1
|
Cox C, Hatfield T, Willars J, Fritz Z. Identifying Facilitators and Inhibitors of Shared Understanding: An Ethnography of Diagnosis Communication in Acute Medical Settings. Health Expect 2024; 27:e14180. [PMID: 39180375 PMCID: PMC11344224 DOI: 10.1111/hex.14180] [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: 04/08/2024] [Revised: 07/10/2024] [Accepted: 07/31/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND AND AIMS Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. METHODS Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2-4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross-examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. RESULTS We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow-up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. CONCLUSIONS In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. PATIENT/PUBLIC CONTRIBUTION A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow-up telephone interview, the development of the interview guides and the participant information sheets.
Collapse
Affiliation(s)
- Caitríona Cox
- The Healthcare Improvement Studies InstituteCambridgeUK
| | - Thea Hatfield
- The Healthcare Improvement Studies InstituteCambridgeUK
| | - Janet Willars
- The Healthcare Improvement Studies InstituteCambridgeUK
| | - Zoë Fritz
- The Healthcare Improvement Studies InstituteCambridgeUK
| |
Collapse
|
2
|
Schwarz J, Hoetger C, Pluschke LS, Muehlensiepen F, Schneider M, Thoma S, Esch T. Psychiatrists' perceptions of conditions and consequences associated with the implementation of open notes: qualitative investigation. BMC Psychiatry 2024; 24:430. [PMID: 38858711 PMCID: PMC11163720 DOI: 10.1186/s12888-024-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE In a growing list of countries, patients are granted access to their clinical notes ("open notes") as part of their online record access. Especially in the field of mental health, open notes remain controversial with some clinicians perceiving open notes as a tool for improving therapeutic outcomes by increasing patient involvement, while others fear that patients might experience psychological distress and perceived stigmatization, particularly when reading clinicians' notes. More research is needed to optimize the benefits and mitigate the risks. METHODS Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis. RESULTS We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts. CONCLUSION Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.
Collapse
Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
| | - Cosima Hoetger
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lena-Sophie Pluschke
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Felix Muehlensiepen
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany
| | - Michael Schneider
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Samuel Thoma
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
3
|
Guo L, Reddy KP, Van Iseghem T, Pierce WN. Enhancing data practices for Whole Health: Strategies for a transformative future. Learn Health Syst 2024; 8:e10426. [PMID: 38883871 PMCID: PMC11176597 DOI: 10.1002/lrh2.10426] [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: 10/27/2023] [Revised: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
We explored the challenges and solutions for managing data within the Whole Health System (WHS), which operates as a Learning Health System and a patient-centered healthcare approach that combines conventional and complementary approaches. Addressing these challenges is critical for enhancing patient care and improving outcomes within WHS. The proposed solutions include prioritizing interoperability for seamless data exchange, incorporating patient-centered comparative clinical effectiveness research and real-world data to personalize treatment plans and validate integrative approaches, and leveraging advanced data analytics tools to incorporate patient-reported outcomes, objective metrics, robust data platforms. Implementing these measures will enable WHS to fulfill its mission as a holistic and patient-centered healthcare model, promoting greater collaboration among providers, boosting the well-being of patients and providers, and improving patient outcomes.
Collapse
Affiliation(s)
- Lei Guo
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- School of Interdisciplinary Health Professions Northern Illinois University DeKalb Illinois USA
| | - Kavitha P Reddy
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- Department of Veterans Affairs VHA Office of Patient-Centered Care and Cultural Transformation Washington D.C. USA
- School of Medicine Washington University in St. Louis St. Louis Missouri USA
| | - Theresa Van Iseghem
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- School of Medicine Saint Louis University St. Louis Missouri USA
| | - Whitney N Pierce
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
| |
Collapse
|
4
|
Turer RW, McDonald SA, Lehmann CU, Thakur B, Dutta S, Taylor RA, Rose CC, Frisch A, Feterik K, Norquist C, Baker CK, Nielson JA, Cha D, Kwan B, Dameff C, Killeen JP, Hall MK, Doerning RC, Rosenbloom ST, Distaso C, Steitz BD. Real-Time Electronic Patient Portal Use Among Emergency Department Patients. JAMA Netw Open 2024; 7:e249831. [PMID: 38700859 PMCID: PMC11069088 DOI: 10.1001/jamanetworkopen.2024.9831] [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: 09/18/2023] [Accepted: 03/05/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Patients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients. Objectives To describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers. Design, Setting, and Participants In this cross-sectional study of 12 teaching and 24 academic-affiliated EDs from 8 health systems in California, Connecticut, Massachusetts, Ohio, Tennessee, Texas, and Washington, patient portal access and usage data were evaluated for all ED patients 18 years or older between April 5, 2021, and April 4, 2022. Exposure Use of the patient portal during ED visit. Main Outcomes and Measures The primary outcomes were the weekly proportions of ED patients who logged into the portal, viewed test results, and viewed clinical notes in real time. Pooled random-effects models were used to evaluate temporal trends and demographic and clinical characteristics associated with real-time portal use. Results The study included 1 280 924 unique patient encounters (53.5% female; 0.6% American Indian or Alaska Native, 3.7% Asian, 18.0% Black, 10.7% Hispanic, 0.4% Native Hawaiian or Pacific Islander, 66.5% White, 10.0% other race, and 4.0% with missing race or ethnicity; 91.2% English-speaking patients; mean [SD] age, 51.9 [19.2] years). During the study, 17.4% of patients logged into the portal while in the ED, whereas 14.1% viewed test results and 2.5% viewed clinical notes. The odds of accessing the portal (odds ratio [OR], 1.36; 95% CI, 1.19-1.56), viewing test results (OR, 1.63; 95% CI, 1.30-2.04), and viewing clinical notes (OR, 1.60; 95% CI, 1.19-2.15) were higher at the end of the study vs the beginning. Patients with active portal accounts at ED arrival had a higher odds of logging into the portal (OR, 17.73; 95% CI, 9.37-33.56), viewing test results (OR, 18.50; 95% CI, 9.62-35.57), and viewing clinical notes (OR, 18.40; 95% CI, 10.31-32.86). Patients who were male, Black, or without commercial insurance had lower odds of logging into the portal, viewing results, and viewing clinical notes. Conclusions and Relevance These findings suggest that real-time patient portal use during ED encounters has increased over time, but disparities exist in portal access that mirror trends in portal usage more generally. Given emergency medicine's role in caring for medically underserved patients, there are opportunities for EDs to enroll and train patients in using patient portals to promote engagement during and after their visits.
Collapse
Affiliation(s)
- Robert W. Turer
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Samuel A. McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Bhaskar Thakur
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sayon Dutta
- Department of Emergency Medicine, Mass General Brigham, Boston, Massachusetts
- Mass General Brigham Digital, Boston, Massachusetts
| | - Richard A. Taylor
- Department of Emergency Medicine and Section for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Heath, New Haven, Connecticut
| | - Christian C. Rose
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Adam Frisch
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kristian Feterik
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Craig Norquist
- Department of Emergency Medicine, HonorHealth, Phoenix, Arizona
| | - Carrie K. Baker
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Jeffrey A. Nielson
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - David Cha
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Brian Kwan
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - Christian Dameff
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - James P. Killeen
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - Michael K. Hall
- Department of Emergency Medicine, University of Washington, Seattle
| | | | - S. Trent Rosenbloom
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Casey Distaso
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
5
|
Swanson K, He S, Calvano J, Chen D, Telvizian T, Jiang L, Chong P, Schwell J, Mak G, Lee J. Biomedical text readability after hypernym substitution with fine-tuned large language models. PLOS DIGITAL HEALTH 2024; 3:e0000489. [PMID: 38625843 PMCID: PMC11020904 DOI: 10.1371/journal.pdig.0000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/21/2024] [Indexed: 04/18/2024]
Abstract
The advent of patient access to complex medical information online has highlighted the need for simplification of biomedical text to improve patient understanding and engagement in taking ownership of their health. However, comprehension of biomedical text remains a difficult task due to the need for domain-specific expertise. We aimed to study the simplification of biomedical text via large language models (LLMs) commonly used for general natural language processing tasks involve text comprehension, summarization, generation, and prediction of new text from prompts. Specifically, we finetuned three variants of large language models to perform substitutions of complex words and word phrases in biomedical text with a related hypernym. The output of the text substitution process using LLMs was evaluated by comparing the pre- and post-substitution texts using four readability metrics and two measures of sentence complexity. A sample of 1,000 biomedical definitions in the National Library of Medicine's Unified Medical Language System (UMLS) was processed with three LLM approaches, and each showed an improvement in readability and sentence complexity after hypernym substitution. Readability scores were translated from a pre-processed collegiate reading level to a post-processed US high-school level. Comparison between the three LLMs showed that the GPT-J-6b approach had the best improvement in measures of sentence complexity. This study demonstrates the merit of hypernym substitution to improve readability of complex biomedical text for the public and highlights the use case for fine-tuning open-access large language models for biomedical natural language processing.
Collapse
Affiliation(s)
- Karl Swanson
- Department of Medicine–Clinical Informatics, University of California–San Francisco, San Francisco, United States of America
| | - Shuhan He
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Josh Calvano
- Department of Anesthesiology and Critical Care, University of New Mexico Hospital, Albuquerque, New Mexico, United States of America
| | - David Chen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Talar Telvizian
- Department of Internal Medicine, Main Line Health Lankenau Medical Center, Wynnewood, Pennsylvania, United States of America
| | - Lawrence Jiang
- Department of Computer Science, Duke University, Durham, North Carolina, United States of America
| | - Paul Chong
- School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, United States of America
| | - Jacob Schwell
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Gin Mak
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Jarone Lee
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
6
|
Doshi R, Amin KS, Khosla P, Bajaj SS, Chheang S, Forman HP. Quantitative Evaluation of Large Language Models to Streamline Radiology Report Impressions: A Multimodal Retrospective Analysis. Radiology 2024; 310:e231593. [PMID: 38530171 DOI: 10.1148/radiol.231593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background The complex medical terminology of radiology reports may cause confusion or anxiety for patients, especially given increased access to electronic health records. Large language models (LLMs) can potentially simplify radiology report readability. Purpose To compare the performance of four publicly available LLMs (ChatGPT-3.5 and ChatGPT-4, Bard [now known as Gemini], and Bing) in producing simplified radiology report impressions. Materials and Methods In this retrospective comparative analysis of the four LLMs (accessed July 23 to July 26, 2023), the Medical Information Mart for Intensive Care (MIMIC)-IV database was used to gather 750 anonymized radiology report impressions covering a range of imaging modalities (MRI, CT, US, radiography, mammography) and anatomic regions. Three distinct prompts were employed to assess the LLMs' ability to simplify report impressions. The first prompt (prompt 1) was "Simplify this radiology report." The second prompt (prompt 2) was "I am a patient. Simplify this radiology report." The last prompt (prompt 3) was "Simplify this radiology report at the 7th grade level." Each prompt was followed by the radiology report impression and was queried once. The primary outcome was simplification as assessed by readability score. Readability was assessed using the average of four established readability indexes. The nonparametric Wilcoxon signed-rank test was applied to compare reading grade levels across LLM output. Results All four LLMs simplified radiology report impressions across all prompts tested (P < .001). Within prompts, differences were found between LLMs. Providing the context of being a patient or requesting simplification at the seventh-grade level reduced the reading grade level of output for all models and prompts (except prompt 1 to prompt 2 for ChatGPT-4) (P < .001). Conclusion Although the success of each LLM varied depending on the specific prompt wording, all four models simplified radiology report impressions across all modalities and prompts tested. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Rahsepar in this issue.
