Communication Preferences and Satisfaction of Secure Messaging Among Patients and Providers in the Military Healthcare System

The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review

BACKGROUND

In recent years, eHealth has received much attention as an opportunity to increase efficiency within healthcare organizations. Adoption of eHealth might consequently help to solve perceived health workforce challenges, including labor shortages and increasing workloads among primary care professionals, who serve as the first point of contact for healthcare in many countries. The purpose of this systematic review was to investigate the impact of general eHealth use and specific eHealth services use on general practice workload in the pre-COVID-19 era.

METHODS

The databases of CINAHL, Cochrane, Embase, IEEE Xplore, Medline ALL, PsycINFO, Web of Science, and Google Scholar were searched, using combinations of keywords including 'eHealth', 'workload', and 'general practice'. Data extraction and quality assessment of the included studies were independently performed by at least two reviewers. Publications were included for the period 2010 - 2020, before the start of the COVID-19 pandemic.

RESULTS

In total, 208 studies describing the impact of eHealth services use on general practice workload were identified. We found that two eHealth services were mainly investigated within this context, namely electronic health records and digital communication services, and that the largest share of the included studies used a qualitative study design. Overall, a small majority of the studies found that eHealth led to an increase in general practice workload. However, results differed between the various types of eHealth services, as a large share of the studies also reported a reduction or no change in workload.

CONCLUSIONS

The impact of eHealth services use on general practice workload is ambiguous. While a small majority of the effects indicated that eHealth increased workload in general practice, a large share of the effects also showed that eHealth use reduced workload or had no impact. These results do not imply a definitive conclusion, which underscores the need for further explanatory research. Various factors, including the study setting, system design, and the phase of implementation, may influence this impact and should be taken into account when general practices adopt new eHealth services.

STUDY REGISTRATION NUMBER

PROSPERO (International Prospective Register of Systematic Reviews) CRD42020199897; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199897 .

Using large language model to guide patients to create efficient and comprehensive clinical care message

OBJECTIVE

This study aims to investigate the feasibility of using Large Language Models (LLMs) to engage with patients at the time they are drafting a question to their healthcare providers, and generate pertinent follow-up questions that the patient can answer before sending their message, with the goal of ensuring that their healthcare provider receives all the information they need to safely and accurately answer the patient's question, eliminating back-and-forth messaging, and the associated delays and frustrations.

METHODS

We collected a dataset of patient messages sent between January 1, 2022 to March 7, 2023 at Vanderbilt University Medical Center. Two internal medicine physicians identified 7 common scenarios. We used 3 LLMs to generate follow-up questions: (1) Comprehensive LLM Artificial Intelligence Responder (CLAIR): a locally fine-tuned LLM, (2) GPT4 with a simple prompt, and (3) GPT4 with a complex prompt. Five physicians rated them with the actual follow-ups written by healthcare providers on clarity, completeness, conciseness, and utility.

RESULTS

For five scenarios, our CLAIR model had the best performance. The GPT4 model received higher scores for utility and completeness but lower scores for clarity and conciseness. CLAIR generated follow-up questions with similar clarity and conciseness as the actual follow-ups written by healthcare providers, with higher utility than healthcare providers and GPT4, and lower completeness than GPT4, but better than healthcare providers.

CONCLUSION

LLMs can generate follow-up patient messages designed to clarify a medical question that compares favorably to those generated by healthcare providers.

Text messaging support to enhance nurses' well-being and connectedness

ABSTRACT

Nurses face numerous stressors due to increasing patient acuity, challenging staffing ratios, and trauma from the COVID-19 pandemic, among many other factors. To help improve nurses' daily self-care, nurses need diverse tools and interventions, such as peer support through text messaging (TM). This article evaluates the benefits of TM and strategies to use TM in providing effective peer support among nurses.

Baseline eHealth Behaviors of Service Members: A Retrospective, Cross-Sectional Analysis of Patient Portal Use Before the Pandemic

INTRODUCTION

The use of electronic health (eHealth) tools has the potential to support the overall health, wellness, fitness status, and ability to deploy worldwide of active duty service members (SMs). Additionally, the Coronavirus Disease 2019 pandemic forced healthcare organizations to quickly convert to virtual care settings to decrease face-to-face interactions and increase access to healthcare using technology. The shift to virtual care and the push to increase use of eHealth tools heightened the need to understand how military members interact with eHealth tools. Little is known about the factors that influence SMs use of eHealth tools and if having a health condition increases or decreases use. To evaluate these factors, we completed a cross-sectional, retrospective analysis on a sample of 198,388 active duty SMs aged 18 to 68 years.

