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Dang P, Chavez A, Pham C, Tipton M, Woodard LD, Adepoju OE. Proxy use of patient portals on behalf of children: Federally Qualified Health Centers as a case study. Digit Health 2024; 10:20552076231224073. [PMID: 38205036 PMCID: PMC10777763 DOI: 10.1177/20552076231224073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Objective This study examined the proxy use of patient portals for children in a large Federally Qualified Health Centers (FQHC) network in Texas. Methods We used de-identified individual-level data of patients, 0-18 years, who had 1+ visits between December 2018 and November 2020. Logistic regression was used to examine patient-, clinic-, and geographic-level factors associated with portal usage by an assumed proxy (i.e. parent or guardian). Results The proxy portal usage rate increased from 28% in the pre-pandemic months (November 2018-February 2020) to 34% in the pandemic months (March-Nov 2020). Compared to patients 0-5 years, patients aged 6 to 18 years had lower odds of portal usage (6-10 OR: 0.77, p < 0.001; 11-14 OR: 0.62, p < 0.001; 15-18 OR: 0.51, p < 0.001). Minoritized groups had significantly lower odds of portal usage when compared to their non-Hispanic White counterparts (non-Hispanic Black OR: 0.78, p < 0.001; Hispanic OR 0.63, p < 0.001; Asian OR: 0.69, p < 0.001). Having one chronic condition was associated with portal usage (OR: 1.57, p < 0.001); however, there were no significant differences in portal usage between those with none or multiple chronic conditions. Portal usage also varied by service lines, with obstetrics and gynecology (OR: 1.84, p < 0.001) and behavioral health (OR 1.82, p < 0.001) having the highest odds of usage when compared to pediatrics. Having a telemedicine visit was the strongest predictor of portal usage (OR: 2.30, p < 0.001), while residence in zip codes with poor broadband internet access was associated with lower odds of portal usage (OR: 0.97, p < 0.001). Conclusion While others have reported portal usage rates as high as 64% in pediatric settings, our analysis suggests proxy portal usage rates of 30% in pediatric FQHC settings, with race/ethnicity, age group, and chronic disease status being significant drivers of portal non-usage. These findings highlight the need for appropriate and responsive health information technology approaches for vulnerable populations receiving care in low-resource settings.
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Affiliation(s)
- Patrick Dang
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - Arlette Chavez
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - Cecilia Pham
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Mary Tipton
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - LeChauncy D Woodard
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Omolola E Adepoju
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
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Sisk BA, Lin S, Balls-Berry J(JE, Servin AE, Mack JW. Identifying contributors to disparities in patient access of online medical records: examining the role of clinician encouragement. JAMIA Open 2023; 6:ooad049. [PMID: 37425488 PMCID: PMC10325895 DOI: 10.1093/jamiaopen/ooad049] [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: 10/17/2022] [Revised: 04/30/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
Objective The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR). Materials and Methods We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement. Results In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7-14.0), college education or higher (OR, 1.9; 95% CI, 1.4-2.7), history of cancer (OR, 1.5; 95% CI, 1.0-2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7-3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5-0.8, and OR, 0.5; 95% CI, 0.3-0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3-2.3), have college education (OR, 1.5; 95% CI, 1.1-2.0), history of cancer (OR, 1.8; 95% CI, 1.3-2.5), and greater income levels (OR, 1.8-3.6). Discussion Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity. Conclusions Clinicians have an important role to ensure that all patients benefit from online EMR use.