Collapse
Affiliation(s)
- Rushabh Doshi
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Kanhai S Amin
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Pavan Khosla
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Simar S Bajaj
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Sophie Chheang
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Howard P Forman
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| |
Collapse
|
7
|
Steitz BD, Turer RW, Lin CT, MacDonald S, Salmi L, Wright A, Lehmann CU, Langford K, McDonald SA, Reese TJ, Sternberg P, Chen Q, Rosenbloom ST, DesRoches CM. Perspectives of Patients About Immediate Access to Test Results Through an Online Patient Portal. JAMA Netw Open 2023; 6:e233572. [PMID: 36939703 PMCID: PMC10028486 DOI: 10.1001/jamanetworkopen.2023.3572] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/17/2023] [Indexed: 03/21/2023] Open
Abstract
Importance The 21st Century Cures Act Final Rule mandates the immediate electronic availability of test results to patients, likely empowering them to better manage their health. Concerns remain about unintended effects of releasing abnormal test results to patients. Objective To assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal. Design, Setting, and Participants This large, multisite survey study was conducted at 4 geographically distributed academic medical centers in the US using an instrument adapted from validated surveys. The survey was delivered in May 2022 to adult patients and care partners who had accessed test results via an online patient portal account between April 5, 2021, and April 4, 2022. Exposures Access to test results via a patient portal between April 5, 2021, and April 4, 2022. Main Outcomes and Measures Responses to questions related to demographics, test type and result, reaction to result, notification experience and future preferences, and effect on health and well-being were aggregated. To evaluate characteristics associated with patient worry, logistic regression and pooled random-effects models were used to assess level of worry as a function of whether test results were perceived by patients as normal or not normal and whether patients were precounseled. Results Of 43 380 surveys delivered, there were 8139 respondents (18.8%). Most respondents were female (5129 [63.0%]) and spoke English as their primary language (7690 [94.5%]). The median age was 64 years (IQR, 50-72 years). Most respondents (7520 of 7859 [95.7%]), including 2337 of 2453 individuals (95.3%) who received nonnormal results, preferred to immediately receive test results through the portal. Few respondents (411 of 5473 [7.5%]) reported that reviewing results before they were contacted by a health care practitioner increased worry, though increased worry was more common among respondents who received abnormal results (403 of 2442 [16.5%]) than those whose results were normal (294 of 5918 [5.0%]). The result of the pooled model for worry as a function of test result normality was statistically significant (odds ratio [OR], 2.71; 99% CI, 1.96-3.74), suggesting an association between worry and nonnormal results. The result of the pooled model evaluating the association between worry and precounseling was not significant (OR, 0.70; 99% CI, 0.31-1.59). Conclusions and Relevance In this multisite survey study of patient attitudes and preferences toward receiving immediately released test results via a patient portal, most respondents preferred to receive test results via the patient portal despite viewing results prior to discussion with a health care professional. This preference persisted among patients with nonnormal results.
Collapse
Affiliation(s)
- Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert W. Turer
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Scott MacDonald
- Department of Clinical Informatics, University of California Davis Health, Sacramento
| | - Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christoph U. Lehmann
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
| | - Karen Langford
- Department of Insights and Operations, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel A. McDonald
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
| | - Thomas J. Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul Sternberg
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Catherine M. DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
8
|
Griffin AC, Troszak LK, Van Campen J, Midboe AM, Zulman DM. Tablet distribution to veterans: an opportunity to increase patient portal adoption and use. J Am Med Inform Assoc 2022; 30:73-82. [PMID: 36269168 PMCID: PMC9748532 DOI: 10.1093/jamia/ocac195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Examine whether distribution of tablets to patients with access barriers influences their adoption and use of patient portals. MATERIALS AND METHODS This retrospective cohort study included Veterans Affairs (VA) patients (n = 28 659) who received a VA-issued tablet between November 1, 2020 and April 30, 2021. Tablets included an app for VA's My HealtheVet (MHV) portal. Veterans were grouped into 3 MHV baseline user types (non-users, inactive users, and active users) based on MHV registration status and feature use pre-tablet receipt. Three multivariable models were estimated to examine the factors predicting (1) MHV registration among non-users, (2) any MHV feature use among inactive users, and (3) more MHV use among active users post-tablet receipt. Differences in feature use during the 6 months pre-/post-tablet were examined with McNemar chi-squared tests of proportions. RESULTS In the 6 months post-tablet, 1298 (8%) non-users registered for MHV, 525 (24%) inactive users used at least one MHV feature, and 4234 (46%) active users increased feature use. Across veteran characteristics, there were differences in registration and feature use post-tablet, particularly among older adults and those without prior use of video visits (P < .01). Among active users, use of all features increased during the 6 months post-tablet, with the greatest differences in viewing prescription refills and scheduling appointments (P < .01). CONCLUSION Providing patients who experience barriers to in-person care with a portal-enabled device supports engagement in health information and management tasks. Additional strategies are needed to promote registration and digital inclusion among inactive and non-users of portals.
Collapse
Affiliation(s)
- Ashley C Griffin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Lara K Troszak
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - James Van Campen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Amanda M Midboe
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Donna M Zulman
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
9
|
Kharko A, Hägglund M. Nocebo effects from clinical notes: reason for action, not opposition for clinicians of patients with medically unexplained symptoms. JOURNAL OF MEDICAL ETHICS 2022; 49:jme-2022-108795. [PMID: 36600610 DOI: 10.1136/jme-2022-108795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Anna Kharko
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Schwarz J, Esch T. [OpenNotes in mental health? Pro]. DER NERVENARZT 2022; 93:1163-1164. [PMID: 35913587 DOI: 10.1007/s00115-022-01357-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Seebad 82/83, 15562, Rüdersdorf, Deutschland.
| | - Tobias Esch
- Fakultät für Gesundheit (Department für Humanmedizin), Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten-Herdecke, Witten, Deutschland
| |
Collapse
|
11
|
Hötger C, Heuser-Collier I. [OpenNotes in mental health? Contra]. DER NERVENARZT 2022; 93:1165-1166. [PMID: 35913586 DOI: 10.1007/s00115-022-01356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Cosima Hötger
- Fakultät für Gesundheit (Department für Humanmedizin), Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten-Herdecke, Witten, Deutschland
| | - Isabella Heuser-Collier
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| |
Collapse
|
12
|
Müller J, Weinert L, Svensson L, Rivinius R, Kreusser MM, Heinze O. Mobile Access to Medical Records in Heart Transplantation Aftercare: Mixed-Methods Study Assessing Usability, Feasibility and Effects of a Mobile Application. Life (Basel) 2022; 12:1204. [PMID: 36013383 PMCID: PMC9410472 DOI: 10.3390/life12081204] [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: 06/30/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patient access to medical records can improve quality of care. The phellow application (app) was developed to provide patients access to selected content of their medical record. It was tested at a heart transplantation (HTx) outpatient clinic. The aims of this study were (1) to assess usability of phellow, (2) to determine feasibility of implementation in routine care, and (3) to study the effects app use had on patients' self-management. METHODS Usability was measured quantitatively through the System Usability Scale (SUS). Furthermore, usability, feasibility, and effects on self-management were qualitatively assessed through interviews with users, non-users, and health care providers. RESULTS The SUS rating (n = 31) was 79.9, indicating good usability. Twenty-three interviews were conducted. Although appreciation and willingness-to-use were high, usability problems such as incompleteness of record, technical issues, and complex registration procedures were reported. Improved technical support infrastructure, clearly defined responsibilities, and app-specific trainings were suggested for further implementation. Patients described positive effects on their self-management. CONCLUSIONS To be feasible for implementation in routine care, usability problems should be addressed. Feedback on the effect of app use was encouraging. Accompanying research is crucial to monitor usability improvements and to further assess effects of app use on patients.
Collapse
Affiliation(s)
- Julia Müller
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Lina Weinert
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Section for Translational Health Economics, Department for Conservative Dentistry, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Laura Svensson
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Michael M. Kreusser
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Oliver Heinze
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| |
Collapse
|
13
|
Chen JS, Baxter SL. Applications of natural language processing in ophthalmology: present and future. Front Med (Lausanne) 2022; 9:906554. [PMID: 36004369 PMCID: PMC9393550 DOI: 10.3389/fmed.2022.906554] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in technology, including novel ophthalmic imaging devices and adoption of the electronic health record (EHR), have resulted in significantly increased data available for both clinical use and research in ophthalmology. While artificial intelligence (AI) algorithms have the potential to utilize these data to transform clinical care, current applications of AI in ophthalmology have focused mostly on image-based deep learning. Unstructured free-text in the EHR represents a tremendous amount of underutilized data in big data analyses and predictive AI. Natural language processing (NLP) is a type of AI involved in processing human language that can be used to develop automated algorithms using these vast quantities of available text data. The purpose of this review was to introduce ophthalmologists to NLP by (1) reviewing current applications of NLP in ophthalmology and (2) exploring potential applications of NLP. We reviewed current literature published in Pubmed and Google Scholar for articles related to NLP and ophthalmology, and used ancestor search to expand our references. Overall, we found 19 published studies of NLP in ophthalmology. The majority of these publications (16) focused on extracting specific text such as visual acuity from free-text notes for the purposes of quantitative analysis. Other applications included: domain embedding, predictive modeling, and topic modeling. Future ophthalmic applications of NLP may also focus on developing search engines for data within free-text notes, cleaning notes, automated question-answering, and translating ophthalmology notes for other specialties or for patients, especially with a growing interest in open notes. As medicine becomes more data-oriented, NLP offers increasing opportunities to augment our ability to harness free-text data and drive innovations in healthcare delivery and treatment of ophthalmic conditions.