MATERIALS AND METHODS

We used two Military Health System (MHS) data sources-Tricare Online (TOL) Patient Portal 2018 audit logs and outpatient electronic health record data. Using eHealth behaviors identified in the audit logs, we evaluated and compared individual characteristics (i.e., "gender", "age", "race", and "marital status"), environmental factors (i.e., "rank", "military branch", and "geographic location"), and six available health conditions (i.e., congenital health defects, amputation, anxiety, sleep, traumatic brain injury, and depression). Since moderate usage of eHealth tools is linked to improved health outcomes, adherence, communication, and increased consumer satisfaction, a logistic regression model was developed to find the factors most associated with moderate (3-11 logins per year) use of the portal.

RESULTS

Electronic health use increased by SMs with underlying health conditions or if they were managing family member health. Most SMs who used the TOL Patient Portal were of ages 25-34 years, White, and married. The mean age is 32.53 for males and 29.98 for females. Over half of the TOL Patient Portal SM users utilized the portal one to two times. Most SMs used the TOL Patient Portal in Virginia, Texas, California, Florida, North Carolina, Georgia, and Maryland. The highest use was during the months of March to May. Frequent patient portal actions include searching for appointments, viewing health information, viewing medical encounters, and refilling medications. Although SMs with congenital health defects, anxiety, sleep issues, and depression have higher patient portal use rates, SMs with depression have a negative association with using the patient portal at a "moderate" rate. Viewing family member health information and searching for appointments were strongly associated with patient portal moderate use.

CONCLUSIONS

Our findings support top military initiatives to improve the overall health, wellness, and readiness of SMs while decreasing the MHS's overall cost of care while providing a foundation to compare "pre" and "post" pandemic eHealth behaviors. It is essential to note that SMs are more likely to use a patient portal to seek information or manage family member health. This key factor identifies the significance of family health promotion and readiness in the active duty SM's life. The long-term goal of our study is to build the foundation for delivering tailored health information and eHealth tools to promote health and readiness-centric patient engagement.

Impact of Asynchronous Electronic Communication-Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

BACKGROUND

Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear.

OBJECTIVE

To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs.

METHODS

We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits' impacts on clinical and health care delivery outcomes.

RESULTS

Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs.

CONCLUSIONS

Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.

Email Use Reconsidered in Health Professions Education: Viewpoint

Email has become a popular means of communication in the past 40 years, with more than 200 billion emails sent each day worldwide. When used appropriately, email can be an effective and useful form of correspondence, although improper practices, such as email incivility, can present challenges. Email is ubiquitous in education and health care, where it is used for student-to-teacher, provider-to-provider, and patient-to-provider communications, but not all students, faculty members, and health professionals are skilled in its use. This paper examines the challenges and opportunities posed by email communication in health professions education and reveals important deficiencies in training, as well as steps that can be taken by health professions educators to address them. Recommendations are offered to help health professions educators develop approaches for teaching email professionalism.

Gateless communication: A concept analysis

The movement toward the use of electronic technologies in everyday life has also impacted healthcare. Patient portals allow patients to send messages to their healthcare team from the comfort of their own homes and even on mobile devices. With responses typically sent within 24 business hours, some patients are looking for more timely feedback to their health questions. This is true in behavioral health, where real-time communication between psychologist-patient is valued. It is not uncommon for psychiatric providers including psychiatrists and nurse practitioners to provide personal cell phone numbers or secure-texting services to their patients. The real-time texting that occurs between patients and providers is emerging as a new way in which information is shared. A literature review in PubMed and CINAHL revealed a plethora of research conducted on information exchanged via the patient portal; however, there appears to be a gap in the information known about direct patient-provider communication that utilizes other types of technology. This concept analysis looks at this type of communication and proposes that a new concept be developed to perform future research studies. "Gateless communication" will be explored using a previous paper eight-step method for conceptualizing this new concept.