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Affiliation(s)
- Bryan A Sisk
- Corresponding Author: Bryan A. Sisk, MD, Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, 4523 Clayton Avenue, 8005, St. Louis, MO 63110, USA;
| | - Sunny Lin
- General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Argentina E Servin
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts, USA
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3
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Leung T, Agrawal L, Sharman R. The Role of Access Type and Age Group in the Breadth of Use of Patient Portals: Observational Study. J Med Internet Res 2022; 24:e41972. [PMID: 36574284 PMCID: PMC9832356 DOI: 10.2196/41972] [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: 08/16/2022] [Revised: 11/06/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
| | - Lavlin Agrawal
- State University of New York, University at Buffalo, Buffalo, NY, United States
| | - Raj Sharman
- State University of New York, University at Buffalo, Buffalo, NY, United States
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4
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Blease C, DesRoches CM. Open notes in patient care: confining deceptive placebos to the past? JOURNAL OF MEDICAL ETHICS 2022; 48:572-574. [PMID: 34702766 DOI: 10.1136/medethics-2021-107746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Increasing numbers of health organisations are offering some or all of their patients access to the visit notes housed in their electronic health records (so-called 'open notes'). In some countries, including Sweden and the USA, this innovation is advanced with patients using online portals to access their clinical records including the visit summaries written by clinicians. In many countries, patients can legally request copies of their records; however, open notes are different because this innovation offers patients rapid, real-time access via electronic devices. In this brief report, we explore what open notes might mean for placebo use in clinical care. Survey research into patient access to their clinical notes shows that increased transparency enhances patients' understanding about their medications and augments engagement with their care. We reflect on the consequences of access for placebo prescribing, particularly for the common practice of deceptive placebo use, in which patients are not aware they are being offered a placebo. In addition, we explore how open notes might facilitate placebo and nocebo effects among patients. Bridging placebo studies with medical ethics, we identify a range of empirical research gaps that now warrant further study.
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Affiliation(s)
- Charlotte Blease
- General Medicine and Primary Care, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine M DesRoches
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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5
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Schuller BW, Burch C, Casterton T, Crowther C, Fowler J, Stenmark MH. Precision patient education using a "flipped classroom" approach. J Appl Clin Med Phys 2022; 23:e13601. [PMID: 35482549 PMCID: PMC9121034 DOI: 10.1002/acm2.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives To improve patient education delivered over telemedicine by using a “flipped classroom”‐inspired approach. Methods A “flipped classroom” is an education strategy used to engage active learning by sending students home with lecture material and reserving classroom time for collaborative learning. To adapt this approach for use in radiation oncology patient education, three pieces of written education material were created: introduction to radiation oncology, treatment planning scan, and treatment delivery. An automated system was created to deliver precisely timed emails at three time points ahead of appointments. Appointment time was then used for collaborative learning with our staff. As a primary endpoint, email engagement metrics were tracked via the automated system. Secondarily, enrolled patients were surveyed to assess level of understanding (before vs. after intervention), anxiety (before vs. after intervention), and satisfaction. Additionally, email delivery timing, clarity, relevance, and patient support were evaluated. Data analyses test the impact of active learning against our existing education approaches. Results Overall, 77.1% of the emails were opened, and of those, patients accessed 72.2% of the education material. Patients re‐read the education material 4.6 times on average. Active learning increased patient understanding regarding the purpose of the treatment planning scan (p = 0.031) and increased patient understanding of what to expect during daily radiation treatments (p = 0.0078). Patients reported reduced anxiety (p = 0.031) and high scores for satisfaction, timing, clarity, relevance, and overall support. Conclusions Patient engagement with the education material was high, and they continued to access it many times. Active learning enhances patient comprehension of complex treatment information leading to decreased anxiety. Furthermore, this technique can be incorporated into existing telemedicine with basic technology.