Collapse
Affiliation(s)
- Jimmy S. Chen
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, United States
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, United States
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, United States
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, United States
| |
Collapse
|
14
|
Suir I, Oosterhaven J, Boonzaaijer M, Nuysink J, Jongmans M. The AIMS home-video method: parental experiences and appraisal for use in neonatal follow-up clinics. BMC Pediatr 2022; 22:338. [PMID: 35690764 PMCID: PMC9187888 DOI: 10.1186/s12887-022-03398-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background In The Netherlands, prematurely born infants and their parents are offered regular developmental check-ups in a hospital setting. In line with providing healthcare at distance, the use of video footage showing the infant’s behavior and movements, taken by parents at home and assessed by professionals online, might be a fruitful future practice. The focus of this study was to gain insight into parental experiences with the Alberta Infant Motor Scale home-video method and their appraisal of its applicability for use in an outpatient neonatal follow-up clinic. Method A qualitative descriptive study among parents of healthy extremely or very premature infants (GA 26.2–31.5 weeks) participating in a longitudinal study of motor development between 3–18 months corrected age. Ten semi-structured interviews were conducted and transcribed verbatim. Data was analyzed independently. Inductive content analysis was performed following the process of the AIMS home-video method. Results Parents appraised the AIMS home-video method as manageable and fun to do. Instructions, instruction film, and checklists were clear. Transferring the video footage from their phone to their computer and uploading it to the web portal was sometimes time-consuming. Parents gained a better awareness of their infant’s motor development and found the provided feedback a confirmation of what they already thought about their infant’s development and was reassuring that their child was doing well. First-time parents seemed more uncertain and had a greater need for information about (motor) development, but on the other hand, also had confidence in their child. All parents thought that home-videos can be an addition to follow-up visits, but cannot replace (all) visits. It may be an opportunity to reduce the frequency of hospital visits, while still having their infant monitored. Conclusion Parents appraised the AIMS home-video method positively and are of the opinion that home-videos can be of added value in monitoring infants at risk in neonatal follow-up additional to hospital visits. In future research a user-friendly application and/or platform to exchange video footage safely between parents and professionals should be developed with all possible stakeholders involved and implementation should be explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03398-9.
Collapse
Affiliation(s)
- I Suir
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands. .,Faculty of Social and Behavioural Sciences, Department of Pedagogical and Educational Sciences, Utrecht University, Utrecht, The Netherlands.
| | - J Oosterhaven
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
| | - M Boonzaaijer
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands.,Faculty of Social and Behavioural Sciences, Department of Pedagogical and Educational Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Neonatology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - J Nuysink
- Research Group Lifestyle and Health, Research Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
| | - M Jongmans
- Faculty of Social and Behavioural Sciences, Department of Pedagogical and Educational Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Neonatology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| |
Collapse
|
15
|
Kujala S, Hörhammer I, Väyrynen A, Holmroos M, Nättiaho-Rönnholm M, Hägglund M, Johansen MA. Patients' Experiences of Web-Based Access to Electronic Health Records in Finland: Cross-sectional Survey. J Med Internet Res 2022; 24:e37438. [PMID: 35666563 PMCID: PMC9210208 DOI: 10.2196/37438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 02/06/2023] Open
Abstract
Background Patient portals that provide access to electronic health records offer a means for patients to better understand and self-manage their health. Yet, patient access to electronic health records raises many concerns among physicians, and little is known about the use practices and experiences of patients who access their electronic health records via a mature patient portal that has been available for citizens for over five years. Objective We aimed to identify patients’ experiences using a national patient portal to access their electronic health records. In particular, we focused on understanding usability-related perceptions and the benefits and challenges of reading clinical notes written by health care professionals. Methods Data were collected from 3135 patient users of the Finnish My Kanta patient portal through a web-based survey in June 2021 (response rate: 0.7%). Patients received an invitation to complete the questionnaire when they logged out of the patient portal. Respondents were asked to rate the usability of the patient portal, and the ratings were used to calculate approximations of the System Usability Scale score. Patients were also asked about the usefulness of features, and whether they had discussed the notes with health professionals. Open-ended questions were used to ask patients about their experiences of the benefits and challenges related to reading health professionals’ notes. Results Overall, patient evaluations of My Kanta were positive, and its usability was rated as good (System Usability Scale score approximation: mean 72.7, SD 15.9). Patients found the portal to be the most useful for managing prescriptions and viewing the results of examinations and medical notes. Viewing notes was the most frequent reason (978/3135, 31.2%) for visiting the portal. Benefits of reading the notes mentioned by patients included remembering and understanding what was said by health professionals and the instructions given during an appointment, the convenience of receiving information about health and care, the capability to check the accuracy of notes, and using the information to support self-management. However, there were challenges related to difficulty in understanding medical terminology, incorrect or inadequate notes, missing notes, and usability. Conclusions Patients actively used medical notes to receive information to follow professionals' instructions to take care of their health, and patient access to electronic health records can support self-management. However, for the benefits to be realized, improvements in the quality and availability of medical professionals’ notes are necessary. Providing a standard information structure could help patients find the information they need. Furthermore, linking notes to vocabularies and other information sources could also improve the understandability of medical terminology; patient agency could be supported by allowing them to add comments to their notes, and patient trust of the system could be improved by allowing them to control the visibility of the professionals’ notes.
Collapse
Affiliation(s)
- Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Iiris Hörhammer
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Akseli Väyrynen
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Mari Holmroos
- Kela, The Social Insurance Institution of Finland, Helsinki, Finland
| | | | - Maria Hägglund
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Monika Alise Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
16
|
Fisher KA, Kennedy K, Bloomstone S, Fukunaga MI, Bell SK, Mazor KM. Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD. PATIENT EDUCATION AND COUNSELING 2022; 105:726-733. [PMID: 34175167 PMCID: PMC8651798 DOI: 10.1016/j.pec.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To understand the impact of sharing clinic notes on communication and self-management among patients with COPD and to develop recommendations for writing patient-centered notes. METHODS Thirty patients with COPD participated in 'think-aloud' interviews in which they reviewed their COPD-specific clinic note. Interviews were coded using conventional content analysis, organized by the six-function communication framework. RESULTS Participants were predominantly White (93.3%), with a mean age of 65.5 years. More than half had a high school degree or less, half reported difficulty understanding spoken information, and nearly half sometimes need help reading medical materials. Patients indicated notes provided an opportunity to learn details of their condition and facilitated information sharing - strengthening information exchange. Reading notes enabled self-management through motivation, prompting information seeking, and reminding them of action steps. Patients reacted positively to statements suggesting the provider listened to them, saw them as a person, and was attentive to details, which fostered the relationship. Most patients reacted negatively to medical terminology, incorrect information, and wording that was perceived as disparaging. CONCLUSIONS Sharing clinic notes with patients can promote information exchange, enable self-management, and strengthen the patient-provider relationship. PRACTICE IMPLICATIONS Incorporating patients' recommendations for writing notes could strengthen the benefits of sharing notes.
Collapse
Affiliation(s)
- Kimberly A Fisher
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| | - Kara Kennedy
- University of Massachusetts Medical School, Worcester, USA.
| | - Sarah Bloomstone
- Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| | - Mayuko Ito Fukunaga
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA; Department of Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, USA.
| | | | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| |
Collapse
|
17
|
Assiri G. The Impact of Patient Access to Their Electronic Health Record on Medication Management Safety: A Narrative Review. Saudi Pharm J 2022; 30:185-194. [PMID: 35498224 PMCID: PMC9051961 DOI: 10.1016/j.jsps.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/05/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction As the American's Federal Health Insurance Portability and Accountability Act (HIPAA) stated that patients should be allowed to review their medical records, and as information technology is ever more widely used by healthcare professionals and patients, providing patients with online access to their own medical records through a patient portal is becoming increasingly popular. Previous research has been done regarding the impact on the quality and safety of patients' care, rather than explicitly on medication safety, when providing those patients with access to their electronic health records (EHRs). Aim This narrative review aims to summarise the results from previous studies on the impact on medication management safety concepts of adult patients accessing information contained in their own EHRs. Result A total of 24 studies were included in this review. The most two commonly studied measures of safety in medication management were: (a) medication adherence and (b) patient-reported experience. Other measures, such as: discrepancies, medication errors, appropriateness and Adverse Drug Events (ADEs) were the least studied. Conclusion The results suggest that providing patients with access to their EHRs can improve medication management safety. Patients pointed out improvements to the safety of their medications and perceived stronger medication control. The data from these studies lay the foundation for future research.
Collapse
Key Words
- ACOVE, Assessing Care Of Vulnerable Elders
- ADE, Adverse Drug Events
- CI, Confidence Interval
- EHR, Electronic Health Record
- Electronic health record
- Electronic medical records
- HIPAA, American’s Federal Health Insurance Portability and Accountability Act
- HIV/AIDS, Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome
- LMR, Longitudinal Medical Record
- MHV, MyHealtheVet
- OR, Odds Ratio
- OTC, over-the-counter
- PAERS, Patient Access to Electronic Records System
- PCP, Primary Care Physician
- PDC, Proportion of Days Covered
- PG, Patient Gateway
- PHR, Personal Health Record
- Patient access and medication management
- Patient participation
- RCT, Randomised Controlled Trial
- RR, Relative Risk
- SPARO, System Providing Access to Records Online
- UK, United Kingdom
- USA, United States of America
- VA, Veterans Affairs
- WDS, WellDoc System
Collapse
|
18
|
Leung T, Lau M, Lehmann CU, Holmgren AJ, Medford RJ, Ramirez CM, Chen CN. The 21st Century Cures Act and Multiuser Electronic Health Record Access: Potential Pitfalls of Information Release. J Med Internet Res 2022; 24:e34085. [PMID: 35175207 PMCID: PMC8895284 DOI: 10.2196/34085] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/07/2021] [Accepted: 12/26/2021] [Indexed: 01/24/2023] Open
Abstract
Although the Office of The National Coordinator for Health Information Technology's (ONC) Information Blocking Provision in the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multiuser electronic health record (EHR) access and proxy access, concerns on the potential for harm in adolescent care contexts exist. We describe how the provision could erode patients' (both adolescent and older patients alike) trust and willingness to seek care. The rule's preventing harm exception does not apply to situations where the patient is a minor and the health care provider wishes to restrict a parent's or guardian's access to the minor's EHI to avoid violating the minor's confidentiality and potentially harming patient-clinician trust. This may violate previously developed government principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate "shadow charting" will be burdensome (and prohibitive) for health care providers. Under the privacy exception, patients have the opportunity to request information to not be shared; however, depending on institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot "improperly encourage or induce a patient's request to block information." Fearing being found in violation of the information blocking provisions, providers may feel that they are unable to guide patients navigating the release of their EHI in the multiuser or proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations that care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multiuser or proxy access situations.
