Implementing and Using a Patient Portal: A qualitative exploration of patient and provider perspectives on engaging patients

Evaluation of Experiences and Attitudes of Patients Towards Patient Portal-Enabled Access to Their Health Information or Medical Records: A Qualitative Grounded Theory Study

The demand for patient-centred care and patient engagement in their healthcare has driven patient portal introduction. The widespread adoption and use of patient portals, however, has been a rather slow process in the United Kingdom. Hence, a limited number of studies have explored patient perceptions and experiences of general portal use, which forms a foundation for successful implementation of a portal. This study, therefore, focuses on the experiences and attitudes of patients regarding use of patient portals and access to their health information. It further explores various factors perceived by patients that may influence portal use and uptake. The overall findings from this study highlight positive patient perceptions of portal use. Nevertheless, it demonstrates various areas of improvement essential to ensure future success of portal implementation and acceptance.

An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis

BACKGROUND

Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited.

OBJECTIVE

This study aimed to explore the factors associated with portal messaging use by rural patients.

METHODS

We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density.

RESULTS

A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income.

CONCLUSIONS

Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.

The Impact of an Electronic Portal on Patient Encounters in Primary Care: Interrupted Time-Series Analysis

BACKGROUND

Electronic patient portals are online applications that allow patients access to their own health information, a form of asynchronous virtual care. The long-term impact of portals on the use of traditional primary care services is unclear, but it is an important question at this juncture, when portals are being incorporated into many primary care practices.

OBJECTIVE

We sought to investigate how an electronic patient portal affected the use of traditional, synchronous primary care services over a much longer time period than any existing studies and to assess the impact of portal messaging on clinicians' workload.

METHODS

We conducted a propensity-score-matched, open-cohort, interrupted time-series evaluation of a primary care portal from its implementation in 2010. We extracted information from the electronic medical record regarding age, sex, education, income, family health team enrollment, diagnoses at index date, and number of medications prescribed in the previous year. We also extracted the annual number of encounters for up to 8 years before and after the index date and provider time spent on secure messaging through the portal.

RESULTS

A total of 7247 eligible portal patients and 7647 eligible potential controls were identified, with 3696 patients matched one to one. We found that portal registration was associated with an increase in the number of certain traditional encounters over the time period surrounding portal registration. Following the index year, there was a significant jump in annual number of visits to physicians in the portal arm (0.42 more visits/year vs control, P<.001) but not for visits to nurse practitioners and physician assistants. The annual number of calls to the practice triage nurses also showed a greater increase in the portal arm compared to the control arm after the index year (an additional 0.10 calls, P=.006). The average provider time spent on portal-related work was 5.7 minutes per patient per year.

CONCLUSIONS

We found that portal registration was associated with a subsequent increase in the number of some traditional encounters and an increase in clerical workload for providers. Portals have enormous potential to truly engage patients as partners in their own health care, but their impact on use of traditional health care services and clerical burden must also be considered when they are incorporated into primary care.

Perceived barriers and enablers of a personal health record from the healthcare provider perspective

Personal health records (PHRs) have been implemented around the world as a means to increase the safety, quality, and efficiency of health care. The Ministry of National Guard Health Affairs in the Kingdom of Saudi Arabia launched their PHR in 2018. This study aimed to explore healthcare provider (HCP) perspectives of barriers to and enablers of PHR adoption in Saudi Arabia. The 291 participating HCPs (40.5% nurses, 23.0% pharmacists, 17.2% physicians, 15.5% technicians, and 3.8% other) selected the following as top-3 barriers to PHR adoption: 1) lack of patient awareness (19.4%), 2) patient low literacy (17.7%), and 3) patient resistance to new technologies (12.5%). Of these, 36 responded to the open-ended question gauging feedback on the PHR. Three main themes were identified from the comments: 1) general perceptions of the PHR (positive attitudes, negative attitudes, additional features); 2) patient engagement as a requirement for the successful implementation of the PHR; and 3) education/training of HCPs, patients, and caregivers. This analysis extends our understanding of HCP perspectives of barriers and enablers to PHR adoption. Further qualitative research with patients is required to confirm our findings.

