S. Chinese Americans' Use of Patient Portal Systems: Scoping Review. JMIR Hum Factors 2022; 9:e27924. [PMID: 35363153 PMCID: PMC9015766 DOI: 10.2196/27924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/23/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients. Objective This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs. Methods The authors conducted a literature search using the PRISMA Protocol for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) for extracting articles published in major databases (MEDLINE, Embase, and PsycINFO) on patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for the study method type, sample population, and main outcomes of interest. Results In total, 17 articles were selected for inclusion in the review. The included articles were heterogenous and varied in their study aims, methodologies, sample populations, and outcomes. Major findings identified from the articles include variable patterns of portal access and use among Chinese Americans compared to other racial or ethnic groups, with limited evidence on the specific barriers and facilitators for this group; a preference for cross-sectional quantitative tools such as patient surveys and electronic health record–based data over qualitative or other methodologies; and a pattern of aggregating Chinese American–related data into a larger Asian or Asian American designation. Conclusions There is limited research evaluating the use patterns, experiences, and needs of Chinese Americans who access and use patient portal systems. Existing research is heterogeneous, largely cross-sectional, and does not disaggregate Chinese Americans from larger Asian demographics. Future research should be devoted to the specific portal use patterns, preferences, and needs of Chinese Americans to help ensure contextually appropriate and acceptable design and implementation of these digital health tools.
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Affiliation(s)
- Katharine Lawrence
- Healthcare Innovation Bridging Research, Informatics, and Design (HiBRID) Lab, Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Stella Chong
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Holly Krelle
- Division of Healthcare Delivery Services, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Timothy Roberts
- NYU Health Sciences Library, NYU Grossman School of Medicine, New York, NY, United States
| | - Lorna Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chau Trinh-Shevrin
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Stella Yi
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Simona Kwon
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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25
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Acholonu RG, Raphael JL. The Influence of the Electronic Health Record on Achieving Equity and Eliminating Health Disparities for Children. Pediatr Ann 2022; 51:e112-e117. [PMID: 35293812 DOI: 10.3928/19382359-20220215-01] [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: 11/20/2022]
Abstract
The electronic health record (EHR) has been heralded as a transformative approach to modernizing health care and advancing health equity. Access to the EHR can facilitate shared clinical decision-making and improved communication with patients, families, and among health care providers. Recent legislative and regulatory efforts have been passed to increase the transparency as well as the initiatives to increase the meaningful use of the EHR. Yet despite these well-intended efforts, challenges to addressing health equity through the EHR persist. This article reviews three distinct challenges to addressing health equity related to the EHR. We discuss (1) both the implicit and explicit bias that exist in EHR documentation, (2) the gaps that remain between screening for social determinants of health and the effective inclusion and billing of that screening into the EHR, and (3) the disparities that exist with the use of patient portals. Addressing these three areas will enhance the opportunities to advance health equity through the use of the EHR and bring us one step closer to eliminating health disparities in pediatric health care. [Pediatr Ann. 2022;51(3):e112-e117.].
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26
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Ramasawmy M, Poole L, Thorlu-Bangura Z, Chauhan A, Murali M, Jagpal P, Bijral M, Prashar J, G-Medhin A, Murray E, Stevenson F, Blandford A, Potts HWW, Khunti K, Hanif W, Gill P, Sajid M, Patel K, Sood H, Bhala N, Modha S, Mistry M, Patel V, Ali SN, Ala A, Banerjee A. Frameworks for implementation, uptake and use of digital health interventions in ethnic minority populations: a scoping review using cardiometabolic disease as a case study. (Preprint). JMIR Cardio 2022; 6:e37360. [PMID: 35969455 PMCID: PMC9412726 DOI: 10.2196/37360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions. Objective We aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease. Methods SCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice. Results Of 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies.