Collapse
Affiliation(s)
| | - May Lau
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX, United States
| | - Christoph U Lehmann
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Data Sciences and Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - A Jay Holmgren
- Department of Medicine, Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, CA, United States
| | - Richard J Medford
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Charina M Ramirez
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX, United States
| | - Clifford N Chen
- Division of Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX, United States
| |
Collapse
|
19
|
Hagström J, Blease C, Haage B, Scandurra I, Hansson S, Hägglund M. Use and Experiences of Online Access to Electronic Health Records for Parents, Children, and Adolescents: Protocol for a Scoping Review (Preprint). JMIR Res Protoc 2022; 11:e36158. [PMID: 35704386 PMCID: PMC9244655 DOI: 10.2196/36158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/10/2022] [Accepted: 05/29/2022] [Indexed: 12/17/2022] Open
Abstract
Background As patient online access to electronic health records becomes the standard, implementation of access for adolescents and parents varies across providers, regions, and countries. There is currently no international compilation of evidence to guide policy decisions in matters such as age limit for access and the extent of parent proxy access. Objective This paper presents the protocol for a scoping review of different stakeholders’ (including but not limited to end users) perspectives on use, opinions, and experiences pertaining to online access to electronic health records by parents, children, and adolescents. Methods This scoping review will be conducted according to the Arksey and O’Malley framework. Several databases will be used to conduct a literature search (PubMed, CINAHL, and PsycInfo), in addition to literature found outside of these databases. All authors will participate in screening identified papers, following the research question: How do different stakeholders experience parents’, children’s, and adolescents’ online access to the electronic health records of children and adolescents? Data abstraction will include but will not be limited to publication type, publication year, country, sample characteristics, setting, study aim, research question, and conclusions. The data to be analyzed are from publicly available secondary sources, so this study does not require an ethics review. Results The results from this scoping review will be presented in a narrative form, and additional data on study characteristics will be presented in diagrams or tabular format. This scoping review protocol was first initiated by Uppsala University in June 2021 as part of the NordForsk-funded research project NORDeHEALTH. The results are expected to be presented in a scoping review in June 2022. The results will be disseminated through stakeholder meetings, scientific conference presentations, oral presentations to the public, and publication in a peer-reviewed journal. Conclusions This is, to our knowledge, the first study to map the literature on the use and experiences of parents’ and adolescents’ online access to the electronic health records of children and adolescents. The findings will describe what benefits and risks have been experienced by different stakeholders so far in different countries. A mapping of studies could inform the design and implementation of future regulations around access to patient-accessible electronic health records. International Registered Report Identifier (IRRID) DERR1-10.2196/36158
Collapse
Affiliation(s)
- Josefin Hagström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Barbara Haage
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | | | - Scharlett Hansson
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
20
|
Kernebeck S, Busse TS, Jux C, Bork U, Ehlers JP. Electronic Medical Records for (Visceral) Medicine: An Overview of the Current Status and Prospects. Visc Med 2022; 37:476-481. [PMID: 35087897 DOI: 10.1159/000519254] [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: 04/19/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background Electronic medical records (EMRs) offer key advantages over analog documentation in healthcare. In addition to providing details about current and past treatments, EMRs enable clear and traceable documentation regardless of the location. This supports evidence-based, multi-professional treatment and leads to more efficient healthcare. However, there are still several challenges regarding the use of EMRs. Understanding these challenges is essential to improve healthcare. The aim of this article is to provide an overview of the current state of EMRs in the field of visceral medicine, to describe the future prospects in this field, and to highlight some of the challenges that need to be faced. Summary The benefits of EMRs are manifold and particularly pronounced in the area of quality assurance and improvement of communication not only between different healthcare professionals but also between physicians and patients. Besides the danger of medical errors, the health consequences for the users (cognitive load) arise from poor usability or a system that does not fit into the real world. Involving users in the development of EMRs in the sense of participatory design can be helpful here. The use of EMRs in practice together with patients should be accompanied by training to ensure optimal outcomes in terms of shared decision-making. Key Message EMRs offer a variety of benefits. However, it is critical to consider user involvement, setting specificity, and user training during development, implementation, and use in order to minimize unintended consequences.
Collapse
Affiliation(s)
- Sven Kernebeck
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Theresa Sophie Busse
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Chantal Jux
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Ulrich Bork
- Department of Gastrointestinal-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden, Germany
| | - Jan P Ehlers
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
21
|
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]
|
22
|
Schwarz J, Bärkås A, Blease C, Collins L, Hägglund M, Markham S, Hochwarter S. Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review. JMIR Ment Health 2021; 8:e34170. [PMID: 34904956 PMCID: PMC8715358 DOI: 10.2196/34170] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)-often referred to as open notes-have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. OBJECTIVE This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders' perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. METHODS A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. RESULTS Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members' mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. CONCLUSIONS PAEHRs in MHC may strengthen user involvement, patients' autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention.
Collapse
Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Annika Bärkås
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Lorna Collins
- Social Science Research Unit, University College London, London, United Kingdom
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sarah Markham
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Stefan Hochwarter
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
23
|
Notes at your fingertips: Open note considerations regarding pediatric and adolescent care. Curr Probl Pediatr Adolesc Health Care 2021; 51:101102. [PMID: 34794891 DOI: 10.1016/j.cppeds.2021.101102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The clinician's note serves an increasing number of audiences, the most recent addition being the patient and, in the case of pediatrics, the parent/guardian. The early work of the OpenNotes initiative followed by the recently enacted 21st Century Cures Act Information Blocking Rule has mandated easy and timely electronic access to notes involving their clinical care. While many benefits have already been described and most drawbacks unrealized, the care of pediatric and adolescent patients brings unique challenges to enable this functionality while preserving patient, parent, and family confidentiality. Given statewide variability in affording these protections, there remains a technological gap in uniformly assisting clinicians to do the right thing while remaining compliant with the law. More research is needed on the impact and new workflow considerations for using an open notes approach across care settings and within academic institutions. Additional education and training are needed to adapt note writing to accommodate patient understanding and encourage patient engagement while conveying the complexity of medical decision making. As transparency and shared medical decision-making become more prevalent within medicine, clinicians' communication and documentation styles need to evolve to meet that challenge.
Collapse
|
24
|
The 21st Century Cures Act and Emergency Medicine - Part 1: Digitally Sharing Notes and Results. Ann Emerg Med 2021; 79:7-12. [PMID: 34756447 DOI: 10.1016/j.annemergmed.2021.07.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Indexed: 01/13/2023]
Abstract
Among the provisions of the 21st Century Cures Act is the mandate for digital sharing of clinician notes and test results through the patient portal of the clinician's electronic health record system. Although there is considerable evidence of the benefit to clinic patients from open notes and minimal apparent additional burden to primary care clinicians, emergency department (ED) note sharing has not been studied. With easier access to notes and results, ED patients may have an enhanced understanding of their visit, findings, and clinician's medical decisionmaking, which may improve adherence to recommendations. Patients may also seek clarifications and request edits to their notes. EDs can develop workflows to address patient concerns without placing new undue burden on clinicians, helping to realize the benefits of sharing notes and test results digitally.
Collapse
|
25
|
Rahimian M, Warner JL, Salmi L, Rosenbloom ST, Davis RB, Joyce RM. Open notes sounds great, but will a provider's documentation change? An exploratory study of the effect of open notes on oncology documentation. JAMIA Open 2021; 4:ooab051. [PMID: 34661067 PMCID: PMC8518311 DOI: 10.1093/jamiaopen/ooab051] [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: 03/02/2021] [Revised: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The effects of shared clinical notes on patients, care partners, and clinicians ("open notes") were first studied as a demonstration project in 2010. Since then, multiple studies have shown clinicians agree shared progress notes are beneficial to patients, and patients and care partners report benefits from reading notes. To determine if implementing open notes at a hematology/oncology practice changed providers' documentation style, we assessed the length and readability of clinicians' notes before and after open notes implementation at an academic medical center in Boston, MA, USA. Materials and Methods We analyzed 143 888 notes from 60 hematology/oncology clinicians before and after the open notes debut at Beth Israel Deaconess Medical Center, from January 1, 2012 to September 1, 2016. We measured the providers' (medical doctor/nurse practitioner) documentation styles by analyzing character length, the number of addenda, note entry mode (dictated vs typed), and note readability. Measurements used 5 different readability formulas and were assessed on notes written before and after the introduction of open notes on November 25, 2013. Results After the introduction of open notes, the mean length of progress notes increased from 6174 characters to 6648 characters (P < .001), and the mean character length of the "assessment and plan" (A&P) increased from 1435 characters to 1597 characters (P < .001). The Average Grade Level Readability of progress notes decreased from 11.50 to 11.33, and overall readability improved by 0.17 (P = .01). There were no statistically significant changes in the length or readability of "Initial Notes" or Letters, inter-doctor communication, nor in the modality of the recording of any kind of note. Conclusions After the implementation of open notes, progress notes and A&P sections became both longer and easier to read. This suggests clinician documenters may be responding to the perceived pressures of a transparent medical records environment.
Collapse
Affiliation(s)
- Maryam Rahimian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy L Warner
- Department of General Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Liz Salmi
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - S Trent Rosenbloom
- Department of General Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Roger B Davis
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robin M Joyce
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
26
|
Adanijo A, McWilliams C, Wykes T, Jilka S. Investigating Mental Health Service User Opinions on Clinical Data Sharing: Qualitative Focus Group Study. JMIR Ment Health 2021; 8:e30596. [PMID: 34477558 PMCID: PMC8449295 DOI: 10.2196/30596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Sharing patient data can help drive scientific advances and improve patient care, but service users are concerned about how their data are used. When the National Health Service proposes to scrape general practitioner records, it is very important that we understand these concerns in some depth. OBJECTIVE This study aims to investigate views of mental health service users on acceptable data sharing to provide clear recommendations for future data sharing systems. METHODS A total of 4 focus groups with 4 member-checking groups were conducted via the internet between October 2020 and March 2021, with a total of 22 service users in the United Kingdom. Thematic analysis was used to identify the themes. RESULTS Six main themes, with several subthemes were identified, such as the purpose of data sharing-for profit, public good, and continuation of care; discrimination through the misattribution of physical symptoms to mental health conditions (ie, diagnostic overshadowing) alongside the discrimination of individuals or groups within society (ie, institutional discrimination); safeguarding data by preserving anonymity and confidentiality, strengthening security measures, and holding organizations accountable; data accuracy and informed consent-increasing transparency about data use and choice; and incorporating service user involvement in system governance to provide insight and increase security. CONCLUSIONS This study extends the limited research on the views and concerns of mental health service users regarding acceptable data sharing. If adopted, the recommendations should improve the confidence of service users in sharing their data. The five recommendations include screening to ensure that data sharing benefits the public, providing service users with information about how their data are shared and what for, highlighting the existing safeguarding procedures, incorporating service user involvement, and developing tailored training for health care professionals to address issues of diagnostic overshadowing and inaccurate health records. Adopting such systems would aid in data sharing for legitimate interests that will benefit patients and the National Health Service.