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Affiliation(s)
- Bradley W Schuller
- SCL Health, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
| | - Christina Burch
- SCL Health, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
| | | | | | - Jordan Fowler
- SCL Health, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
| | - Matthew H Stenmark
- Kaiser Permanente, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
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6
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Yeung K. The Health Care Sector's Experience of Blockchain: A Cross-disciplinary Investigation of Its Real Transformative Potential. J Med Internet Res 2021; 23:e24109. [PMID: 34932009 PMCID: PMC8726042 DOI: 10.2196/24109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/16/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Academic literature highlights blockchain's potential to transform health care, particularly by seamlessly and securely integrating existing data silos while enabling patients to exercise automated, fine-grained control over access to their electronic health records. However, no serious scholarly attempt has been made to assess how these technologies have in fact been applied to real-world health care contexts. OBJECTIVE The primary aim of this paper is to assess whether blockchain's theoretical potential to deliver transformative benefits to health care is likely to become a reality by undertaking a critical investigation of the health care sector's actual experience of blockchain technologies to date. METHODS This mixed methods study entailed a series of iterative, in-depth, theoretically oriented, desk-based investigations and 2 focus group investigations. It builds on the findings of a companion research study documenting real-world engagement with blockchain technologies in health care. Data were sourced from academic and gray literature from multiple disciplinary perspectives concerned with the configuration, design, and functionality of blockchain technologies. The analysis proceeded in 3 stages. First, it undertook a qualitative investigation of observed patterns of blockchain for health care engagement to identify the application domains, data-sharing problems, and the challenges encountered to date. Second, it critically compared these experiences with claims about blockchain's potential benefits in health care. Third, it developed a theoretical account of challenges that arise in implementing blockchain in health care contexts, thus providing a firmer foundation for appraising its future prospects in health care. RESULTS Health care organizations have actively experimented with blockchain technologies since 2016 and have demonstrated proof of concept for several applications (use cases) primarily concerned with administrative data and to facilitate medical research by enabling algorithmic models to be trained on multiple disparately located sets of patient data in a secure, privacy-preserving manner. However, blockchain technology is yet to be implemented at scale in health care, remaining largely in its infancy. These early experiences have demonstrated blockchain's potential to generate meaningful value to health care by facilitating data sharing between organizations in circumstances where computational trust can overcome a lack of social trust that might otherwise prevent valuable cooperation. Although there are genuine prospects of using blockchain to bring about positive transformations in health care, the successful development of blockchain for health care applications faces a number of very significant, multidimensional, and highly complex challenges. Early experience suggests that blockchain is unlikely to rapidly and radically revolutionize health care. CONCLUSIONS The successful development of blockchain for health care applications faces numerous significant, multidimensional, and complex challenges that will not be easily overcome, suggesting that blockchain technologies are unlikely to revolutionize health care in the near future.
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Affiliation(s)
- Karen Yeung
- Birmingham Law School and School of Computer Science, University of Birmingham, Birmingham, United Kingdom
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7
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Holmgren AJ, Downing NL, Tang M, Sharp C, Longhurst C, Huckman RS. Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use. J Am Med Inform Assoc 2021; 29:453-460. [PMID: 34888680 PMCID: PMC8689796 DOI: 10.1093/jamia/ocab268] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The COVID-19 pandemic changed clinician electronic health record (EHR) work in a multitude of ways. To evaluate how, we measure ambulatory clinician EHR use in the United States throughout the COVID-19 pandemic. Materials and Methods We use EHR meta-data from ambulatory care clinicians in 366 health systems using the Epic EHR system in the United States from December 2019 to December 2020. We used descriptive statistics for clinician EHR use including active-use time across clinical activities, time after-hours, and messages received. Multivariable regression to evaluate total and after-hours EHR work adjusting for daily volume and organizational characteristics, and to evaluate the association between messages and EHR time. Results Clinician time spent in the EHR per day dropped at the onset of the pandemic but had recovered to higher than prepandemic levels by July 2020. Time spent actively working in the EHR after-hours showed similar trends. These differences persisted in multivariable models. In-Basket messages received increased compared with prepandemic levels, with the largest increase coming from messages from patients, which increased to 157% of the prepandemic average. Each additional patient message was associated with a 2.32-min increase in EHR time per day (P < .001). Discussion Clinicians spent more total and after-hours time in the EHR in the latter half of 2020 compared with the prepandemic period. This was partially driven by increased time in Clinical Review and In-Basket messaging. Conclusions Reimbursement models and workflows for the post-COVID era should account for these demands on clinician time that occur outside the traditional visit.