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Affiliation(s)
- Mel Ramasawmy
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Lydia Poole
- Institute of Health Informatics, University College London, London, United Kingdom
| | | | - Aneesha Chauhan
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mayur Murali
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Parbir Jagpal
- School of Pharmacy, University of Birmingham, Birmingham, United Kingdom
| | - Mehar Bijral
- University College London Medical School, University College London, London, United Kingdom
| | - Jai Prashar
- University College London Medical School, University College London, London, United Kingdom
| | - Abigail G-Medhin
- Department of Population Health Sciences, King's College London, London, United Kingdom
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, United Kingdom
| | - Fiona Stevenson
- eHealth Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, United Kingdom
| | - Ann Blandford
- University College London Interaction Centre, University College London, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Wasim Hanif
- Department of Diabetes and Institute of Translational Medicine, University Hospital Birmingham, Birmingham, United Kingdom
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Madiha Sajid
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Kiran Patel
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Harpreet Sood
- Health Education England, London, United Kingdom
- Hurley Group Practice, London, United Kingdom
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Shivali Modha
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Manoj Mistry
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Vinod Patel
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sarah N Ali
- Department of Diabetes and Endocrinology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Aftab Ala
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
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27
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Gillie M, Ali D, Vadlamuri D, Carstarphen KJ. Telehealth Literacy as a Social Determinant of Health: A Novel Screening Tool to Support Vulnerable Patient Equity. J Alzheimers Dis Rep 2022; 6:67-72. [PMID: 35360275 PMCID: PMC8925120 DOI: 10.3233/adr-210024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 01/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Telehealth has evolved as a solution to COVID-19 isolation precautions and remote care with well-established health, socioeconomic, and practical benefits. However, there are many gaps in the current literature regarding telehealth use among older, low health literate, and resource-limited populations. There are ethical considerations that warrant understanding this digital divide. Objective: The objective of this review is to propose the Telehealth Literacy Screening Tool (TLST) for use in older adults and support the future inclusion of telehealth literacy as an important social determinant of health (SDOH). Methods: Initially a four-week outreach was performed that targeted older adults and low-health literate patients at the MedVantage Clinic (MVC) within Ochsner Health (OH) to identify common barriers to patient engagement with the OH Epic MyChart telehealth platform. Themes from those barriers directed a meta-synthetic review of the methods and ethical considerations of current, validated technological and telehealth literacy screening tools. Those findings were reported based on the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: Based on the barriers identified during our MVC patient outreach, PRISMA-reported review of telehealth literacy screening research, and evaluation of the MyChart platform and the technological resources required for its use; we developed a multidimensional questionnaire for telehealth literacy screening of older adults. Conclusion: The TLST is designed to identify patients in need of additional interventions for successful connection to telehealth services. This is an important step towards addressing the ethical obligation to decrease disparities in telehealth literacy for vulnerable populations and identifying telehealth literacy as a SDOH.
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Affiliation(s)
- Monica Gillie
- Ochsner Health, New Orleans, LA, USA
- Stanford - O’Connor Family Medicine Residency, San Jose, CA, USA
| | - Diab Ali
- Ochsner Health, New Orleans, LA, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diamler Vadlamuri
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kathy Jo Carstarphen
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Internal Medicine, Ochsner Health, New Orleans, LA, USA
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28
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Lee EW, McCloud RF, Viswanath K. Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment. J Med Internet Res 2022; 24:e25419. [PMID: 34994700 PMCID: PMC8783288 DOI: 10.2196/25419] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/25/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups.
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Affiliation(s)
- Edmund Wj Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | | | - Kasisomayajula Viswanath
- Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard T H Chan School of Public Health, Boston, MA, United States
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Sipanoun P, Oulton K, Gibson F, Wray J. A systematic review of the experiences and perceptions of users of an electronic patient record system in a pediatric hospital setting. Int J Med Inform 2022; 160:104691. [DOI: 10.1016/j.ijmedinf.2022.104691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/06/2023]
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Schultz CL, McCahan SM, Lewis AM, Bunnell HT, Alderfer MA. Online patient portal use by caregivers in pediatric oncology: Are we widening sociodemographic disparities? Pediatr Blood Cancer 2021; 68:e29373. [PMID: 34582096 DOI: 10.1002/pbc.29373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Financial and regulatory incentives have encouraged and increased the availability of online patient portals that provide caregivers access to their child's electronic health records (EHR). Such access is believed to promote better engagement and outcomes of care. Little is known about the use of portals by caregivers of children with cancer. This study sought to examine whether sociodemographic and clinical care variables are associated with portal activation in a pediatric oncology sample. METHODS Sociodemographic and clinical characteristics were extracted from the EHR of pediatric oncology patients treated for their first cancer in the Nemours Center for Cancer and Blood Disorders between 2012 and 2017. A Child Opportunity Index (COI) was calculated based on home zip code. Characteristics of children whose caregivers did and did not activate the portal were compared. RESULTS Sixty-six percent of caregivers activated a portal account with a peak within 90 days of diagnosis. In logistic regression, caregivers with a younger aged child, spoke English, lived closer to the hospital, lived in higher COI area, with longer treatment length, and more radiology tests had greater odds of portal activation. Those with private health insurance or White race were overrepresented among those who activated an account in univariate analysis. CONCLUSION The majority of caregivers of children with cancer activate portal accounts; however, differences in sociodemographic and clinical variables across those who did and did not activate accounts emerged. As portals become ubiquitous, we must understand how they are used and mitigate widening inequities caused by disparate portal use.
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Affiliation(s)
- Corinna L Schultz
- Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital, Wilmington, Delaware, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Suzanne M McCahan
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Nemours Biomedical Research Informatics Center, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - H Timothy Bunnell
- Nemours Biomedical Research Informatics Center, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Melissa A Alderfer
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware, USA
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Santos AD, Caine V, Robson PJ, Watson L, Easaw JC, Petrovskaya O. Oncology Patients' Experiences With Novel Electronic Patient Portals to Support Care and Treatment: Qualitative Study With Early Users and Nonusers of Portals in Alberta, Canada. JMIR Cancer 2021; 7:e32609. [PMID: 34822338 PMCID: PMC8663539 DOI: 10.2196/32609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 02/06/2023] Open
Abstract
Background With the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients’ experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. Objective The purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta’s unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. Methods This qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. Results Participants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta’s patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants’ broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient–provider relationship. Conclusions Although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them.