Collapse
Affiliation(s)
- Abimbola Adanijo
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Caoimhe McWilliams
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sagar Jilka
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
27
|
Fitzsimons M, Power K, McCrea Z, Kiersey R, White M, Dunleavy B, O'Donoghue S, Lambert V, Delanty N, Doherty CP. Democratizing epilepsy care: Utility and usability of an electronic patient portal. Epilepsy Behav 2021; 122:108197. [PMID: 34273742 DOI: 10.1016/j.yebeh.2021.108197] [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: 05/24/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Electronic patient portals (ePortals) can facilitate greater healthcare democratization by providing patients and/or their authorized care partners with secure access to their medical records when and where needed. Such democratization can promote effective healthcare provider-patient partnerships, shared decision-making, and greater patient engagement in managing their health condition. This study examined the usefulness of providing individualized services and care in epilepsy (PiSCES), an epilepsy ePortal, as an enabler of more democratized epilepsy care. METHODS Seventy-two individuals with epilepsy and 18 care partners were invited to report on their experience of interacting via PiSCES with clinical documents (epilepsy care summary record; epilepsy clinic letters) authored about them by healthcare providers. The OpenNotes reporting tool was adapted to capture participant experience. RESULTS Twenty-five percent of invited patients and 44% of invited care partners reported on interacting with their epilepsy care summary; 14% of patients and 67% of care partners invited reported on their epilepsy clinic letters. Participant testimonials illustrate the value of PiSCES in: promoting autonomy, aiding memory, developing the knowledgeable patient, and enhancing healthcare partnerships. Ninety-six percent and 100% of respondents, respectively, reported understanding their epilepsy care summary and epilepsy clinic letter; 77% said the summary described their epilepsy history to date; 96% indicated that the letter provided an accurate description of their clinical encounter; 92% and 96%, respectively, valued access to their summary record and clinic letters; 77% of summary record and 73% clinic letter respondents reported learning something about their epilepsy or the healthcare service via PiSCES. Illustrating their potential patient and care partner safety role, 42% respondents identified inaccuracies in their clinical documents which were subsequently resolved by a clinician. SIGNIFICANCE In the post-digital world highly customized on-demand products and services have come to be expected. Similarly, in epilepsy care, technologies such as PiSCES can enable more personalized, transparent, and engaging services.
Collapse
Affiliation(s)
- Mary Fitzsimons
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Kevin Power
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zita McCrea
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rachel Kiersey
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maire White
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Brendan Dunleavy
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Sean O'Donoghue
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Norman Delanty
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Colin P Doherty
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, St. James's Hospital, Dublin, Ireland; Academic Unit of Neurology, Trinity College Dublin
| |
Collapse
|
28
|
Dymek C, Kim B, Melton GB, Payne TH, Singh H, Hsiao CJ. Building the evidence-base to reduce electronic health record-related clinician burden. J Am Med Inform Assoc 2021; 28:1057-1061. [PMID: 33340326 DOI: 10.1093/jamia/ocaa238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022] Open
Abstract
Clinicians face competing pressures of being clinically productive while using imperfect electronic health record (EHR) systems and maximizing face-to-face time with patients. EHR use is increasingly associated with clinician burnout and underscores the need for interventions to improve clinicians' experiences. With an aim of addressing this need, we share evidence-based informatics approaches, pragmatic next steps, and future research directions to improve 3 of the highest contributors to EHR burden: (1) documentation, (2) chart review, and (3) inbox tasks. These approaches leverage speech recognition technologies, natural language processing, artificial intelligence, and redesign of EHR workflow and user interfaces. We also offer a perspective on how EHR vendors, healthcare system leaders, and policymakers all play an integral role while sharing responsibility in helping make evidence-based sociotechnical solutions available and easy to use.
Collapse
Affiliation(s)
- Christine Dymek
- Division of Digital Healthcare Research, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Bryan Kim
- Healthcare Delivery and Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Genevieve B Melton
- Department of Surgery and Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas H Payne
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Chun-Ju Hsiao
- Division of Digital Healthcare Research, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| |
Collapse
|
29
|
Vaitiekunas L, Coomer K, Turner C, Brown A, Sabesan S. Medical Oncology Care Plan: a tool for improving the provision of clinical information to patients. Intern Med J 2021; 51:1332-1335. [PMID: 34423549 DOI: 10.1111/imj.15449] [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] [Received: 10/21/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
Improving clinical communication between patient and clinician through the provision of written information empowers patients to make informed decisions, underpinning patient-centred care and leading to greater health outcomes. The Townsville Cancer Centre has formulated a holistic care plan template for each patient as a tool to enhance this communication. Using questionnaire-based and qualitative surveys, understanding of the patient's cancer and perspectives of clinicians were examined. The results demonstrate that patients generally have a firm knowledge base of their disease with the predominant finding being that patients wish to be more informed with written information about their diagnosis and alternatives for treatment. While initially time consuming, completion of care plans had many benefits for clinicians; they prompted them to collect holistic information, engage in discussions to capture patient goals and document details about prognosis, treatment options and management of side-effects. Medical oncology care plans provide a sustainable method to provide clinicians a practical template to gather vital information and encourage patients to participate in the decision-making process for healthcare.
Collapse
Affiliation(s)
- Laurence Vaitiekunas
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Keegan Coomer
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Cassie Turner
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Amy Brown
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sabe Sabesan
- Department of Medical Oncology, The Townsville University Hospital, Townsville, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
30
|
Fogler JM, Ratliff-Schaub K, McGuinn L, Crutchfield P, Schwartz J, Soares N. OpenNotes: Anticipatory Guidance and Ethical Considerations for Pediatric Psychologists in Interprofessional Settings. J Pediatr Psychol 2021; 47:189-194. [PMID: 34383944 DOI: 10.1093/jpepsy/jsab091] [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: 04/13/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The 21st Century Cures Act included an "OpenNotes" mandate to foster transparent communication among patients, families, and clinicians by offering rapid electronic access to clinical notes. This article seeks to address concerns about increased documentation burden, vulnerability to patient complaints, and other unforeseen consequences of patients having near-real-time access to their records. METHODS This topical review explores both extant literature, and case examples from the authors' direct experience, about potential responses/reactions to OpenNotes. RESULTS The ethics of disclosing medical information calls for nuanced approaches: Although too little access can undermine a patient's autonomy and the capacity for truly egalitarian shared decision-making, unfettered access to all medical information has significant potential to harm them. Suggested strategies for mitigating risks in premature disclosure include patient and provider education and "modularizing" sensitive information in notes. CONCLUSION The OpenNotes era has ushered in the possibilities of greater patient and family collaboration in shared decision-making and reduced barriers to documentation sharing. However, it has raised new ethical and clinician documentation considerations. In addition to clinician education, patients and families could benefit from education around the purpose of clinical documentation, how to utilize OpenNotes, and the benefits of engaging in dialogue regarding the content and tone of documentation.
Collapse
Affiliation(s)
- Jason M Fogler
- Boston Children's Hospital and Harvard Medical School, USA
| | - Karen Ratliff-Schaub
- Prisma Health and University of South Carolina School of Medicine Greenville, USA
| | | | | | | | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, USA
| |
Collapse
|
31
|
Abstract
This article reflects on the breadth of digital developments seen in primary care over time, as well as the rapid and significant changes prompted by the COVID-19 crisis. Recent research and experience have shone further light on factors influencing the implementation and usefulness of these approaches, as well as unresolved challenges and unintended consequences. These are considered in relation to not only digital technology and infrastructure, but also wider aspects of health systems, the nature of primary care work and culture, patient characteristics and inequalities, and ethical issues around data privacy, inclusion, empowerment, empathy and trust. Implications for the future direction and sustainability of these approaches are discussed, taking account of novel paradigms, such as artificial intelligence, and the growing capture of primary care data for secondary uses. Decision makers are encouraged to think holistically about where value is most likely to be added, or risks being taken away, when judging which innovations to carry forward. It concludes that, while responding to this public health emergency has created something of a digital 'big bang' for primary care, an incremental, adaptive, patient-centered strategy, focused on augmenting rather than replacing existing services, is likely to prove most fruitful in the longer term.
Collapse
Affiliation(s)
- Claudia Pagliari
- Global eHealth Group, Usher Institute, Edinburgh Global Health Academy & Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
| |
Collapse
|
32
|
Pohontsch NJ, Zimmermann T, Lehmann M, Rustige L, Kurz K, Löwe B, Scherer M. ICD-10-Coding of Medically Unexplained Physical Symptoms and Somatoform Disorders-A Survey With German GPs. Front Med (Lausanne) 2021; 8:598810. [PMID: 33859988 PMCID: PMC8042316 DOI: 10.3389/fmed.2021.598810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background: General practitioners (GPs) are reluctant to use codes that correspond to somatization syndromes. Aim: To quantify GPs' views on coding of medically unexplained physical symptoms (MUPS), somatoform disorders, and associated factors. Design and Setting: Survey with German GPs. Methods: We developed six survey items [response options "does not apply at all (1)"-"does fully apply (6)"], invited a random sample of 12.004 GPs to participate in the self-administered cross-sectional survey and analysed data using descriptive statistics and logistic regression analyses. Results: Response rate was 15.2% with N = 1,731 valid responses (54.3% female). Participants considered themselves familiar with ICD-10 criteria for somatoform disorders (M = 4.52; SD =.036) and considered adequate coding as essential prerequisite for treatment (M = 5.02; SD = 1.21). All other item means were close to the scale mean: preference for symptom or functional codes (M = 3.40; SD = 1.21), consideration of the possibility of stigmatisation (M = 3.30; SD = 1.35) and other disadvantages (M = 3.28; SD = 1.30) and coding only if psychotherapy is intended (M = 3.39; SD = 1.46). Exposure, guideline knowledge, and experience were most strongly associated with GPs' self-reported coding behaviour. Conclusions: Subjective exposure, guideline knowledge, and experience as a GP, but no sociodemographic variable being associated with GPs' subjective coding behaviour could indicate that GPs offer a relatively homogeneous approach to coding and handling of MUPS and somatoform disorders. Strengthening guideline knowledge and implementation, and practise with simulated patients could increase the subjective competence to cope with the challenge that patients with MUPS and somatoform disorders present.