The association between information technology sophistication and patient portal use: A cross sectional study in Eastern North Carolina

Even with the extolled benefits of patient portals, there has been some challenges to ensuring patient portal use. This study examines if a patient's level of information technology (IT) sophistication, defined as the degree of use of diverse information technologies by an individual, is associated with their use of a patient portal. Patients previous experience and exposure to other similar technologies like desktop computer, laptop, internet, smart phone, or social media explains their willingness to use information technology for their health. Data on a cross-sectional survey of 565 individuals in Eastern NC was available for analysis. Multinomial regression analyses revealed that IT sophistication is important in determining whether patients will use a patient portal. It specifies that patients with low IT sophistication compared to those with high IT sophistication were more likely to have never activated their patient portals (RRR = 2.2155, p < 0.009), or to have activated but never used a patient portal (RRR = 3.5869, p < 0.010). The findings of this study should aid healthcare leaders as they strive to improve patient engagement. They should continue to promote the benefits of the patient portal and consider offering personalized support programs for patients with low IT sophistication.

Is primary health care ready for artificial intelligence? What do primary health care stakeholders say?

Background

Effective deployment of AI tools in primary health care requires the engagement of practitioners in the development and testing of these tools, and a match between the resulting AI tools and clinical/system needs in primary health care. To set the stage for these developments, we must gain a more in-depth understanding of the views of practitioners and decision-makers about the use of AI in primary health care. The objective of this study was to identify key issues regarding the use of AI tools in primary health care by exploring the views of primary health care and digital health stakeholders.

Methods

This study utilized a descriptive qualitative approach, including thematic data analysis. Fourteen in-depth interviews were conducted with primary health care and digital health stakeholders in Ontario. NVivo software was utilized in the coding of the interviews.

Results

Five main interconnected themes emerged: (1) Mismatch Between Envisioned Uses and Current Reality—denoting the importance of potential applications of AI in primary health care practice, with a recognition of the current reality characterized by a lack of available tools; (2) Mechanics of AI Don’t Matter: Just Another Tool in the Toolbox– reflecting an interest in what value AI tools could bring to practice, rather than concern with the mechanics of the AI tools themselves; (3) AI in Practice: A Double-Edged Sword—the possible benefits of AI use in primary health care contrasted with fundamental concern about the possible threats posed by AI in terms of clinical skills and capacity, mistakes, and loss of control; (4) The Non-Starters: A Guarded Stance Regarding AI Adoption in Primary Health Care—broader concerns centred on the ethical, legal, and social implications of AI use in primary health care; and (5) Necessary Elements: Facilitators of AI in Primary Health Care—elements required to support the uptake of AI tools, including co-creation, availability and use of high quality data, and the need for evaluation.

Conclusion

The use of AI in primary health care may have a positive impact, but many factors need to be considered regarding its implementation. This study may help to inform the development and deployment of AI tools in primary health care.

Revisiting Provider Role in Patient Use of Online Medical Records

OBJECTIVES

 Provider encouragement for patient use of online medical record (OMR) systems is poorly understood. The study examines temporal trends and predictors of provider encouragement and the effects of encouragement on OMR use.

METHODS

 Health Information National Trends Survey administered in 2017 and 2020 were used. Subjects were 18 to 75 years old with access to the Internet or smart devices. From 2017 and 2020, 2,558 and 3,058 subjects were included, respectively.

RESULTS

 In 2020, 52.8% reported receiving provider encouragement within the last year for OMR use compared with 41.3% in 2017 (p < 0.001). For respondents with chronic diseases (such as diabetes, hypertension, heart, or lung diseases [CVMD]), encouragement increased from 45.5 to 57.2% (p < 0.001). Sociodemographic determinants and clinical attributes (e.g., provider office visits, cancer history, or CVMDs) significantly (p < 0.05) predicted encouragement. Among CVMD subjects, gender and visit frequency were significant predictors. OMR use within a year grew recently (73.3% in 2020 vs. 60.6% in 2017, p = 0.002) among CVMD subjects reporting encouragement. Provider encouragement was associated (p < 0.05) with secure communication and viewing results using OMRs controlling for other predictors in the overall cohort and among CVMD subjects.

