Factors Associated with Online Patient Portal Utilization Experience in an Arkansas Phone Survey

Introduction: Accessing electronic health record information through a patient portal is associated with numerous benefits to both health care providers and patients. However, patient portal utilization remains low. Little is known about the factors associated with patient portal utilization following the onset of the COVID-19 pandemic. Methods: In March 2022, we conducted a random digit dial phone survey of both cell phones and landlines of adults living in Arkansas that asked numerous demographic and health-related measures, including patient portal utilization in the past 12 months. A total of 2,201 adult Arkansans completed the survey between March 1 and March 28, 2022. Weighted estimates were generated using rank ratio estimation to approximate the 2019 American Community Survey 1-year Arkansas estimates for race/ethnicity (72% White, 15% Black/African American, 7.8% Hispanic, 4.9% other race/ethnicity), age (73% 18-39, 32% 40-59, and 31% 60+), and gender (49% male, 51% female). We fit the data to a logistic regression model. Results: We found that education, employment, prior telehealth experience, having a check-up in the past 2 years, and having a primary care provider were all positively associated with patient portal utilization. We also found that non-Hispanic Black/African-American respondents were less likely to access a patient portal relative to non-Hispanic White respondents. Discussion: Patient portal utilization is related to several demographic and health-related factors among an adult population in Arkansas. Given that the documented benefits of patient portal utilization are broad, under-utilization by groups that already experience relatively worse health outcomes could reproduce or even exacerbate existing health disparities. Additional research is needed to further investigate what barriers to patient portal utilization remain for these populations.

Racial and Ethnic Differences in the Use of Electronic Medical Record Messaging Among Patients With Breast Cancer: A Quality Improvement Study

INTRODUCTION

Despite evidence that use of electronic medical record (EMR) messaging positively impacts patients with cancer, there is little research on utilization patterns. The objective of this study is to describe the use of EMR messaging among breast cancer patients so that future interventions may be developed and targeted appropriately.

MATERIALS AND METHODS

Sociodemographic and MyChart usage data were collected. Study eligibility included patients who completed a visit at an academic breast center and sent at least one message to a provider during the study period (May 2021-May 2022). Chi-square and t-tests were used to describe differences between users and nonusers of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity.

RESULTS

A total of 4069 patients with activated MyChart accounts were included in the analysis. About 3575 (87.9%) were messaging users and 494 (12.1%) were nonusers. The mean age of users was significantly lower compared to the nonusers (57.7 vs 61.2, P< .001). Compared to non-Hispanic White (NHW) individuals, non-Hispanic Black (NHB) (odds ratio [OR]: 0.38, CI [0.21, 0.37]) and Hispanic individuals (OR: 0.35, CI [0.22, 0.57]) were significantly less likely to use electronic messaging. There were statistically significant racial/ethnic differences in the types of messages sent among EMR users.

CONCLUSION

Our study shows disparate EMR messaging utilization based on age, race, and primary language. As the availability of patient portals and electronic messaging increase, it is important to understand the barriers that patients face so that they can be addressed.

Blockchain-enabled cross-chain collaboration model for elderly health information from a whole process perspective

Due to people having less children and the aging population, the demand for elderly health services is increasing, which leads to an increase in demand for elderly health information. However, there is a gap between elderly medical health information and elderly care information due to different storage institutions and storage methods, which makes it difficult for the medical service industry and the elderly service industry to fully grasp and utilize the health information of the elderly. Therefore, it is difficult to provide whole process services that combine elderly medical health and elderly care. To solve the problem of the poor collaborative utilization of elderly healthcare information, this paper, based on blockchain cross-chain technology and the literature and field research, studies the specific contexts that are needed to realize elderly health information collaboration. Based on the system theory viewpoint, the component-based modular design concept is used to identify the attributes and types of current health information of the elderly from health information related to the five modules of prevention, detection, diagnosis, treatment, and rehabilitation in the process of elderly healthcare. This paper explores the structure, elements, and interactions between the medical health information chains and the elderly care information chains. We build a blockchain-enabled cross-chain collaboration model of elderly health information from the perspective of the whole process with the help of the underlying logic of virtual chain, and to realize the applicability and flexibility of cross-chain collaboration for health information for the elderly in the whole process. The research results show that the proposed cross-chain collaboration model can realize the cross-chain collaboration of health information for the elderly with easy implementation, high throughput, and strong privacy protection.