Collapse
Affiliation(s)
- Nadine J. Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Zimmermann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Rustige
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katinka Kurz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
33
|
Turbow S, Hollberg JR, Ali MK. Electronic Health Record Interoperability: How Did We Get Here and How Do We Move Forward? JAMA HEALTH FORUM 2021; 2:e210253. [DOI: 10.1001/jamahealthforum.2021.0253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sara Turbow
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Julie R. Hollberg
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammed K. Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| |
Collapse
|
34
|
Blok AC, Amante DJ, Hogan TP, Sadasivam RS, Shimada SL, Woods S, Nazi KM, Houston TK. Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study. J Gen Intern Med 2021; 36:592-599. [PMID: 33443693 PMCID: PMC7947092 DOI: 10.1007/s11606-020-06304-0] [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: 12/23/2019] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In an effort to foster patient engagement, some healthcare systems provide their patients with open notes, enabling them to access their clinical notes online. In January 2013, the Veterans Health Administration (VA) implemented online access to clinical notes ("VA Notes") through the Blue Button feature of its patient portal. OBJECTIVE To measure the association of online patient access to clinical notes with changes in healthcare utilization and clinician documentation behaviors. DESIGN A retrospective cohort study. PATIENTS Patients accessing My HealtheVet (MHV), the VA's online patient portal, between July 2011 and January 2015. MAIN MEASURES Use of healthcare services (primary care clinic visits and online electronic secure messaging), and characteristics of physician clinical documentation (readability of notes). KEY RESULTS Among 882,575 unique portal users, those who accessed clinical notes (16.2%; N = 122,972) were younger, more racially homogenous (white), and less likely to be financially vulnerable. Compared with non-users, Notes users more frequently used the secure messaging feature on the portal (mean of 2.6 messages (SD 7.0) v. 0.87 messages (SD 3.3) in January-July 2013), but their higher use of secure messaging began prior to VA Notes implementation, and thus was not temporally related to the implementation. When comparing clinic visit rates pre- and post-implementation, Notes users had a small but significant increase in rate of 0.36 primary care clinic visits (2012 v. 2013) compared to portal users who did not view their Notes (p = 0.01). At baseline, the mean reading ease of primary care clinical notes was 53.8 (SD 10.1) and did not improve after implementation of VA Notes. CONCLUSIONS VA Notes users were different than patients with portal access who did not view their notes online, and they had higher rates of healthcare service use prior to and after VA Notes implementation. Opportunities exist to improve clinical note access and readability.
Collapse
Affiliation(s)
- Amanda C Blok
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, USA.
- Systems, Populations and Leadership Department, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Hogan
- Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Medical Center, United States Department of Veterans Affairs, Bedford, MA, USA
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Stephanie L Shimada
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Medical Center, United States Department of Veterans Affairs, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Susan Woods
- Maine Behavioral Healthcare, South Portland, ME, USA
| | - Kim M Nazi
- KMN Consulting Services, Coxsackie, NY, USA
| | - Thomas K Houston
- Learning Health Systems, Department of Medicine, Wake Forest University, Winston-Salem, NC, USA
| |
Collapse
|
35
|
Sarabu C, Lee T, Hogan A, Pageler N. The Value of OpenNotes for Pediatric Patients, Their Families and Impact on the Patient-Physician Relationship. Appl Clin Inform 2021; 12:76-81. [PMID: 33567464 DOI: 10.1055/s-0040-1721781] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND OpenNotes, the sharing of medical notes via a patient portal, has been extensively studied in adults but not in pediatric populations. This has been a contributing factor in the slower adoption of OpenNotes by children's hospitals. The 21st Century Cures Act Final Rule has mandated the sharing of clinical notes electronically to all patients and as health systems prepare to comply, some concerns remain particularly with OpenNotes for pediatric populations. OBJECTIVES After a gradual implementation of OpenNotes at an academic pediatric center, we sought to better understand how pediatric patients and families perceived OpenNotes. This article presents the detailed steps of this informatics-led rollout and patient survey results with a focus on pediatric-specific concerns. METHODS We adapted a previous OpenNotes survey used for adult populations to a pediatric outpatient setting (with parents of children <12 years old). The survey was sent to patients and families via a notification email sent as a standard practice after a clinic visit, in English or Spanish. RESULTS Approximately 7% of patients/families with access to OpenNotes read the note during the study period, and 159 (20%) of those patients responded to the survey. Of the survey respondents, 141 (89%) of patients and families understood their notes; 126 (80%) found the notes always or usually accurate; 24 (15%) contacted their clinicians after reading a note; and 153 (97%) patients/families felt the same or better about their doctor after reading the note. CONCLUSION Although limited by relatively low survey response rate, OpenNotes was well-received by parents of pediatric patients without untoward consequences. The main concerns pediatricians raise about OpenNotes proved to not be issues in the pediatric population. Our results demonstrate clear benefits to adoption of OpenNotes. This provides reassurance that the transition to sharing notes with pediatric patients can be successful and value additive.
Collapse
Affiliation(s)
| | - Tzielan Lee
- Stanford Medicine, Palo Alto, California, United States.,Stanford Children's Health, Palo Alto, California, United States
| | - Adam Hogan
- Stanford Children's Health, Palo Alto, California, United States
| | - Natalie Pageler
- Stanford Medicine, Palo Alto, California, United States.,Stanford Children's Health, Palo Alto, California, United States
| |
Collapse
|
36
|
McCrea Z, Power K, Kiersey R, White M, Breen A, Murphy S, Healy L, Kearney H, Dunleavy B, O'Donoghue S, Lambert V, Delanty N, Doherty C, Fitzsimons M. Coproducing health and well-being in partnership with patients, families, and healthcare providers: A qualitative study exploring the role of an epilepsy patient portal. Epilepsy Behav 2021; 115:107664. [PMID: 33334718 DOI: 10.1016/j.yebeh.2020.107664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coproduced epilepsy care sees people with epilepsy (PwE), their care-proxies, and healthcare providers (HCPs), working together as partners to build strong relationships, improve communication, trust, and share decision-making. Coproduction underpins good quality patient- and family-centered care (PFCC) that is responsive to individual patient needs, preferences, and values. By facilitating information sharing and exchange between partners, electronic patient portals (ePortal) can enable coproduction. This paper explores what HCPs, PwE, and their care-proxies value from their user experience of PiSCES, the Irish epilepsy ePortal. METHODS A purposeful sample of actors involved in the receipt and delivery of epilepsy care and services were recruited via adult epilepsy centers at St James's and Beaumont Hospitals in Dublin. Interactive codesign sessions, surveys, and focus groups were used to elicit perspectives from PwE, care-proxies, and HCPs to understand their perception of how PiSCES could enhance or inhibit the epilepsy care process. RESULTS Results illustrate that participants welcome the role PiSCES can play in: empowering PwE/care-proxies, strengthening confidence in the healthcare system; aiding memory; advancing health literacy, motivating PwE to understand their condition better; acting as a passport of care between different clinical settings; and creating a foundation for stronger coproduction partnerships. PiSCES was generally embraced; however, some HCPs expressed plausible concerns about how clinical implementation might impact their work practices. CONCLUSION "Nothing about me without me" is a core value of the PiSCES initiative, recognizing that people need to be included in the planning of their own treatment and care. Our data show that PwE, their care-proxies, and HCPs value PiSCES potential, particularly in bolstering healthcare partnerships that foster inclusion, confidence, and trust.
Collapse
Affiliation(s)
- Zita McCrea
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kevin Power
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rachel Kiersey
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maire White
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Annette Breen
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Sinead Murphy
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Epilepsy Ireland, 249 Crumlin Rd, Crumlin, Dublin, Ireland
| | - Laura Healy
- Academic Unit of Neurology, St. James's Hospital, Dublin, Ireland
| | - Hugh Kearney
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Brendan Dunleavy
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Sean O'Donoghue
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Norman Delanty
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin Doherty
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; Academic Unit of Neurology, St. James's Hospital, Dublin, Ireland
| | - Mary Fitzsimons
- FutureNeuro SFI Research Centre, For Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
37
|
Chen AT, Swaminathan A. Factors in the Building of Effective Patient-Provider Relationships in the Context of Fibromyalgia. PAIN MEDICINE 2021; 21:138-149. [PMID: 30980668 PMCID: PMC6953340 DOI: 10.1093/pm/pnz054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Fibromyalgia patients face particular challenges in building relationships with health care providers. In this study, we examine, from patients’ perspectives, factors that influence the formation of effective patient–provider relationships. Design This research employed a qualitative approach to analyze data collected from a study that employed semistructured interviews. Methods Multiple methods were used to recruit 23 fibromyalgia patients for interviews. Semistructured interviews were conducted to explore how participants’ information behaviors, including their communication with and relationships to providers, changed over time. The interview data were analyzed using a qualitative analytic method based on interpretative phenomenological analysis and constructivist grounded theory. Results We identified three important factors that influenced the building of effective relationships: patients and providers’ interactions involving information, identifying health care providers that fit patients’ needs, and realizing shared responsibilities. With regard to information, we described three important themes: information gaps, providers as educators/facilitators, and collaborative information behavior. Conclusions Understanding of the key elements of relationship development between patients and providers can be utilized in various ways to improve clinical care. First, the knowledge gained in this study can inform the design of patient education materials that assist patients to identify providers that fit their needs, prepare for consultations, and develop realistic expectations for providers. The findings of this study can also inform the design of resources and tools to enable clinicians to communicate and relate better with their patients.
Collapse
Affiliation(s)
- Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aarti Swaminathan
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
38
|
Benjamins J, Haveman-Nies A, Gunnink M, Goudkuil A, de Vet E. How the Use of a Patient-Accessible Health Record Contributes to Patient-Centered Care: Scoping Review. J Med Internet Res 2021; 23:e17655. [PMID: 33427683 PMCID: PMC7834934 DOI: 10.2196/17655] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/15/2020] [Accepted: 10/28/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Worldwide, patient-centered care is becoming a widely used concept in medical practice, getting more and more attention because of its proven ability to improve quality of care and reduce costs. Although several studies show that patient-accessible electronic health records (PAEHRs) influence certain aspects of patient-centered care, the possible contribution of PAEHR implementation to patient-centered care as a comprehensive concept has not, to our knowledge, been structurally evaluated to date. OBJECTIVE The objective of this study is to review whether and how the use of PAEHRs contributes to patient-centered care both in general and among specific population groups. METHODS We followed PRISMA Extension for Scoping Reviews reporting guidelines. We identified literature in 5 databases, using the terms "patient-accessible medical records," "patient experiences," and "professional experiences" as key concepts. A total of 49 articles were included and analyzed with a charting code list containing 10 elements of patient-centered care. RESULTS Studies were diverse in design, country of origin, functionalities of the investigated PAEHR, and target population. Participants in all studies were adults. Most studies reported positive influence of PAEHR use on patient-centered care; patient accessible health records were appreciated for their opportunity to empower patients, inform patients about their health, and involve patients in their own care. There were mixed results for the extent to which PAEHRs affected the relation between patients and clinicians. Professionals and patients in mental health care held opposing views concerning the impact of transparency, where professionals appeared more worried about potential negative impact of PAEHRs on the patient-clinician relationship. Their worries seemed to be influenced by a reluctant attitude toward patient-centered care. Disadvantaged groups appeared to have less access to and make less use of patient-accessible records than the average population but experienced more benefits than the average population when they actually used PAEHRs. CONCLUSIONS The review indicates that PAEHRs bear the potential to positively contribute to patient-centered care. However, concerns from professionals about the impact of transparency on the patient-clinician relationship as well as the importance of a patient-centered attitude need to be addressed. Potentially significant benefits for disadvantaged groups will be achieved only through easily accessible and user-friendly PAEHRs.