CONCLUSION

 Many respondents reported not receiving provider encouragement for OMR use. These subjects represent millions of U.S. adults, including those participating during the pandemic, with CVMDs or cancer history. Encouragement rates grew over time and was associated with demographic or disease attributes and with OMR use. Future research should assess the optimality of encouragement. Resources enabling provider encouragement should continue and help prevent disparity in health technology use.

Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease

Background

To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use.

Methods

A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology.

Results

Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use.

Conclusions

We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01689-2.

Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study

BACKGROUND

Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia.

OBJECTIVE

The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption.

METHODS

This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling.

RESULTS

Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (β=.17, P=.03) and attitude (β=.61, P<.01). No moderating effects were present.

CONCLUSIONS

This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors.

Functionalities and Issues in the Implementation of Personal Health Records: Systematic Review

Background

Functionalities of personal health record (PHR) are evolving, and continued discussions about PHR functionalities need to be performed to keep it up-to-date. Technological issues such as nonfunctional requirements should also be discussed in the implementation of PHR.

Objective

This study systematically reviewed the main functionalities and issues in implementing the PHR.

Methods

This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search is performed using the online databases Scopus, ScienceDirect, IEEE, MEDLINE, CINAHL, and PubMed for English journal articles and conference proceedings published between 2015 and 2020.

Results

A total of 105 articles were selected in the review. Seven function categories were identified in this review, which is grouped into basic and advanced functions. Health records and administrative records were grouped into basic functions. Medication management, communication, appointment management, education, and self-health monitoring were grouped into advanced functions. The issues found in this study include interoperability, security and privacy, usability, data quality, and personalization.

Conclusions

In addition to PHR basic and advanced functions, other supporting functionalities may also need to be developed based on the issues identified in this study. This paper provides an integrated PHR architectural model that describes the functional requirements and data sources of PHRs.

The formation of patient trust and its transference to online health services: the case of a Dutch online patient portal for rehabilitation care

Background

Trust is widely recognized as a crucial factor in successful physician–patient communication and patient engagement in treatment. However, with the rise of eHealth technologies, such as online patient portals, the role of trust and the factors that influence it need to be reconsidered. In this study, we aim to identify the factors that contribute to trust in an eHealth service and we aim to identify the consequences of trust in an eHealth service in terms of use.

Methods

The Patient Trust Assessment Tool was provided to new outpatients of a rehabilitation center in the Netherlands, that were expected to use the center’s online patient portal. Via this tool, we assessed five trust-related factors. This data was supplemented by questions about demographics (age, gender, rehabilitation treatment) and data about use (number of sessions, total time spent in sessions), derived from data logs. Data was analyzed via Partial Least Squares Structural Equation Modelling.

Results

In total, 93 patients participated in the study. Out of these participants, 61 used the portal at least once. The measurement model was considered good. Trust in the organization was found to affect trust in the care team (β = .63), trust in the care team affected trust in the treatment (β = .60). Both, trust in the care team and trust in the treatment influenced trust in the technology (β = .42 and .30, respectively). Trust in the technology affected the holistic concept trust in the service (β = .78). This holistic trust in the service finally, did not affect use.

Conclusions

This study shows that the formation of this trust is not unidimensional, but consists of different, separate factors (trust in the care organization, trust in the care team and trust in the treatment). Trust transfer does take place from offline to online health services. However, trust in the service does not directly affect the use of the eHealth technology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01552-4.

Acceptability of a Patient Portal (Opal) in HIV Clinical Care: A Feasibility Study