Electronic Medical Record-Based Electronic Messaging Among Patients with Breast Cancer: A Systematic Review

BACKGROUND

Electronic medical record (EMR) systems and electronic messages are an increasingly common conduit between physicians and patients. Clear benefits of this type of communication have been established, especially among cancer patients. Studies suggest that patient portals and electronic messaging platforms can help with care coordination between oncology providers and facilitate asynchronous patient-provider communication. Despite the many benefits, there is little research regarding EMR and secure messaging use, particularly among patients with breast cancer.

OBJECTIVES

The objective of this systematic review was to examine the evidence supporting the use of EMR-based messaging systems in patients with breast cancer.

METHODS

A systematic literature search of Ovid MEDLINE, PubMed, Scopus, Web of Science CINAHL, and Cochrane Library was conducted. Studies were required to be published between 2005 and 2022 and report data on demographic information and electronic messaging between patients and providers. Studies were excluded if they reported insufficient data, did not include breast cancer patients, or were not published in English.

RESULTS

This study identified 10 articles that met inclusion criteria. The resulting studies investigated topics such as: patterns of messaging and medication adherence, cancer screening, messaging as a predictor of behavior or outcomes, and symptom management. The literature indicates that electronic messaging with providers was associated with clinical benefits for breast cancer patients and improved screening behaviors.

CONCLUSION

This review uncovered multiple areas to focus future research on, including ideal volume of electronic messages sent and their relation to prescription adherence, studies focusing solely on the breast cancer population, racial disparities in electronic messaging, and provider perceptions of electronic messaging. It is vital that more work be done to understand barriers and gaps in EMR usage to ensure that all individuals can access this increasingly essential medical service while minimizing physician workload and burnout.

The Role of Access Type and Age Group in the Breadth of Use of Patient Portals: Observational Study

BACKGROUND

Health care delivery and patient satisfaction are improved when patients engage with their medical information through patient portals. Despite their wide availability and multiple functionalities, patient portals and their functionalities are still underused.

OBJECTIVE

We seek to understand factors that lead to patient engagement through multiple portal functionalities. We provide recommendations that could lead to higher patients' usage of their portals.

METHODS

Using data from the Health Information National Trends Survey 5, Cycle 3 (N=2093), we performed descriptive statistics and used a chi-square test to analyze the association between the demographic variables and the use of mobile health apps for accessing medical records. We further fitted a generalized linear model to examine the association between access type and the use of portal functionalities. We further examined the moderation effects of age groups on the impact of access type on portal usage.

RESULTS

Our results show that accessing personal health records using a mobile health app is positively associated with greater patient usage of access capabilities (β=.52; P<.001), patient-provider interaction capabilities (β=.24, P=.006), and patient-personal health information interaction capabilities (β=.23, P=.009). Patients are more likely to interact with their records and their providers when accessing their electronic medical records using a mobile health app. The impacts of mobile health app usage fade with age for tasks consisting of viewing, downloading, and transmitting medical results to a third party (β=-.43, P=.005), but not for those involving patient-provider interaction (β=.05, P=.76) or patient-personal health information interaction (β=-.15, P=.19).

CONCLUSIONS

These findings provide insights on how to increase engagement with diverse portal functionalities for different age groups and thus improve health care delivery and patient satisfaction.

Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study

Background

Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries.

Objective

With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR).

Methods

A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire.

Results

A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR.

Conclusions

This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.

Oncology patients' perception of physicians who use an integrated electronic health record (EHR) during clinic visits: PRIME-EHR double-blind, randomized controlled trial

BACKGROUND

Patients with cancer prefer and positively perceive physicians who communicate face-to-face without the use of a computer. However, the use of electronic health records (EHRs) in the examination room remains a practical necessity. On the basis of existing literature, the authors developed and tested an integration model, PRIME-EHR, that focuses on the best-practice guidelines. To their knowledge, no randomized controlled trials (RCTs) have been conducted to test the effectiveness of such models.

METHODS

In this double-blind, crossover RCT, 120 eligible patients with cancer were enrolled between April 1, 2019 and February 15, 2020 at The University of Texas MD Anderson Cancer Center. The objectives were to compare patients' perceptions of physicians' skills and their overall preference after they watched 2 standardized, scripted video vignettes of physicians: 1 portraying the use of a standard EHR and the other portraying the use of a PRIME-EHR. Actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. Validated questionnaires to rate physicians' compassion (0 = best, 50 = worst), communication skills (14 = poor, 70 = excellent), and professionalism (4 = poor, 20 = very good) were used.