Collapse
Affiliation(s)
- Janine Benjamins
- Icare JGZ, Meppel, Netherlands.,Chairgroup Consumption & Healthy Lifestyles, Wageningen University, Wageningen, Netherlands
| | - Annemien Haveman-Nies
- Chairgroup Consumption & Healthy Lifestyles, Wageningen University, Wageningen, Netherlands.,GGD NOG, Warnsveld, Netherlands
| | | | | | - Emely de Vet
- Chairgroup Consumption & Healthy Lifestyles, Wageningen University, Wageningen, Netherlands
| |
Collapse
|
39
|
van Mens HJT, van Eysden MM, Nienhuis R, van Delden JJM, de Keizer NF, Cornet R. Evaluation of lexical clarification by patients reading their clinical notes: a quasi-experimental interview study. BMC Med Inform Decis Mak 2020; 20:278. [PMID: 33319706 PMCID: PMC7737248 DOI: 10.1186/s12911-020-01286-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Patients benefit from access to their medical records. However, clinical notes and letters are often difficult to comprehend for most lay people. Therefore, functionality was implemented in the patient portal of a Dutch university medical centre (UMC) to clarify medical terms in free-text data. The clarifications consisted of synonyms and definitions from a Dutch medical terminology system. We aimed to evaluate to what extent these lexical clarifications match the information needs of the patients. Secondarily, we evaluated how the clarifications and the functionality could be improved. Methods We invited participants from the patient panel of the UMC to read their own clinical notes. They marked terms they found difficult and rated the ease of these terms. After the functionality was activated, participants rated the clarifications provided by the functionality, and the functionality itself regarding ease and usefulness. Ratings were on a scale from 0 (very difficult) to 100 (very easy). We calculated the median number of terms not understood per participant, the number of terms with a clarification, the overlap between these numbers (coverage), and the precision and recall. Results We included 15 participants from the patient panel. They marked a median of 21 (IQR 19.5–31) terms as difficult in their text files, while only a median of 2 (IQR 1–4) of these terms were clarified by the functionality. The median precision was 6.5% (IQR 2.3–14.25%) and the median recall 8.3% (IQR 4.7–13.5%) per participant. However, participants rated the functionality with median ease of 98 (IQR 93.5–99) and a median usefulness of 79 (IQR 52.5–97). Participants found that many easy terms were unnecessarily clarified, that some clarifications were difficult, and that some clarifications contained mistakes. Conclusions Patients found the functionality easy to use and useful. However, in its current form it only helped patients to understand few terms they did not understand, patients found some clarifications to be difficult, and some to be incorrect. This shows that lexical clarification is feasible even when limited terms are available, but needs further development to fully use its potential.
Collapse
Affiliation(s)
- Hugo J T van Mens
- Department of Medical Informatics, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands. .,Department of Research and Development, ChipSoft B.V., Amsterdam, Netherlands.
| | - Mirte M van Eysden
- Department of Medical Humanities, Julius Center, University Medical Center, Utrecht, Netherlands
| | - Remko Nienhuis
- Department of Research and Development, ChipSoft B.V., Amsterdam, Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center, University Medical Center, Utrecht, Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
40
|
Avdagovska M, Menon D, Stafinski T. Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review. J Med Internet Res 2020; 22:e24568. [PMID: 33289677 PMCID: PMC7755541 DOI: 10.2196/24568] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 01/18/2023] Open
Abstract
Background Despite extensive and continuing research in the area of patient portals, measuring the impact of patient portals remains a convoluted process. Objective This study aims to explore what is known about patient portal evaluations and to provide recommendations for future endeavors. The focus is on mapping the measures used to assess the impact of patient portals on the dimensions of the Quadruple Aim (QA) framework and the Canada Health Infoway’s Benefits Evaluation (BE) framework. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews. A systematic and comprehensive search was conducted using the Ovid platform, and the following databases were searched: Ovid MEDLINE (R) ALL (including epub ahead of print, in-process, and other nonindexed citations), EMBASE, and PsycINFO. CINAHL on the EBSCO platform and Web of Science were searched for studies published between March 2015 and June 2020. A systematic gray literature search was conducted using the Google search engine. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest. Results A total of 96 studies were included for data extraction. The studies were categorized based on the QA dimensions, with strict adherence to the definitions for each dimension. From the patients’ perspective, it was determined that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on the increase in population outreach, decrease in disparities related to access to care services, and improvement in quality of care. From the health care workforce perspective, the evaluations focused on the impact of patients accessing medical records, impact on workflow, impact of bidirectional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decreases in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on health care use. Overall, 77 peer-reviewed studies were mapped on the expanded version of the BE framework. The mapping was performed using subdimensions to create a more precise representation of the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one subdimension. Conclusions The QA and BE frameworks provide guidance in identifying gaps in the current literature by providing a way to show how an impact was assessed. This study highlights the need to appropriately plan how the impact will be assessed and how the findings will be translated into effective adaptations.
Collapse
Affiliation(s)
- Melita Avdagovska
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
41
|
COHEN IGLENN, GERKE SARA, KRAMER DANIELB. Ethical and Legal Implications of Remote Monitoring of Medical Devices. Milbank Q 2020; 98:1257-1289. [PMID: 33078879 PMCID: PMC7772635 DOI: 10.1111/1468-0009.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Policy Points Millions of life-sustaining implantable devices collect and relay massive amounts of digital health data, increasingly by using user-downloaded smartphone applications to facilitate data relay to clinicians via manufacturer servers. Our analysis of health privacy laws indicates that most US patients may have little access to their own digital health data in the United States under the Health Insurance Portability and Accountability Act Privacy Rule, whereas the EU General Data Protection Regulation and the California Consumer Privacy Act grant greater access to device-collected data. Our normative analysis argues for consistently granting patients access to the raw data collected by their implantable devices. CONTEXT Millions of life-sustaining implantable devices collect and relay massive amounts of digital health data, increasingly by using user-downloaded smartphone applications to facilitate data relay to clinicians via manufacturer servers. Whether patients have either legal or normative claims to data collected by these devices, particularly in the raw, granular format beyond that summarized in their medical records, remains incompletely explored. METHODS Using pacemakers and implantable cardioverter-defibrillators (ICDs) as a clinical model, we outline the clinical ecosystem of data collection, relay, retrieval, and documentation. We consider the legal implications of US and European privacy regulations for patient access to either summary or raw device data. Lastly, we evaluate ethical arguments for or against providing patients access to data beyond the summaries presented in medical records. FINDINGS Our analysis of applicable health privacy laws indicates that US patients may have little access to their raw data collected and held by device manufacturers in the United States under the Health Insurance Portability and Accountability Act Privacy Rule, whereas the EU General Data Protection Regulation (GDPR) grants greater access to device-collected data when the processing of personal data falls under the GDPR's territorial scope. The California Consumer Privacy Act, the "little sister" of the GDPR, also grants greater rights to California residents. By contrast, our normative analysis argues for consistently granting patients access to the raw data collected by their implantable devices. Smartphone applications are increasingly involved in the collection, relay, retrieval, and documentation of these data. Therefore, we argue that smartphone user agreements are an emerging but potentially underutilized opportunity for clarifying both legal and ethical claims for device-derived data. CONCLUSIONS Current health privacy legislation incompletely supports patients' normative claims for access to digital health data.
Collapse
Affiliation(s)
- I. GLENN COHEN
- Petrie‐Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law SchoolHarvard University
| | - SARA GERKE
- Petrie‐Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law SchoolHarvard University
| | - DANIEL B. KRAMER
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical CenterHarvard Medical School
| |
Collapse
|
42
|
Kanungo S, Barr J, Crutchfield P, Fealko C, Soares N. Ethical Considerations on Pediatric Genetic Testing Results in Electronic Health Records. Appl Clin Inform 2020; 11:755-763. [PMID: 33176390 DOI: 10.1055/s-0040-1718753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Advances in technology and access to expanded genetic testing have resulted in more children and adolescents receiving genetic testing for diagnostic and prognostic purposes. With increased adoption of the electronic health record (EHR), genetic testing is increasingly resulted in the EHR. However, this leads to challenges in both storage and disclosure of genetic results, particularly when parental results are combined with child genetic results. PRIVACY AND ETHICAL CONSIDERATIONS Accidental disclosure and erroneous documentation of genetic results can occur due to the nature of their presentation in the EHR and documentation processes by clinicians. Genetic information is both sensitive and identifying, and requires a considered approach to both timing and extent of disclosure to families and access to clinicians. METHODS This article uses an interdisciplinary approach to explore ethical issues surrounding privacy, confidentiality of genetic data, and access to genetic results by health care providers and family members, and provides suggestions in a stakeholder format for best practices on this topic for clinicians and informaticians. Suggestions are made for clinicians on documenting and accessing genetic information in the EHR, and on collaborating with genetics specialists and disclosure of genetic results to families. Additional considerations for families including ethics around results of adolescents and special scenarios for blended families and foster minors are also provided. Finally, administrators and informaticians are provided best practices on both institutional processes and EHR architecture, including security and access control, with emphasis on the minimum necessary paradigm and parent/patient engagement and control of the use and disclosure of data. CONCLUSION The authors hope that these best practices energize specialty societies to craft practice guidelines on genetic information management in the EHR with interdisciplinary input that addresses all stakeholder needs.