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Affiliation(s)
- A Jay Holmgren
- Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, California, USA
| | - N Lance Downing
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Mitchell Tang
- Harvard University, Cambridge, Massachusetts, USA.,Harvard Business School, Boston, Massachusetts, USA
| | - Christopher Sharp
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Christopher Longhurst
- Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, California, USA
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8
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Barrett SK, Patrie J, Kitts AB, Hanley M, Swanson CM, Vitzthum von Eckstaedt H, Krishnaraj A. Patient-centered Reporting in Radiology: A Single-site Survey Study of Lung Cancer Screening Results. J Thorac Imaging 2021; 36:367-372. [PMID: 34029279 DOI: 10.1097/rti.0000000000000591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess whether patients preferred traditional or patient-friendly radiology reports and, secondarily, whether one reporting style led to a subjective improvement in patients' understanding of their imaging results and next steps in their clinical care. MATERIALS AND METHODS This randomized study included patients who had previously enrolled in an institutional comprehensive lung cancer screening program. Three hundred patients were randomly selected from the program database to receive both traditional and patient-centered radiology reports. Randomization also occurred at both the risk level of the fictitious test results (low, intermediate, or high) and the order in which the reports were read by each participant. Participants completed a survey providing demographic information and indicating which report style was preferred and which report style led to a better understanding of screening results and future options. In addition, each report style was rated (from 1 to 5) for clarity, understandability, attractiveness, and helpfulness. RESULTS A total of 46 responses for report preference data and 41 responses for attribute rating data were obtained. Overall, participants demonstrate a preference for patient-friendly reports (65.2%) over traditional reports (21.7%). On a 5-point scale, average ratings for patient-friendly reports were higher than traditional reports by 1.2 (P<0.001) for clarity, 1.5 (P<0.001) for understandability, 1.5 (P<0.001) for attractiveness, and 1.0 (P<0.001) for helpfulness. CONCLUSION Data suggest that patients prefer patient-friendly reports over traditional reports and find them to be clearer, more comprehensible, more attractive, and more helpful.
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Affiliation(s)
- Spencer K Barrett
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | - James Patrie
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Michael Hanley
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | - Christina M Swanson
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Arun Krishnaraj
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
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9
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Lyles CR, Adler-Milstein J, Thao C, Lisker S, Nouri S, Sarkar U. Alignment of Key Stakeholders' Priorities for Patient-Facing Tools in Digital Health: Mixed Methods Study. J Med Internet Res 2021; 23:e24890. [PMID: 34435966 PMCID: PMC8430871 DOI: 10.2196/24890] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/19/2021] [Accepted: 06/30/2021] [Indexed: 01/16/2023] Open
Abstract
Background There is widespread agreement on the promise of patient-facing digital health tools to transform health care. Yet, few tools are in widespread use or have documented clinical effectiveness. Objective The aim of this study was to gain insight into the gap between the potential of patient-facing digital health tools and real-world uptake. Methods We interviewed and surveyed experts (in total, n=24) across key digital health stakeholder groups—venture capitalists, digital health companies, payers, and health care system providers or leaders—guided by the Consolidated Framework for Implementation Research. Results Our findings revealed that external policy, regulatory demands, internal organizational workflow, and integration needs often take priority over patient needs and patient preferences for digital health tools, which lowers patient acceptance rates. We discovered alignment, across all 4 stakeholder groups, in the desire to engage both patients and frontline health care providers in broader dissemination and evaluation of digital health tools. However, major areas of misalignment between stakeholder groups have stymied the progress of digital health tool uptake—venture capitalists and companies focused on external policy and regulatory demands, while payers and providers focused on internal organizational workflow and integration needs. Conclusions Misalignment of the priorities of digital health companies and their funders with those of providers and payers requires direct attention to improve uptake of patient-facing digital health tools and platforms.