RESULTS

PRIME-EHR, compared with the standard EHR, resulted in better scores for physician compassion (median score, 5 [interquartile range, 0-10] vs 12 [interquartile range, 4-25]; P = .0009), communication skills (median score, 69 [interquartile range, 63-70] vs 61 [interquartile range, 50-69]; P = .0026), and professionalism (median score, 20 [interquartile range, 18-20] vs 18 [interquartile range, 14-20]; P = .0058). The majority of patients preferred physicians who used PRIME-EHR (n = 70 [77%] vs n = 21 [23%]; P < .0001).

CONCLUSIONS

The PRIME-EHR approach significantly improved patients' perceptions of and preference for the physicians. This integrated model of health care delivery has the potential to improve communication and compassion in cancer care.

A Comparative Analysis of Online Medical Record Utilization and Perception by Cancer Survivorship

BACKGROUND

Cancer survivors face many challenges including coordinating care across multiple providers and maintaining medical records from multiple institutions. Access and utilization of online medical records could help cancer survivors manage this complexity. Here, we examined how cancer survivors differ from those without a history of cancer with regards to utilization and perception of medical records.

METHODS

We conducted a cross-sectional study of 3491 respondents, from the Health Information National Trends survey 5, cycle 2. The association of medical record utilization and perceptions with cancer survivorship was assessed using survey-weighted logistic regression.

RESULTS

Cancer survivors (n=593) were more likely to report that a provider maintains a computerized medical record [adjusted odds ratio (AOR)=2.05; 95% confidence (CI), 1.24-3.41] and were more likely to report confidence in medical record safeguards (AOR=1.44; 95% CI, 1.03-2.03). However, cancer survivors were no more likely to access online medical records than those without a history of cancer (AOR=1.13; 95% CI, 0.69-1.86). Cancer survivors were no more likely to report privacy concerns as a reason for not accessing online medical records, however, survivors were more likely to report a preference for speaking directly with a provider as a reason for not accessing online medical records (AOR=2.24; 95% CI, 0.99-5.05).

CONCLUSIONS

Although cancer survivors are more likely to trust medical record safe guards and do not express increased concerns about online medical record privacy, a preference to speak directly with provider is a barrier of use.

Exploring the topic structure and evolution of associations in information behavior research through co-word analysis

This study aims to reveal the distribution of topics, and the associations among them, in information behavior research from 2009 to 2018. Working with a collection of 6744 publications from the Web of Science database, co-word analysis is used to investigate the overall topic structure, the associations among the topics, and their evolution in different years, which is supplemented by visualization with science maps. The results uncovered an unbalanced distribution of topics, and that the topics cluster into six communities representing subdivisions of this field: information behavior in patient-centered studies; information interaction in the digital environment; information literacy in health and academic contexts; health literacy on the Internet; information behavior in child-centered studies; and information behavior in medical informatics. The findings supplement and provide refinements to work on the state of this field, and help researchers obtain an overview of the past decade to guide their future work.

Information seeking in the context of cigarette smoking: predictors from the Comprehensive Model of Information Seeking (CMIS)

Background: The CMIS indicates that key variables in actively obtaining information on cigarette smoking are demographics, direct experience, salience, and beliefs, which affects subsequent evaluations and utility of information. Method: Cross-sectional data were drawn from the HINTS-FDA 2015 national survey in which a stratified random sample of the U.S. postal addresses (N = 3,738) self-administered a mailed paper questionnaire. Path analysis was conducted to test the CMIS. Results: Age, income, education, sexual orientation, beliefs about behavior change, and salience are significant predictors of perceived utility of information.Direct predictors of information seeking on health effects are comprehension of information (β = .06, 95% CI: .02-.09, p < .05), trust in information sources (β = .23, 95% CI: .18-.276, p < .01), and confidence in obtaining information (β = .10, 95% CI: .047-.160, p < .05). The final model produced fit indices of c² = 356.48, df = 24, CFI = .91, RMSEA = .061 (95% CI: .055-.067), R² = .098. Conclusions: The CMIS is a valid theoretical framework in predicting information seeking on cigarette smoking. This study closes a gap in the literature by addressing key factors simultaneously that influence information seeking on health effects and cessation of cigarette smoking.