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Affiliation(s)
- Amanda D Santos
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Paula J Robson
- Cancer Care Alberta, Alberta Health Services, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Linda Watson
- Cancer Care Alberta, Alberta Health Services, Edmonton, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Jacob C Easaw
- Faculty of Medicine, Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada.,Cross Cancer Institute, Alberta Health Services, Edmonton, AB, Canada
| | - Olga Petrovskaya
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,School of Nursing, University of Victoria, Victoria, BC, Canada
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Lang M, Lemieux S, Hébert J, Sauvageau G, Zawati MH. Legal and Ethical Considerations for the Design and Use of Web Portals for Researchers, Clinicians, and Patients: Scoping Literature Review. J Med Internet Res 2021; 23:e26450. [PMID: 34762055 PMCID: PMC8663501 DOI: 10.2196/26450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/17/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings. Objective This study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases. Methods This study broadly adopts the methods for scoping literature reviews outlined by Arskey and O’Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review. Results We found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data. Conclusions We identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care.
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Affiliation(s)
- Michael Lang
- Centre of Genomics and Policy, Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Sébastien Lemieux
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Josée Hébert
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,The Leucegene Project at Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada.,Division of Hematology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Guy Sauvageau
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Division of Hematology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Seljelid B, Varsi C, Solberg Nes L, Øystese KA, Børøsund E. Feasibility of a Digital Patient–Provider Communication Intervention to Support Shared Decision Making in Chronic Health Care, InvolveMe: A Pilot Study (Preprint). JMIR Form Res 2021; 6:e34738. [PMID: 35389356 PMCID: PMC9030980 DOI: 10.2196/34738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 01/19/2023] Open
Abstract
Background Enhanced communication with health care providers (HCPs) can improve symptom management and health-related quality of life (HRQoL) for patients with chronic health conditions. Access to appropriate communication venues is needed to improve communication, however. As such, digital communication interventions mediated by patient portals carry the potential to support patient-provider communication and interaction and through this, also facilitate shared decision-making (SDM). The InvolveMe intervention was designed to provide patients with the opportunity to communicate symptoms and informational needs prior to consultation via digital assessment, including prioritizing what is most important to discuss with their HCPs, as well as to interact with HCPs through secure messages between outpatient visits. Objective The aim of this study was to assess the feasibility of the InvolveMe intervention by investigating acceptability, demand (ie, system use), and limited efficacy. Methods The study was designed as a single-arm, pre-post feasibility study combining quantitative and qualitative methods for data collection. Patients from an endocrine outpatient clinic were invited to use the InvolveMe intervention for 3 months, and HCPs administering InvolveMe were invited to participate in a focus group. Guided by descriptions of how to design feasibility studies by Bowen et al, feasibility was tested by exploring (1) acceptability, using data collected during recruitment from patient participants and nonparticipants (ie, declined to participate or did not meet study requirements), HCP experiences with recruitment, and the System Usability Scale (SUS); (2) demand via exploration of system use through extraction of system log data and HCP experiences with system use; and (3) limited efficacy testing, via exploration of potential effects from the Short-Form Health Survey (RAND 36), Hospital Anxiety and Depression Scale, and Health Literacy Questionnaire. Results Patient participants (N=23) were a median 54 (range 26-78) years old and primarily male (14/23, 61%). Nonparticipants (N=16) were a median 73 (range 55-80) years old and primarily male (12/16, 75%). The average SUS score was 72.2, indicating good system usability. Assessments were completed by 8 participants from home prior to outpatient visits. The assessments entailed various bodily symptoms and needs for information. Participants sent 17 secure messages related to patient administrative matters, symptoms, and challenges. Focus group participants (N=4) were all female and registered nurses. Data were analyzed in 2 predefined themes: Acceptability and Demand. Acceptability included the subthemes intervention attractiveness and intervention suitability. Demand included the subthemes elements of SDM and intervention challenges and opportunities. All patient participants completed outcome measures at baseline, and 19 (19/23, 83%) completed outcome measures at 3 months. These preliminary efficacy findings were mixed and inconclusive. Conclusions The study design provided findings from both patient and HCP perspectives and supported feasibility of the InvolveMe intervention. The investigation of acceptability and demand supported the potential for remote SDM mediated by patient portals using assessments and secure messages. Trial Registration ClinicalTrials.gov NCT NCT04218721; https://www.clinicaltrials.gov/ct2/show/NCT04218721
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Affiliation(s)
- Berit Seljelid
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cooperation, Patient Education and Equivalent Health Services, Oslo University Hospital, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Kristin Astrid Øystese
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
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Fujioka JK, Bickford J, Gritke J, Stamenova V, Jamieson T, Bhatia RS, Desveaux L. Implementation Strategies to Improve Engagement With a Multi-Institutional Patient Portal: Multimethod Study. J Med Internet Res 2021; 23:e28924. [PMID: 34709195 PMCID: PMC8587179 DOI: 10.2196/28924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. Objective This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. Methods This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. Results Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. Conclusions Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement.