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Affiliation(s)
- Courtney Rees Lyles
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Crishyashi Thao
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sarah Lisker
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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10
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Swoboda CM, DePuccio MJ, Fareed N, McAlearney AS, Walker DM. Patient Portals: Useful for Whom and for What? A Cross-Sectional Analysis of National Survey Data. Appl Clin Inform 2021; 12:573-581. [PMID: 34233367 DOI: 10.1055/s-0041-1731339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Patients who use patient portals may be more engaged and empowered in their care; however, differences in who accesses patient portals remain. The characteristics of who uses patient portals more frequently and who perceives them as useful may also differ, as well as which functions people use. OBJECTIVE We assessed the characteristics of patient portal users to examine who uses them more frequently and who perceives them as useful. In addition, we wanted to see if those who use them more frequently or perceive them to be more useful use different functions or more functions of patient portals. METHODS Pooled cross-sectional data from 2017 to 2018 Health Information National Trends Survey (HINTS) were used. Ordinal regression models were developed to assess frequency of use and perceived usefulness by demographics, and multivariable logistic regression models were used to examine the association between the use of 10 patient portal functions and frequency of use and perceived usefulness of patient portals. RESULTS The odds of using patient portals more frequently were higher among those with Bachelor's degrees, incomes between $35,000 and $75,000, and those with two or more chronic conditions. Respondents with three or more chronic conditions had higher odds of rating patient portals as useful. Those who used their patient portal 10 or more times in the past year had higher odds of using all functions except for viewing test results compared with those who used their patient portal one to two times per year. Those who rated patient portals as "very useful" had higher odds of using seven of the functions compared with those who rated them "not very"/"not at all useful." CONCLUSION It is important to continue to assess usefulness, frequency of use, and overall patient portal function use to identify opportunities to increase patient engagement with patient portals.
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Affiliation(s)
- Christine M Swoboda
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Matthew J DePuccio
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Naleef Fareed
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Daniel M Walker
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
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11
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Elysee G, Yu H, Herrin J, Horwitz LI. Association between 30-day readmission rates and health information technology capabilities in US hospitals. Medicine (Baltimore) 2021; 100:e24755. [PMID: 33663091 PMCID: PMC7909153 DOI: 10.1097/md.0000000000024755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.
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Affiliation(s)
- Gerald Elysee
- Health Information Technology Programs, Benjamin Franklin Institute of Technology, Boston, MA
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven
| | - Jeph Herrin
- Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, New Haven, CT
| | - Leora I. Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, Center for Healthcare Innovation and Delivery Science, New York University Grossman School of Medicine, New York, NY
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Paccoud I, Baumann M, Le Bihan E, Pétré B, Breinbauer M, Böhme P, Chauvel L, Leist AK. Socioeconomic and behavioural factors associated with access to and use of Personal Health Records. BMC Med Inform Decis Mak 2021; 21:18. [PMID: 33435970 PMCID: PMC7805047 DOI: 10.1186/s12911-020-01383-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/25/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Access to and use of digital technology are more common among people of more advantaged socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. METHODS A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. RESULTS A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted models testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. CONCLUSION The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with less advantaged socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity.
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Affiliation(s)
- Ivana Paccoud
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Michèle Baumann
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Etienne Le Bihan
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Benoît Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - Mareike Breinbauer
- Department of General Medicine and Geriatrics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philip Böhme
- Department of Endocrinology, Diabetology and Nutrition, Regional Network LORDIAMN, University Hospital of Nancy, Nancy, France
| | - Louis Chauvel
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Anja K. Leist
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
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13
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El-Toukhy S, Méndez A, Collins S, Pérez-Stable EJ. Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey. J Am Board Fam Med 2020; 33:953-968. [PMID: 33219074 PMCID: PMC7849369 DOI: 10.3122/jabfm.2020.06.190402] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patient access to their medical records through patient portals (PPs) facilitates information exchange and provision of quality health care. Understanding factors that characterize patients with limited access to and use of PPs is needed. METHODS Data were from the 2017-2018 Health Information National Trends Survey 5, Cycles 1 and 2, a nationally representative survey of US adults ≥ 18 years old (n = 6789). Weighted multivariate logistic regressions modeled the associations between patient characteristics and access to, facilitators of use, and use of PPs and their functions. RESULTS Individuals without (vs with) a regular doctor (adjusted odds ratio [aOR], 0.4; CI, 0.3-0.5) or health insurance (aOR, 0.4; CI, 0.2-0.7), those with high school (aOR 0.4; CI, 0.3-0.5) or with vocational/some college (aOR, 0.5; CI, 04.-0.7) education (vs college/postgraduate), or those with limited English proficiency (vs those who speak English very well) (aOR, 0.7; CI, 0.5-0.9) were less likely to report accessing their personal medical records. Women (vs men) were more likely to report accessing their medical records (aOR, 1.5; CI, 1.2-1.8). Similar patterns were found for PPs access and facilitators of use. Less consistent associations emerged between patient characteristics and use of PP functionalities. CONCLUSIONS PP access and use are low. Having a primary care clinician, patient's educational attainment, and being a woman were factors associated with PP access and use, but not race/ethnicity. Once access was achieved, use of PP functionalities was generally uniform across demographic segments. Facilitating PP access and use among all patient populations is warranted.