Collapse
Affiliation(s)
- Shibani Kanungo
- Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Jayne Barr
- Internal Medicine-Pediatrics, MetroHealth, Cleveland, Ohio, United States
| | - Parker Crutchfield
- Medical Ethics, Humanities, and Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Casey Fealko
- Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Neelkamal Soares
- Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| |
Collapse
|
43
|
Müller J, Ullrich C, Poss-Doering R. Beyond Known Barriers-Assessing Physician Perspectives and Attitudes Toward Introducing Open Health Records in Germany: Qualitative Study. J Particip Med 2020; 12:e19093. [PMID: 33155984 PMCID: PMC7679209 DOI: 10.2196/19093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/05/2020] [Accepted: 10/16/2020] [Indexed: 01/30/2023] Open
Abstract
Background Giving patients access to their medical records (ie, open health records) can support doctor-patient communication and patient-centered care and can improve quality of care, patients’ health literacy, self-care, and treatment adherence. In Germany, patients are entitled by law to have access to their medical records. However, in practice doing so remains an exception in Germany. So far, research has been focused on organizational implementation barriers. Little is known about physicians’ attitudes and perspectives toward opening records in German primary care. Objective This qualitative study aims to provide a better understanding of physicians’ attitudes toward opening records in primary care in Germany. To expand the knowledge base that future implementation programs could draw from, this study focuses on professional self-conception as an influencing factor regarding the approval for open health records. Perspectives of practicing primary care physicians and advanced medical students were explored. Methods Data were collected through semistructured guide-based interviews with general practitioners (GPs) and advanced medical students. Participants were asked to share their perspectives on open health records in German general practices, as well as perceived implications, their expectations for future medical records, and the conditions for a potential implementation. Data were pseudonymized, audiotaped, and transcribed verbatim. Themes and subthemes were identified through thematic analysis. Results Barriers and potential advantages were reported by 7 GPs and 7 medical students (N=14). The following barriers were identified: (1) data security, (2) increased workload, (3) costs, (4) the patients’ limited capabilities, and (5) the physicians’ concerns. The following advantages were reported: (1) patient education and empowerment, (2) positive impact on the practice, and (3) improved quality of care. GPs’ professional self-conception influenced their approval for open records: GPs considered their aspiration for professional autonomy and freedom from external control to be threatened and their knowledge-based support of patients to be obstructed by open records. Medical students emphasized the chance to achieve shared decision making through open records and expected the implementation to be realistic in the near future. GPs were more hesitant and voiced a strong resistance toward sharing notes on perceptions that go beyond clinical data. Reliable technical conditions, the participants’ consent, and a joint development of the implementation project to meet the GPs’ interests were requested. Conclusions Open health record concepts can be seen as a chance to increase transparency in health care. For a potential future implementation in Germany, thorough consideration regarding the compatibility of GPs’ professional values would be warranted. However, the medical students’ positive attitude provides an optimistic perspective. Further research and a broad support from decision makers would be crucial to establish open records in Germany.
Collapse
Affiliation(s)
- Julia Müller
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
44
|
Parsons CR, Hron JD, Bourgeois FC. Preserving privacy for pediatric patients and families: use of confidential note types in pediatric ambulatory care. J Am Med Inform Assoc 2020; 27:1705-1710. [PMID: 32989446 DOI: 10.1093/jamia/ocaa202] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study evaluates and characterizes the use of a confidential clinic note type as part of the implementation of open notes at a free-standing children's hospital. We describe how this electronic health record feature which disables patient and family access to selected notes in the patient portal is used across our institution, which clinicians are using this feature, and the type of data our clinicians consider confidential. MATERIALS AND METHODS Through retrospective chart review, we have evaluated the use of a confidential note type over a 1-year period. RESULTS We identified 402 964 clinic notes created during a 1-year period, of which 9346 (2.3%) were flagged as confidential. Use of this confidential note type was associated with female patient sex and increase in patient age. It was used most frequently by a small subset of providers. 922 (83.8%) of 1100 notes manually reviewed contained sensitive information. Reasons for confidential notes varied, but patient's mental health was most commonly identified. DISCUSSION Our data demonstrate variability in the use of a confidential note type across specialties, patient ages, and types of confidential information. This note type is frequently utilized by a subset of providers who often manage sensitive patient and parent information. As vendors and institutions enable open notes, thoughtful implementation and provider education surrounding the use of this confidential feature is needed. CONCLUSION A confidential clinic note feature is an integral aspect of pediatric open notes implementation. This feature supports protection of confidential information pertaining to our patients and their caregivers.
Collapse
Affiliation(s)
- Chase R Parsons
- Boston Children's Hospital, Division of General Pediatrics Boston, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan D Hron
- Boston Children's Hospital, Division of General Pediatrics Boston, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Fabienne C Bourgeois
- Boston Children's Hospital, Division of General Pediatrics Boston, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
45
|
Blease CR, Walker J, Torous J, O'Neill S. Sharing Clinical Notes in Psychotherapy: A New Tool to Strengthen Patient Autonomy. Front Psychiatry 2020; 11:527872. [PMID: 33192647 PMCID: PMC7655789 DOI: 10.3389/fpsyt.2020.527872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/22/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Charlotte R. Blease
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Jan Walker
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Stephen O'Neill
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
46
|
Rexhepi H, Moll J, Huvila I. Online electronic healthcare records: Comparing the views of cancer patients and others. Health Informatics J 2020; 26:2915-2929. [DOI: 10.1177/1460458220944727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study investigates differences in attitudes towards, and experiences with, online electronic health records between cancer patients and patients with other conditions, highlighting what is characteristic to cancer patients. A national patient survey on online access to electronic health records was conducted, where cancer patients were compared with all other respondents. Overall, 2587 patients completed the survey (response rate 0.61%). A total of 347 respondents (13.4%) indicated that they suffered from cancer. Results showed that cancer patients are less likely than other patients to use online electronic health records due to general interest (p < 0.001), but more likely for getting an overview of their health history (p = 0.001) and to prepare for visits (p < 0.001). Moreover, cancer patients rate benefits of accessing their electronic health records online higher than other patients and see larger positive effects regarding improved communication with and involvement in healthcare.
Collapse
Affiliation(s)
| | - Jonas Moll
- Örebro University School of Business, Sweden
| | | |
Collapse
|
47
|
Blease CR, Delbanco T, Torous J, Ponten M, DesRoches CM, Hagglund M, Walker J, Kirsch I. Sharing clinical notes, and placebo and nocebo effects: Can documentation affect patient health? J Health Psychol 2020; 27:135-146. [PMID: 32772861 DOI: 10.1177/1359105320948588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This paper connects findings from the field of placebo studies with research into patients' interactions with their clinician's visit notes, housed in their electronic health records. We propose specific hypotheses about how features of clinicians' written notes might trigger mechanisms of placebo and nocebo effects to elicit positive or adverse health effects among patients. Bridging placebo studies with (a) survey data assaying patient and clinician experiences with portals and (b) randomized controlled trials provides preliminary support for our hypotheses. We conclude with actionable proposals for testing our understanding of the health effects of access to visit notes.
Collapse
Affiliation(s)
| | - Tom Delbanco
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Catherine M DesRoches
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Maria Hagglund
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Uppsala University, Uppsala, Sweden
| | - Jan Walker
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
48
|
Power K, McCrea Z, White M, Breen A, Dunleavy B, O'Donoghue S, Jacquemard T, Lambert V, El-Naggar H, Delanty N, Doherty C, Fitzsimons M. The development of an epilepsy electronic patient portal: Facilitating both patient empowerment and remote clinician-patient interaction in a post-COVID-19 world. Epilepsia 2020; 61:1894-1905. [PMID: 32668026 PMCID: PMC7404863 DOI: 10.1111/epi.16627] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/15/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
Objectives The current coronavirus disease 2019 (COVID‐19) pandemic stresses an urgency to accelerate much‐needed health service reform. Rapid and courageous changes being made to address the immediate impact of the pandemic are demonstrating that the means and technology to enable new models of health care exist. For example, innovations such as electronic patient portals (ePortal) can facilitate (a) radical reform of outpatient care; (b) cost containment in the economically constrained aftermath of the pandemic; (c) environmental sustainability by reduction of unnecessary journeys/transport. Herein, the development of Providing Individualised Services and Care in Epilepsy (PiSCES), an ePortal to the Irish National Epilepsy Electronic Patient Record, is demonstrated. This project, which pre‐dates the COVID‐19 crisis, aims to facilitate better patient‐ and family‐centered epilepsy care. Methods A combination of ethnographic research, document analysis, and joint application design sessions was used to elicit PiSCES requirements. From these, a specification of desired modules of functionality was established and guided the software development. Results PiSCES functional features include “My Epilepsy Care Summary,” “My Epilepsy Care Goals,” “My Epilepsy Clinic Letters,” “Help Us Measure Your Progress,” “Prepare For Your Clinic Visit,” “Information for Your Healthcare Provider.” The system provides people with epilepsy access to, and engages them as co‐authors of, their own medical record. It can promote improved patient‐clinician partnerships and facilitate patient self‐management. Significance In the aftermath of COVID‐19, it is highly unlikely that the healthcare sector will return to a “business as usual” way of delivering services. The pandemic is expected to accelerate adoption of innovations like PiSCES. It is therefore a catalyst for change that will deliver care that is more responsive to individual patient needs and preferences.
Collapse
Affiliation(s)
- Kevin Power
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zita McCrea
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maire White
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Annette Breen
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Tim Jacquemard
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Hany El-Naggar
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Norman Delanty
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin Doherty
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, St. James's Hospital, Dublin, Ireland
| | - Mary Fitzsimons
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
49
|
Leach D, Vivekanantham K, Kwong A, Aldridge ES, Buntine PG. Improving the patient experience in the Emergency Department Short Stay Unit. Australas Emerg Care 2020; 23:265-271. [PMID: 32763103 DOI: 10.1016/j.auec.2020.07.004] [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] [Received: 02/05/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To explore whether giving patients admitted to the Short Stay Unit (SSU) in the Emergency Department (ED) their medical notes improved patient understanding of key information. METHODS A two armed non-blinded randomised controlled trial was performed, with patients enrolled on admission to the SSU from the ED. The intervention was provision of a copy of the patient's medical notes both on admission to SSU and on discharge, together with a plain English statement about their medical condition and a detailed care plan. Control patients were provided with standard care (verbal information). Patients were surveyed in SSU and followed up two weeks post discharge via telephone interview. Treating clinicians, in both the ED and SSU, were surveyed to establish acceptability of the intervention. RESULTS Two hundred patients were enrolled, with 176 completing the study. The intervention group found the information provided more helpful (p=0.048) and understood their condition and treatment plan better than the control group (p=0.034). All other data points, despite a positive trend towards the intervention, were statistically insignificant. CONCLUSIONS This study suggests that this simple intervention may positively contribute to the patient experience, with no discernible negative effect on the overall delivery of safe and efficient healthcare.
Collapse
Affiliation(s)
- Deb Leach
- Eastern Health, Australia; Monash University, Australia
| | | | | | | | - Paul G Buntine
- Eastern Health, Australia; Box Hill Hospital, Eastern Health, Australia; Monash University, Australia
| |
Collapse
|
50
|
|