Opal (opalmedapps.com), a patient portal in use at the Cedars Cancer Centre of the McGill University Health Centre (MUHC) (Montreal, Canada), gives cancer patients access to their medical records, collects information on patient-reported outcome measures (PROMs), and has demonstrated patient satisfaction with care. This feasibility study aims to evaluate Opal's potential acceptability in the context of HIV care. People living with HIV (PLWH) and their healthcare providers (HCPs) completed cross-sectional surveys from August 2019 to February 2020 at large HIV centers, including the Chronic Viral Illness Service of the MUHC, and other HIV clinical sites in Montreal and Paris, France. This study comprised 114 PLWH (mean age 48 years old, SD = 12.4), including 74% men, 24% women, and 2% transgender or other; and 31 HCPs (mean age 46.5 years old, SD = 11.4), including 32% men, 65% women, and 3% other. Ownership of smartphones and tablets was high (93% PLWH, 96% HCPs), and participants were willing to use Opal (74% PLWH, 68% HCPs). Participants were interested in most Opal functions and PROMs, particularly PROMs capturing quality of life (89% PLWH, 77% HCPs), experience of healthcare (86% PLWH, 97% HCPs), and HIV self-management (92% PLWH, 97% HCPs). This study suggests Opal has high acceptability and potential usefulness as perceived by PLWH and HCPs.

Patient Portal Implementation and Uptake: Qualitative Comparative Case Study

BACKGROUND

Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot.

OBJECTIVE

This study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation.

METHODS

A qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data.

RESULTS

Results from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users.

CONCLUSIONS

There is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care.

Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review

Background

Electronic personal health records (ePHRs) are defined as electronic applications through which individuals can access, manage, and share health information in a private, secure, and confidential environment. Existing evidence shows their benefits in improving outcomes, especially for chronic disease patients. However, their use has not been as widespread as expected partly due to barriers faced in their adoption and use. We aimed to identify the types of barriers to a patient, provider, and caregiver adoption/use of ePHRs and to analyze their extent in chronic disease care.

Methods

A systematic search in Medline, PubMed, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, and the Institute of Electrical and Electronics Engineers (IEEE) database was performed to find original studies assessing barriers to ePHR adoption/use in chronic care until the end of 2018. Two researchers independently screened and extracted data. We used the PHR adoption model and the Unified Theory of Acceptance and Use of Technology to analyze the results. The Mixed Methods Appraisal Tool (MMAT) version 2018 was used to assess the quality of evidence in the included studies.

Results

Sixty publications met our inclusion criteria. Issues found hindering ePHR adoption/use in chronic disease care were associated with demographic factors (e.g., patient age and gender) along with key variables related to health status, computer literacy, preferences for direct communication, and patient’s strategy for coping with a chronic condition; as well as factors related to medical practice/environment (e.g., providers’ lack of interest or resistance to adopting ePHRs due to workload, lack of reimbursement, and lack of user training); technological (e.g., concerns over privacy and security, interoperability with electronic health record systems, and lack of customized features for chronic conditions); and chronic disease characteristics (e.g., multiplicities of co-morbid conditions, settings, and providers involved in chronic care).

Conclusions

ePHRs can be meaningfully used in chronic disease care if they are implemented as a component of comprehensive care models specifically developed for this care. Our results provide insight into hurdles and barriers mitigating ePHR adoption/use in chronic disease care. A deeper understating of the interplay between these barriers will provide opportunities that can lead to an enhanced ePHR adoption/use.

Adopting Patient Portals in Hospitals: Qualitative Study

BACKGROUND

Theoretical models help to explain or predict the adoption of electronic health (eHealth) technology and illustrate the complexity of the adoption process. These models provide insights into general factors that influence the use of eHealth technology. However, they do not give hospitals much actionable knowledge on how to facilitate the adoption process.

OBJECTIVE

Our study aims to provide insights into patient portal adoption processes among patients and hospital staff, including health care professionals (HCPs), managers, and administrative clerks. Studying the experiences and views of stakeholders answers the following question: How can hospitals encourage patients and HCPs to adopt a patient portal?

METHODS

We conducted 22 semistructured individual and group interviews (n=69) in 12 hospitals and four focus groups with members of national and seminational organizations and patient portal suppliers (n=53).

RESULTS

The effort hospitals put into adopting patient portals can be split into three themes. First, inform patients and HCPs about the portal. This communication strategy has four objectives: users should (1) know about the portal, (2) know how the portal works, (3) know that action on the portal is required, and (4) know where to find help with the portal. Second, embed the patient portal in the daily routine of HCPs and management. This involves three forms of support: (1) hospital policy, (2) management by monitoring the numbers, and (3) a structured implementation strategy that includes all staff of one department. Third, try to adjust the portal to meet patients' needs to optimize user-friendliness in two ways: (1) use patients' feedback and (2) focus on optimizing for patients with special needs (eg, low literacy and low digital skills).