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Affiliation(s)
- Jamie Keiko Fujioka
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | | | | | - Vess Stamenova
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Trevor Jamieson
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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LeLaurin JH, Nguyen OT, Thompson LA, Hall J, Bian J, Cho HD, Acharya R, Harle CA, Salloum RG. Disparities in Pediatric Patient Portal Activation and Feature Use. JAMIA Open 2021; 4:ooab086. [PMID: 34604712 PMCID: PMC8480543 DOI: 10.1093/jamiaopen/ooab086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.
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Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Oliver T Nguyen
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jaclyn Hall
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Hee Deok Cho
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ratna Acharya
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
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Rodriguez NJ, Okwara NC, Shen L, Jajoo K, Chan WW. Impact of Telemedicine Modalities on Equitable Access to Ambulatory Gastroenterology Care. Gastroenterology 2021; 161:742-747.e3. [PMID: 34051240 PMCID: PMC8380677 DOI: 10.1053/j.gastro.2021.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Nicolette J. Rodriguez
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Noreen C. Okwara
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Lin Shen
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kunal Jajoo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Walter W. Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Lam BD, Bourgeois F, Dong ZJ, Bell SK. Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations. J Am Med Inform Assoc 2021; 28:685-694. [PMID: 33367831 DOI: 10.1093/jamia/ocaa293] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements. OBJECTIVE To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors. METHODS Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months. RESULTS 6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, "other," or "multiple" race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a "troublemaker" (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families. CONCLUSIONS About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.
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Affiliation(s)
- Barbara D Lam
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Zhiyong J Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Goedhart NS, Zuiderent-Jerak T, Woudstra J, Broerse JEW, Betten AW, Dedding C. Persistent inequitable design and implementation of patient portals for users at the margins. J Am Med Inform Assoc 2021; 28:276-283. [PMID: 33463691 PMCID: PMC7883982 DOI: 10.1093/jamia/ocaa273] [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: 10/29/2020] [Indexed: 12/04/2022] Open
Abstract
Objective Diane Forsythe and other feminist scholars have long shown how system builders’ tacit assumptions lead to the systematic erasure of certain users from the design process. In spite of this phenomena being known in the health informatics literature for decades, recent research shows how patient portals and electronic patients health records continue to reproduce health inequalities in Western societies. To better understand this discrepancy between scholarly awareness of such inequities and mainstream design, this study unravels the (conceptual) assumptions and practices of designers and others responsible for portal implementation in the Netherlands and how citizens living in vulnerable circumstances are included in this process. Materials and methods We conducted semistructured interviews (n = 24) and questionnaires (n = 14) with portal designers, health professionals, and policy advisors. Results In daily design practices, equity is seen as an “end-of-the-pipeline” concern. Respondents identify health care professionals rather than patients as their main users. If patients are included in the design, this generally entails patients in privileged positions. The needs of citizens living in vulnerable circumstances are not prioritized in design processes. Developers legitimize their focus with reference to the innovation-theoretical approach of the Diffusion of Innovations. Discussion and conclusion Although feminist scholars have developed important understandings of the exclusion of citizens living in vulnerable circumstances from portal design, other academic efforts have profoundly shaped daily practices of portal development. Diane Forsythe would likely have taken up this discrepancy as a challenge by finding ways to translate these insights into mainstream systems design.
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Affiliation(s)
- Nicole S Goedhart
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joey Woudstra
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jacqueline E W Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Afke Wieke Betten
- Institute for Science in Society, Radboud Universiteit, Nijmegen, Netherlands
| | - Christine Dedding
- Department of Ethics, Law, and Humanities, Amsterdam UMC - location VUmc, Amsterdam, Netherlands
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Swoboda CM, DePuccio MJ, Fareed N, McAlearney AS, Walker DM. Patient Portals: Useful for Whom and for What? A Cross-Sectional Analysis of National Survey Data. Appl Clin Inform 2021; 12:573-581. [PMID: 34233367 DOI: 10.1055/s-0041-1731339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Patients who use patient portals may be more engaged and empowered in their care; however, differences in who accesses patient portals remain. The characteristics of who uses patient portals more frequently and who perceives them as useful may also differ, as well as which functions people use. OBJECTIVE We assessed the characteristics of patient portal users to examine who uses them more frequently and who perceives them as useful. In addition, we wanted to see if those who use them more frequently or perceive them to be more useful use different functions or more functions of patient portals. METHODS Pooled cross-sectional data from 2017 to 2018 Health Information National Trends Survey (HINTS) were used. Ordinal regression models were developed to assess frequency of use and perceived usefulness by demographics, and multivariable logistic regression models were used to examine the association between the use of 10 patient portal functions and frequency of use and perceived usefulness of patient portals. RESULTS The odds of using patient portals more frequently were higher among those with Bachelor's degrees, incomes between $35,000 and $75,000, and those with two or more chronic conditions. Respondents with three or more chronic conditions had higher odds of rating patient portals as useful. Those who used their patient portal 10 or more times in the past year had higher odds of using all functions except for viewing test results compared with those who used their patient portal one to two times per year. Those who rated patient portals as "very useful" had higher odds of using seven of the functions compared with those who rated them "not very"/"not at all useful." CONCLUSION It is important to continue to assess usefulness, frequency of use, and overall patient portal function use to identify opportunities to increase patient engagement with patient portals.