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Affiliation(s)
- Sherine El-Toukhy
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS).
| | - Alejandra Méndez
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
| | - Shavonne Collins
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
| | - Eliseo J Pérez-Stable
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
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Blease C, Kharko A, Locher C, DesRoches CM, Mandl KD. US primary care in 2029: A Delphi survey on the impact of machine learning. PLoS One 2020; 15:e0239947. [PMID: 33031411 PMCID: PMC7544100 DOI: 10.1371/journal.pone.0239947] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To solicit leading health informaticians' predictions about the impact of AI/ML on primary care in the US in 2029. DESIGN A three-round online modified Delphi poll. PARTICIPANTS Twenty-nine leading health informaticians. METHODS In September 2019, health informatics experts were selected by the research team, and invited to participate the Delphi poll. Participation in each round was anonymous, and panelists were given between 4-8 weeks to respond to each round. In Round 1 open-ended questions solicited forecasts on the impact of AI/ML on: (1) patient care, (2) access to care, (3) the primary care workforce, (4) technological breakthroughs, and (5) the long-future for primary care physicians. Responses were coded to produce itemized statements. In Round 2, participants were invited to rate their agreement with each item along 7-point Likert scales. Responses were analyzed for consensus which was set at a predetermined interquartile range of ≤ 1. In Round 3 items that did not reach consensus were redistributed. RESULTS A total of 16 experts participated in Round 1 (16/29, 55%). Of these experts 13/16 (response rate, 81%), and 13/13 (response rate, 100%), responded to Rounds 2 and 3, respectively. As a result of developments in AI/ML by 2029 experts anticipated workplace changes including incursions into the disintermediation of physician expertise, and increased AI/ML training requirements for medical students. Informaticians also forecast that by 2029 AI/ML will increase diagnostic accuracy especially among those with limited access to experts, minorities and those with rare diseases. Expert panelists also predicted that AI/ML-tools would improve access to expert doctor knowledge. CONCLUSIONS This study presents timely information on informaticians' consensus views about the impact of AI/ML on US primary care in 2029. Preparation for the near-future of primary care will require improved levels of digital health literacy among patients and physicians.