CONCLUSIONS

Asking stakeholders what they have learned from their efforts to stimulate patient portal use in hospitals elicited rich insights into the adoption process. These insights are missing in the theoretical models. Therefore, our findings help to translate the relatively abstract factors one finds in theoretical models to the everyday pragmatics of eHealth projects in hospitals.

Exploring perceptions and use of the patient portal by young adults with type 1 diabetes: A qualitative study

Emerging adults have been raised in the digital age and are therefore prime candidates for using a patient portal to manage chronic conditions. The limited body of research both identifies the underutilization of the patient portal and suggests increased use of the portal for the chronically ill as a tool to alleviate caregiver stress, as well as a potential modality to assist emerging adults to manage their chronic illnesses. This qualitative study was completed to obtain an understanding of emerging adults familiarity with the electronic patient portal and to elicit the perception of the usefulness of the portal to support self-management of type I diabetes. Findings provide a preliminary understanding of how a sampling of emerging adults with type I diabetes uses, perceives the benefits of, and wants to improve technology for diabetes self-management.

A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal

BACKGROUND

Patient portals are becoming ubiquitous. Previous research has documented substantial barriers, especially among vulnerable patient subgroups such as those with lower socioeconomic status or limited health literacy (LHL). We tested the effectiveness of delivering online, video-based portal training to patients in a safety net setting.

METHODS

We created an online video curriculum about accessing the San Francisco Health Network portal, and then randomized 93 English-speaking patients with 1+ chronic diseases to receive 1) an in-person tutorial with a research assistant, or 2) a link to view the videos on their own. We also examined a third, nonrandomized usual care comparison group. The primary outcome was portal log-in (yes/no) 3 to 6 months post-training, assessed via the electronic health record. Secondary outcomes were self-reported attitudes and skills collected via baseline and follow-up surveys.

RESULTS

Mean age was 54 years, 51% had LHL, 60% were nonwhite, 52% were female, 45% reported fair/poor health, and 76% reported daily Internet use. At followup, 21% logged into the portal, with no differences by arm (P = .41), but this was higher than the overall clinic rate of 9% (P < .01) during the same time period. We found significant prepost improvements in self-rated portal skills (P = .03) and eHealth literacy (P < .01). Those with LHL were less likely to log in post-training (P < .01).

CONCLUSIONS

Both modalities of online training were comparable, and neither mode enabled a majority of vulnerable patients to use portals, especially those with LHL. This suggests that portal training will need to be more intensive or portals need improved usability to meaningfully increase use among diverse patients.

Design and Development of a Person-Centered Patient Portal Using Participatory Stakeholder Co-Design

Background

Patient portals are increasingly accepted as part of standard medical care. However, to date, most patient portals provide just passive access to medical data. The use of modern technology such as smartphones and data personalization algorithms offers the potential to make patient portals more person-centered and enabling.

Objective

The aim of this study is to share our experience in designing and developing a person-centered patient portal following a participatory stakeholder co-design approach.

Methods

Our stakeholder co-design approach comprised 6 core elements: (1) equal coleadership, including a cancer patient on treatment; (2) patient preference determination; (3) security, governance, and legal input; (4) continuous user evaluation and feedback; (5) continuous staff input; and (6) end-user testing. We incorporated person-centeredness by recognizing that patients should decide for themselves their level of medical data access, all medical data should be contextualized with explanatory content, and patient educational material should be personalized and timely.

Results

Using stakeholder co-design, we built, and are currently pilot-testing, a person-centered patient portal smartphone app called Opal.

Conclusions

Inclusion of all stakeholders in the design and development of patient-facing software can help ensure that the necessary elements of person-centeredness, clinician acceptability, and informatics feasibility are achieved.

Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study

BACKGROUND

As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy.

OBJECTIVE

This study aimed to obtain and present an overview of patients' perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD.

METHODS

We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study.