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Affiliation(s)
- Christine M Swoboda
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Matthew J DePuccio
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Naleef Fareed
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Daniel M Walker
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
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40
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Gleason KT, Peterson S, Himmelfarb CRD, Villanueva M, Wynn T, Bondal P, Berg D, Jerde W, Newman-Toker D. Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study. Diagnosis (Berl) 2021; 8:187-192. [PMID: 33006949 PMCID: PMC8019684 DOI: 10.1515/dx-2020-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/22/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient's Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge. METHODS We deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED. RESULTS Of those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED. CONCLUSIONS Patient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.
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Affiliation(s)
- Kelly T. Gleason
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Susan Peterson
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cheryl R. Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Taylor Wynn
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Paula Bondal
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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41
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Zhang T, Shen N, Booth R, LaChance J, Jackson B, Strudwick G. Supporting the use of patient portals in mental health settings: a scoping review. Inform Health Soc Care 2021; 47:62-79. [PMID: 34032528 DOI: 10.1080/17538157.2021.1929998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With the increased use of patient portals in acute and chronic care settings as a strategy to support patient care and improve patient-centric care, there is still little known about the impact of patient portals in mental health contexts. The purposes of this review were to: 1) identify the critical success factors for successful patient portal implementation and adoption among end-users that could be utilized in a mental health setting; 2) uncover what we know about existing mental health portals and their effectiveness for end-users; and 3) determine what indicators are being used to evaluate existing patient portals for end-users that may be applied in a mental health context. This scoping review was conducted through a search of six electronic databases including Medline, EMBASE, PsycINFO, and CINAHL for articles published between 2007 and 2021. A total of 31 articles were included in the review. Critical success factors of patient portal implementation included those related to education, usefulness, usability, culture, and resources. Only two patient portals had articles published related to their effectiveness for end-users (one in Canada and the other in the United States). More than 100 measures of process (n = 73) and outcome (n = 59) indicators were extracted from the studies and mapped to the Benefits Evaluation Framework. Patient portals carry great potential to improve patient care, but more attention needs to be given to ensure they are being evaluated through the development and implementation phases with the end-users in mind. Further understanding of process indicators relating to use are essential for long-term patient adoption of portals to obtain their potential benefits.
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Affiliation(s)
- Timothy Zhang
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nelson Shen
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jessica LaChance
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Brianna Jackson
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Yale School of Nursing, Yale University, Orange, Connecticut, USA
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
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Hochmuth A, Wrona KJ, Exner AK, Dockweiler C. Digitization and health inequality and equity in nursing. Pflege 2021; 34:151-158. [PMID: 33890829 DOI: 10.1024/1012-5302/a000803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The use of information and communication technologies (ICT) in health care is increasing attention. To describe health inequalities and equity with regard to the use of digital health technologies in a care context and to understand interrelationships, it is of particular importance for the field of care research to use models and theories that explain health inequalities and equity in the use of digital technologies. Aims: This article aims to identify models and theories from the field of nursing and health research that explain the phenomenon of health inequalities and the influence of digital health technologies on the emergence of inequalities. Methods: Relevant articles were searched in electronic databases (MEDLINE, CINAHL & SocINDEX) between July and August 2019 in German and English, within the methodological framework of a scoping review. The systematic literature search and data extraction were performed by 2 reviewers. The description of data refers to standard criteria by 8-1Christiansen and Baum (1997). Results: From a total of 25 relevant articles, 2 were identified for inclusion in the current overview. One model is focusing on ICT for health and the other model focuses on eHealth. No nursing theory could be identified in the context of describing the phenomenon of digital inequality. Conclusions: In both models, there is a lack of discussion about the impact of nursing aspects on the use and acceptance of eHealth technologies. One point should also be the development of models and theories that consider the user perspective of vulnerable groups.