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Affiliation(s)
- Charlotte Blease
- Division of General Medicine, OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Anna Kharko
- Department of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
- Department of Anesthesiology, Boston Children’s Hospital, Boston, MA, United States of America
| | - Catherine M. DesRoches
- Division of General Medicine, OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Kenneth D. Mandl
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, United States of America
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15
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Ganguli I, Orav EJ, Lupo C, Metlay JP, Sequist TD. Patient and Visit Characteristics Associated With Use of Direct Scheduling in Primary Care Practices. JAMA Netw Open 2020; 3:e209637. [PMID: 32852551 PMCID: PMC7453311 DOI: 10.1001/jamanetworkopen.2020.9637] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Medical practices increasingly allow patients to schedule their own visits through online patient portals, yet little is known about who adopts direct scheduling or how this service is used. OBJECTIVE To determine patient and visit characteristics associated with direct scheduling, visit patterns, and potential implications for access and continuity in the primary care setting. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used electronic health record (EHR) data from 17 adult primary care practices in a large academic medical center in the Boston, Massachusetts, area. Participants included patients 18 years or older who were attributed in the EHR to an active primary care physician at 1 of the included primary care practices, were enrolled in the patient portal, and had at least 1 visit to 1 of these practices between March 1, 2018, and March 1, 2019, the period of analysis. Data were analyzed from October 25, 2019, to April 14, 2020. MAIN OUTCOMES AND MEASURES Adoption of direct scheduling, defined as at least 1 use during the study period. Usual scheduling was defined as scheduling with clinic staff by telephone or in person. RESULTS We examined 134 225 completed visits by 62 080 patients (mean [SD] age, 51.1 [16.4] years, 37 793 [60.9%] women) attributed to 140 primary care physicians at 17 primary care practices. A total of 5020 patients (8.1% [95% CI, 7.9%-8.3%]) adopted direct scheduling, with an age range of 18 to 95 years. Compared with nonadopters in the same practices, adopters were younger (adjusted odds ratio [AOR] per additional year, 0.98 [95% CI, 0.98-0.99]) and were more likely to be White (AOR, 1.09 [95% CI, 1.01-1.17]) and commercially insured (AOR vs uninsured, 1.40 [95% CI, 1.11-1.76]) and to have more comorbidities (AOR per additional comorbidity, 1.07 [95% CI, 1.04-1.11]). Compared with usually scheduled visits, directly scheduled visits were more likely to be for general medical examinations (1979 visits [36.7%] vs 26 519 visits [21.9%]; P < .001) and with one's own primary care physician (5267 visits [95.2%] vs 94 634 visits [73.5%]; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that direct scheduling was associated with greater primary care continuity. Early adopters were more likely to be young, White, and commercially insured, and to the extent these differences persist as direct scheduling is used more widely, this service may widen socioeconomic disparities in primary care access.
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Affiliation(s)
- Ishani Ganguli
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - E. John Orav
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Claire Lupo
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joshua P. Metlay
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Thomas D. Sequist
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Mass General Brigham, Boston, Massachusetts
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16
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Adler-Milstein J, Raphael K, Bonner A, Pelton L, Fulmer T. Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey. J Am Med Inform Assoc 2020; 27:1206-1213. [PMID: 32772089 DOI: 10.1093/jamia/ocaa129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/08/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To measure US hospitals' adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers. MATERIALS AND METHODS In an online survey of a national, random sample of 797 US acute-care hospitals in 2018-2019, 479 (60.1%) responded. We calculated nationally representative measures of the percentages of hospitals with EHRs that include structured documentation of the 4Ms and exchange/communications functions. RESULTS Structured EHR documentation of the 4Ms was fully implemented in at least 1 unit in 64.0% of hospitals and across all units in 41.5% of hospitals. Of the 4Ms, structured documentation was the highest for medications (91.3% in at least 1 unit) and the lowest for mentation (70.3% in at least 1 unit). All exchange/communication functions had been implemented in at least 1 unit in 16.2% of facilities and across all units in 7.6% of hospitals. Less than half of the hospitals had an EHR portal for long-term care facilities to access hospital information (45.4% in at least 1 unit), sent information electronically to long-term care facilities (44.6%), and had training for adults/caregivers on the patient portal (32.1%). DISCUSSION Despite significant national investment in EHRs, hospital EHRs do not yet include key documentation, exchange, and communication functions needed to support evidence-based care for the older adults who comprise the majority of the inpatient population. Additional policy efforts are likely needed to promote the expansion of EHR capabilities into these high-value domains. CONCLUSIONS US acute-care hospital EHRs are lacking key functions that support care for older adults.
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Affiliation(s)
- Julia Adler-Milstein
- Department of Medicine & Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, California, USA
| | - Katherine Raphael
- Department of Health Policy, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Terry Fulmer
- John A. Hartford Foundation, New York City, New York, USA
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Ochoa C, Baron-Lee J, Popescu C, Busl KM. Electronic patient portal utilization by neurology patients and association with outcomes. Health Informatics J 2020; 26:2751-2761. [PMID: 32674698 PMCID: PMC9215314 DOI: 10.1177/1460458220938533] [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] [Indexed: 11/16/2022]
Abstract
Existing literature on electronic patient portals demonstrates mixed findings for portal user demographic patterns and relationships between portal usage and clinical outcomes. This study sought to determine characteristics of portal users specific to a neurology patient population and examine whether usage predicted decreased clinic visits and risk of hospitalization. A cross-sectional analysis on 13,483 patients seen at a tertiary neurology outpatient clinic over a 1-year period found significant associations between demographics, and interactions between age, sex, and race. Black and Hispanic patients were less likely to be portal users. While females had higher odds of portal usage overall, their probability decreased with increasing age. Portal users had higher rates of clinic utilization but no difference in hospitalization risk. These results highlight demographics that may need strategic targeting to increase portal uptake and the need for other interventions for populations more likely to experience health events resulting in hospitalization.
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18
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Khoong EC, Rivadeneira NA, Hiatt RA, Sarkar U. The Use of Technology for Communicating With Clinicians or Seeking Health Information in a Multilingual Urban Cohort: Cross-Sectional Survey. J Med Internet Res 2020; 22:e16951. [PMID: 32250280 PMCID: PMC7171563 DOI: 10.2196/16951] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 01/17/2023] Open
Abstract
Background Technology is being increasingly used to communicate health information, but there is limited knowledge on whether these strategies are effective for vulnerable populations, including non–English speaking or low-income individuals. Objective This study assessed how language preferences (eg, English, Spanish, or Chinese), smartphone ownership, and the type of clinic for usual source of care (eg, no usual source of care, nonintegrated safety net, integrated safety net, private or community clinic, academic tertiary medical center, or integrated payer-provider) affect technology use for health-related communication. Methods From May to September 2017, we administered a nonrandom, targeted survey to 1027 English-, Spanish-, and Chinese-speaking San Francisco residents and used weighted multivariable logistic regression analyses to assess predictors of five technology use outcomes. The three primary predictors of interest—language preference, smartphone ownership, and type of clinic for usual care—were adjusted for age, gender, race or ethnicity, limited English proficiency, educational attainment, health literacy, and health status. Three outcomes focused on use of email, SMS text message, or phone apps to communicate with clinicians. The two other outcomes were use of Web-based health videos or online health support groups. Results Nearly one-third of participants watched Web-based health videos (367/1027, 35.74%) or used emails to communicate with their clinician (318/1027, 30.96%). In adjusted analyses, individuals without smartphones had significantly lower odds of texting their clinician (adjusted odds ratio [aOR] 0.27, 95% CI 0.13-0.56), using online health support groups (aOR 0.14, 95% CI 0.04-0.55), or watching Web-based health videos (aOR 0.31, 95% CI 0.15-0.64). Relative to English-speaking survey respondents, individuals who preferred Chinese had lower odds of texting their clinician (aOR 0.25, 95% CI 0.08-0.79), whereas Spanish-speaking survey respondents had lower odds of using apps to communicate with clinicians (aOR 0.34, 95% CI 0.16-0.75) or joining an online support group (aOR 0.30, 95% CI 0.10-0.92). Respondents who received care from a clinic affiliated with the integrated safety net, academic tertiary medical center, or integrated payer-provider systems had higher odds than individuals without a usual source of care at using emails, SMS text messages, or apps to communicate with clinicians. Conclusions In vulnerable populations, smartphone ownership increases the use of many forms of technology for health purposes, but device ownership itself is not sufficient to increase the use of all technologies for communicating with clinicians. Language preference impacts the use of technology for health purposes even after considering English proficiency. Health system factors impact patients’ use of technology-enabled approaches for communicating with clinicians. No single factor was associated with higher odds of using technology for all health purposes; therefore, existing disparities in the use of digital health tools among diverse and vulnerable populations can only be addressed using a multipronged approach.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Natalie A Rivadeneira
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States.,Hellen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
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