RESULTS

We included 29 patients (16/29, 55% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14%), whereas others used internet >3 times a week (23/29, 79%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals.

CONCLUSIONS

Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers.

Who adopts a patient portal?: An application of the diffusion of innovation model

BACKGROUND

Patient portals have emerged as an important tool through which patients can access online health information and engage in their health care. However, we know little about how patients perceive portals and whether patient perceptions might influence portal adoption.

OBJECTIVE

Apply the diffusion of innovation (DOI) theory to assess perceptions of adopters and non-adopters of a patient portal.

METHODS

We conducted a cross-sectional survey of adopters and non-adopters of the portal. Our survey consisted of perceived attributes from the DOI theory, socio-demographic characteristics and patient perceptions of technology adoption.

RESULTS

Three factors representing perceived attributes from DOI theory accounted for 73% of the variance in the data: Factor 1 - Relative Advantage (27%); Factor 2 - Ease of Use (24%) and Factor 3 - Trialability (22%). Adopters perceived greater Relative Advantage [mean (SD)] = 3.8 (0.71) versus 3.2 (0.89), p < 0.001, Ease of Use = 4.1 (0.71) versus 3.3 (0.95), p < 0.001 and Trialability = 4.0 (0.57) versus 3.4 (0.99), p < 0.001 than non-adopters. In multivariate modelling, age [OR = 3.75, 95% CI: (2.17, 6.46), p < 0.001] and income [OR = 1.87, 95% CI: (1.17, 3.00), p < 0.01] predicted adoption of the portal. Among DOI factors, Relative advantage predicted adoption of the portal [OR = 1.48, 95% CI: (1.03, 2.11), p < 0.05].

CONCLUSION

Patients will adopt a patient portal if they perceive it to offer a relative advantage over existing practices such as telephoning or visiting the doctor's office. Organisations seeking to increase the adoption of patient portals should implement strategies to promote the relative advantage of portals as, for example, through posters in waiting and exam rooms. A digital divide in the adoption of patient portals may exist with respect to age and income.

Designing a Patient Portal for Patient-Centered Care: Cross-Sectional Survey

BACKGROUND

In recent literature, patient portals are considered as important tools for the delivery of patient-centered care. To date, it is not clear how patients would conceptualize a patient portal and which health information needs they have when doing so.

OBJECTIVE

This study aimed (1) to investigate health information needs, expectations, and attitudes toward a patient portal and (2) to assess whether determinants, such as patient characteristics, health literacy, and empowerment status, can predict two different variables, namely the importance people attribute to obtaining health information when using a patient portal and the expectations concerning personal health care when using a patient portal.

METHODS

We conducted a cross-sectional survey of the Flemish population on what patients prefer to know about their digital health data and their expectations and attitudes toward using a patient portal to access their electronic health record. People were invited to participate in the survey through newsletters, social media, and magazines. We used a questionnaire including demographics, health characteristics, health literacy, patient empowerment, and patient portal characteristics.

RESULTS

We received 433 completed surveys. The health information needs included features such as being notified when one's health changes (371/396, 93.7%), being notified when physical parameters increase to dangerous levels (370/395, 93.7%), observing connections between one's symptoms or diseases or biological parameters (339/398, 85.2%), viewing the evolution of one's health in function of time (333/394, 84.5%), and viewing information about the expected effect of treatment (349/395, 88.4%). Almost 90% (369/412) of respondents were interested in using a patient portal. Determinants of patients' attachment for obtaining health information on a patient portal were (1) age between 45 and 54 years (P=.05); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) commitment to question physicians' decisions (P=.03, R²=0.122). Determinants of patients' expectations on improved health care by accessing a patient portal were (1) lower education level (P=.04); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) problems in understanding health information (P=.04; R²=0.106).

CONCLUSIONS

The interest in using a patient portal is considerable in Flanders. People would like to receive alerts or some form of communication from a patient portal in case they need to act to manage their health. Determinants such as education, attached importance to shared decision making, difficulties in finding relevant health information, and the attached importance in questioning the decisions of physicians need to be considered in the design of a patient portal.