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Affiliation(s)
| | - Kamil J Wrona
- Dept. Demography and Health & Centre for ePublic Health Research, School of Public Health, Bielefeld University, Bielefeld
| | | | - Christoph Dockweiler
- Centre for ePublic Health Research, School of Public Health, Bielefeld University, Bielefeld
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Nouri SS, Adler-Milstein J, Thao C, Acharya P, Barr-Walker J, Sarkar U, Lyles C. Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review. J Am Med Inform Assoc 2021; 27:834-841. [PMID: 32364238 DOI: 10.1093/jamia/ocaa024] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/09/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The study sought to determine which patient characteristics are associated with the use of patient-facing digital health tools in the United States. MATERIALS AND METHODS We conducted a literature review of studies of patient-facing digital health tools that objectively evaluated use (eg, system/platform data representing frequency of use) by patient characteristics (eg, age, race or ethnicity, income, digital literacy). We included any type of patient-facing digital health tool except patient portals. We reran results using the subset of studies identified as having robust methodology to detect differences in patient characteristics. RESULTS We included 29 studies; 13 had robust methodology. Most studies examined smartphone apps and text messaging programs for chronic disease management and evaluated only 1-3 patient characteristics, primarily age and gender. Overall, the majority of studies found no association between patient characteristics and use. Among the subset with robust methodology, white race and poor health status appeared to be associated with higher use. DISCUSSION Given the substantial investment in digital health tools, it is surprising how little is known about the types of patients who use them. Strategies that engage diverse populations in digital health tool use appear to be needed. CONCLUSION Few studies evaluate objective measures of digital health tool use by patient characteristics, and those that do include a narrow range of characteristics. Evidence suggests that resources and need drive use.
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Affiliation(s)
- Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Crishyashi Thao
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Prasad Acharya
- Chronic Disease Control Branch, Center for Healthy Communities, California Department of Public Health, Sacramento, California, USA
| | - Jill Barr-Walker
- Zuckerberg San Francisco General Hospital Library, University of California, San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Courtney Lyles
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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44
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Ammenwerth E, Neyer S, Hörbst A, Mueller G, Siebert U, Schnell-Inderst P. Adult patient access to electronic health records. Cochrane Database Syst Rev 2021; 2:CD012707. [PMID: 33634854 PMCID: PMC8871105 DOI: 10.1002/14651858.cd012707.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To support patient-centred care, healthcare organisations increasingly offer patients access to data stored in the institutional electronic health record (EHR). OBJECTIVES Primary objective 1. To assess the effects of providing adult patients with access to electronic health records (EHRs) alone or with additional functionalities on a range of patient, patient-provider, and health resource consumption outcomes, including patient knowledge and understanding, patient empowerment, patient adherence, patient satisfaction with care, adverse events, health-related quality of life, health-related outcomes, psychosocial health outcomes, health resource consumption, and patient-provider communication. Secondary objective 1. To assess whether effects of providing adult patients with EHR access alone versus EHR access with additional functionalities differ among patient groups according to age, educational level, or different status of disease (chronic or acute). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus in June 2017 and in April 2020. SELECTION CRITERIA Randomised controlled trials and cluster-randomised trials of EHR access with or without additional functionalities for adults with any medical condition. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included 10 studies with 78 to 4500 participants and follow-up from 3 to 24 months. Nine studies assessed the effects of EHR with additional functionalities, each addressing a subset of outcomes sought by this review. Five studies focused on patients with diabetes mellitus, four on patients with specific diseases, and one on all patients. All studies compared EHR access alone or with additional functionalities plus usual care versus usual care only. No studies assessing the effects of EHR access alone versus EHR access with additional functionalities were identified. Interventions required a variety of data within the EHR, such as patient history, problem list, medication, allergies, and lab results. In addition to EHR access, eight studies allowed patients to share self-documented data, seven offered individualised disease management functions, seven offered educational disease-related information, six supported secure communication, and one offered preventive reminders. Only two studies were at low or unclear risk of bias across domains. Meta-analysis could not be performed, as participants, interventions, and outcomes were too heterogeneous, and most studies presented results based on different adjustment methods or variables. The quality of evidence was rated as low or very low across outcomes. Overall differences between intervention and control groups, if any, were small. The relevance of any small effects remains unclear for most outcomes because in most cases, trial authors did not define a minimal clinically important difference. Overall, results suggest that the effects of EHR access alone and with additional functionalities are mostly uncertain when compared with usual care. Patient knowledge and understanding: very low-quality evidence is available from one study, so we are uncertain about effects of the intervention on patient knowledge about diabetes and blood glucose testing. Patient empowerment: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient empowerment measures. Patient adherence: low-quality evidence from two studies suggests that the intervention may slightly improve adherence to the process of monitoring risk factors and preventive services. Effects on medication adherence are conflicting in two studies; this may or may not improve to a clinically relevant degree. Patient satisfaction with care: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient satisfaction, with conflicting results. Adverse events: two small studies reported on mortality; one of these also reported on serious and other adverse events, but sample sizes were too small for small differences to be detected. Therefore, low-quality evidence suggests that the intervention may have little to no effect on mortality and other adverse events. Health-related quality of life: only very low-quality evidence from one study is available. We are uncertain whether the intervention improves disease-specific quality of life of patients with asthma. Health-related outcomes: low-quality evidence from eight studies suggests that the intervention may have little to no effect on asthma control, glycosylated haemoglobin (HbA1c) levels, blood pressure, low-density lipoprotein or total cholesterol levels, body mass index or weight, or 10-year Framingham risk scores. Low-quality evidence from one study suggests that the composite scores of risk factors for diabetes mellitus may improve slightly with the intervention, but there is uncertainty about effects on ophthalmic medications or intraocular pressure. Psychosocial health outcomes: no study investigated psychosocial health outcomes in a more than anecdotal way. Health resource consumption: low-quality evidence for adult patients in three studies suggests that there may be little to no effect of the intervention on different measures of healthcare use. Patient-provider communication: very low-quality evidence is available from a single small study, and we are uncertain whether the intervention improves communication measures, such as the number of messages sent. AUTHORS' CONCLUSIONS The effects of EHR access with additional functionalities in comparison with usual care for the most part are uncertain. Only adherence to the process of monitoring risk factors and providing preventive services as well as a composite score of risk factors for diabetes mellitus may improve slightly with EHR access with additional functionalities. Due to inconsistent terminology in this area, our search may have missed relevant studies. As the overall quality of evidence is very low to low, future research is likely to change these results. Further trials should investigate the impact of EHR access in a broader range of countries and clinical settings, including more patients over a longer period of follow-up, as this may increase the likelihood of detecting effects of the intervention, should these exist. More studies should focus on assessing outcomes such as patient empowerment and behavioural outcomes, rather than concentrating on health-related outcomes alone. Future studies should distinguish between effects of EHR access only and effects of additional functionalities, and investigate the impact of mobile EHR tools. Future studies should include information on usage patterns, and consider the potential for widening health inequalities with implementation of EHR access. A taxonomy for EHR access and additional functionalities should be developed to promote consistency and comparability of outcome measures, and facilitate future reviews by better enabling cross-study comparisons.
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Affiliation(s)
- Elske Ammenwerth
- Department of Biomedical Informatics and Mechatronics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Stefanie Neyer
- Department of Nursing Science and Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Alexander Hörbst
- Department of Biomedical Informatics and Mechatronics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Gerhard Mueller
- Department of Nursing Science and Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Petra Schnell-Inderst
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Nøst TH, Faxvaag A, Steinsbekk A. Participants' views and experiences from setting up a shared patient portal for primary and specialist health services- a qualitative study. BMC Health Serv Res 2021; 21:171. [PMID: 33627122 PMCID: PMC7903028 DOI: 10.1186/s12913-021-06188-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/17/2021] [Indexed: 01/05/2023] Open
Abstract
Background Recently, there has been an increasing focus among healthcare organisations on implementing patient portals. Previous studies have mainly focussed on the experiences of patient portal use. Few have investigated the processes of deciding what content and features to make available, in particular for shared portals across healthcare domains. The aim of the study was to investigate views on content and experiences from the configuration process among participants involved in setting up a shared patient portal for primary and specialist health services. Methods A qualitative study including 15 semi-structured interviews with persons participating in patient portal configuration was conducted from October 2019 to June 2020. Results Whether a shared patient portal for all the health services in the region should be established was not questioned by any of the informants. It was experienced as a good thing to have numerous participants present in the discussions on configuration, but it also was said to increase the complexity of the work. The informants considered a patient portal to be of great value for patient care, among other things because it would lead to improvements in patient follow-up and increased patient empowerment. Nevertheless, some informants advocated caution as they thought the patient portal possibly could lead to an increase in healthcare providers’ workloads and to anxiety and worries, as well as to inequality in access to health care among patients. The findings were categorized into the themes ‘A tool for increased patient involvement’, ‘Which information should be available for the patient’, ‘Concerns about increased workload’, ‘Too complex to use versus not interesting enough’, ‘Involving all services’ and ‘Patient involvement’. Conclusions Establishing a shared patient portal for primary and specialist health services was considered unproblematic. There was, however, variation in opinions on which content and features to include. This variation was related to concerns about increasing the workload for health care providers, causing anxiety and inequality among patients, and ensuring that the solution would be interesting enough to adopt.
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Affiliation(s)
- Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Arild Faxvaag
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Orthopaedy, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Digital Health Care Unit, Norwegian Centre for E-Health Research, Tromsø, Norway
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Veinot TC, Ancker JS, Bakken S. Health informatics and health equity: improving our reach and impact. J Am Med Inform Assoc 2021; 26:689-695. [PMID: 31411692 DOI: 10.1093/jamia/ocz132] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Health informatics studies the use of information technology to improve human health. As informaticists, we seek to reduce the gaps between current healthcare practices and our societal goals for better health and healthcare quality, safety, or cost. It is time to recognize health equity as one of these societal goals-a point underscored by this Journal of the American Medical Informatics Association Special Focus Issue, "Health Informatics and Health Equity: Improving our Reach and Impact." This Special Issue highlights health informatics research that focuses on marginalized and underserved groups, health disparities, and health equity. In particular, this Special Issue intentionally showcases high-quality research and professional experiences that encompass a broad range of subdisciplines, methods, marginalized populations, and approaches to disparities. Building on this variety of submissions and other recent developments, we highlight contents of the Special Issue and offer an assessment of the state of research at the intersection of health informatics and health equity.
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Affiliation(s)
- Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
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47
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Cemballi AG, Karter AJ, Schillinger D, Liu JY, McNamara DS, Brown W, Crossley S, Semere W, Reed M, Allen J, Lyles CR. Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study. J Am Med Inform Assoc 2020; 28:1252-1258. [PMID: 33236117 DOI: 10.1093/jamia/ocaa281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
The substantial expansion of secure messaging (SM) via the patient portal in the last decade suggests that it is becoming a standard of care, but few have examined SM use longitudinally. We examined SM patterns among a diverse cohort of patients with diabetes (N = 19 921) and the providers they exchanged messages with within a large, integrated health system over 10 years (2006-2015), linking patient demographics to SM use. We found a 10-fold increase in messaging volume. There were dramatic increases overall and for patient subgroups, with a majority of patients (including patients with lower income or with self-reported limited health literacy) messaging by 2015. Although more physicians than nurses and other providers messaged throughout the study, the distribution of health professions using SM changed over time. Given this rapid increase in SM, deeper understanding of optimizing the value of patient and provider engagement, while managing workflow and training challenges, is crucial.
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Affiliation(s)
- Anupama Gunshekar Cemballi
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Andrew J Karter
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - William Brown
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
| | - Scott Crossley
- Department of Applied Linguistics and ESL, Georgia State University, Atlanta, Georgia, USA
| | - Wagahta Semere
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jill Allen
- Kaiser Research Insights and Operations, Kaiser Permanente, Pleasanton, California, USA
| | - Courtney Rees Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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48
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Antonio MG, Petrovskaya O, Lau F. The State of Evidence in Patient Portals: Umbrella Review. J Med Internet Res 2020; 22:e23851. [PMID: 33174851 PMCID: PMC7688386 DOI: 10.2196/23851] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Abstract
Background Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. Objective This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. Methods For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Results Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Conclusions Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.
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Affiliation(s)
| | | | - Francis Lau
- University of Victoria, Victoria, BC, Canada
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Hochheiser H, Valdez RS. Human-Computer Interaction, Ethics, and Biomedical Informatics. Yearb Med Inform 2020; 29:93-98. [PMID: 32823302 PMCID: PMC7442500 DOI: 10.1055/s-0040-1701990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objectives
: To provide an overview of recent work at the intersection of Biomedical Informatics, Human-Computer Interaction, and Ethics.
Methods
: Search terms for Human-Computer Interaction, Biomedical Informatics, and Ethics were used to identify relevant papers published between 2017 and 2019.Relevant papers were identified through multiple methods, including database searches, manual reviews of citations, recent publications, and special collections, as well as through peer recommendations. Identified articles were reviewed and organized into broad themes.
Results
: We identified relevant papers at the intersection of Biomedical Informatics, Human-Computer Interactions, and Ethics in over a dozen journals. The content of these papers was organized into three broad themes: ethical issues associated with systems in use, systems design, and responsible conduct of research.
Conclusions
: The results of this overview demonstrate an active interest in exploring the ethical implications of Human-Computer Interaction concerns in Biomedical Informatics. Papers emphasizing ethical concerns associated with patient-facing tools, mobile devices, social media, privacy, inclusivity, and e-consent reflect the growing prominence of these topics in biomedical informatics research. New questions in these areas will likely continue to arise with the growth of precision medicine and citizen science.
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Affiliation(s)
- Harry Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA
| | - Rupa S Valdez
- Public Health Sciences & Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia USA
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Abstract
OBJECTIVE To summarize significant research contributions on ethics in medical informatics published in 2019. METHODS An extensive search using PubMed/Medline was conducted to identify the scientific contributions published in 2019 that address ethics issues in medical informatics. The selection process comprised three steps: 1) 15 candidate best papers were first selected by the two section editors; 2) external reviewers from internationally renowned research teams reviewed each candidate best paper; and 3) the final selection of three best papers was conducted by the editorial committee of the Yearbook. RESULTS The three selected best papers explore timely issues of concern to the community and demonstrate how ethics considerations influence applied informatics. CONCLUSION With regard to ethics in informatics, data sharing and privacy remain primary areas of concern. Ethics issues related to the development and implementation of artificial intelligence is an emerging topic of interest.
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Affiliation(s)
- Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Vignesh Subbian
- College of Engineering, The University of Arizona, Tucson, Arizona, USA
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