Use and the Users of a Patient Portal: Cross-Sectional Study

Background

Patient portals offer patients access to their medical information and tools to communicate with health care providers. It has been shown that patient portals have the potential to positively impact health outcomes and efficiency of health care. It is therefore important that health care organizations identify the patients who use or do not use the patient portal and explore the reasons in either case. The Unified Theory of Acceptance and Use of Technology (UTAUT) is a frequently used theory for explaining the use of information technology. It consists of the following constructs: performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention to use.

Objective

This study aimed to explore the prevalence of patient portal use and the characteristics of patients who use or do not use a patient portal. The main constructs of UTAUT, together with demographics and disease- and care-related characteristics, have been measured to explore the predictive factors of portal use.

Methods

A cross-sectional study was conducted in the outpatient departments for adult patients of a university hospital in the Netherlands. Following outcomes were included: self-reported portal use, characteristics of users such as demographics, disease- and care-related data, eHealth literacy (modified score), and scores of UTAUT constructs. Descriptive analyses and univariate and multivariate logistic regression were also conducted.

Results

In the analysis, 439 adult patients were included. Furthermore, 32.1% (141/439) identified as being a user of the patient portal; 31.2% (137/439) indicated as nonusers, but being aware of the existence of the portal; and 36.6% (161/439) as being nonusers not aware of the existence of the portal. In the entire study population, the factors of being chronically ill (odds ratio, OR 1.62, 95% CI 1.04-2.52) and eHealth literacy (modified score; OR 1.12, 95% CI 1.07-1.18) best predicted portal use. In users and nonusers who were aware of the portal, UTAUT constructs were added to the multivariate logistic regression, with chronically ill and modified eHealth literacy sum score. Effort expectancy (OR 13.02, 95% CI 5.68-29.87) and performance expectancy (OR 2.84, 95% CI 1.65-4.90) are shown to significantly influence portal use in this group.

Conclusions

Approximately one-third of the patients of a university hospital self-reported using the patient portal; most expressed satisfaction. At first sight, being chronically ill and higher scores on the modified eHealth literacy scale explained portal use. Adding UTAUT constructs to the model revealed that effort expectancy (ease of use and knowledge and skills related to portal use) and performance expectancy (perceived usefulness) influenced portal use. Interventions to improve awareness of the portal and eHealth literacy skills of patients and further integration of the patient portal in usual face-to-face care are needed to increase use and potential subsequent patient benefits.

Patients' Use and Evaluation of an Online System to Annotate Radiology Reports with Lay Language Definitions

RATIONALE AND OBJECTIVES

The increasing availability of personal health portals has made it easier for patients to obtain their imaging results online. However, the radiology report typically is designed to communicate findings and recommendations to the referring clinician, and may contain many terms unfamiliar to lay readers. We sought to evaluate a web-based interface that presented reports of knee MRI (magnetic resonance imaging) examinations with annotations that included patient-oriented definitions, anatomic illustrations, and hyperlinks to additional information.

MATERIALS AND METHODS

During a 7-month observational trial, a statement added to all knee MRI reports invited patients to view their annotated report online. We tracked the number of patients who opened their reports, the terms they hovered over to view definitions, and the time hovering over each term. Patients who accessed their annotated reports were invited to complete a survey.

RESULTS

Of 1138 knee MRI examinations during the trial period, 185 patients (16.3%) opened their report in the viewing portal. Of those, 141 (76%) hovered over at least one term to view its definition, and 121 patients (65%) viewed a mean of 27.5 terms per examination and spent an average of 3.5 minutes viewing those terms. Of the 22 patients who completed the survey, 77% agreed that the definitions helped them understand the report and 91% stated that the illustrations were helpful.

CONCLUSIONS

A system that provided definitions and illustrations of the medical and technical terms in radiology reports has potential to improve patients' understanding of their reports and their diagnoses.

Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study

Background

Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems.

Objective

The aim of this study was to develop and prioritize measures of digital patient engagement based on patients’ use of the US Department of Veterans Affairs (VA)’s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions.

Methods

We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures.

Results

All 12 experts completed the study’s three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian’s three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement).

Conclusions

This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients’ use of VA’s My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans.