Patient Portal Functionalities and Uptake: Systematic Review Protocol

Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting

OBJECTIVE

This study aims to understand whether higher use of a patient portal can have an impact on mental health functioning and recovery.

METHOD

A mixed methods approach was used for this study. In 2019-2021, patients with mental health diagnoses at outpatient clinics in an academic centre were invited to complete World Health Organization Disability Assessment Scale 12 (WHODAS-12) and Mental Health Recovery Measure surveys at baseline, 3 months, and 6 months after signing up for the portal. At the 3-month time point, patients were invited to a semistructured interview with a member of the team to contextualize the findings obtained from the surveys. Analytics data was also collected from the platform to understand usage patterns on the portal.

RESULTS

Overall, 113 participants were included in the analysis. There was no significant change in mental health functioning and recovery scores over the 6-month period. However, suboptimal usage was observed as 46% of participants did not complete any tasks within the portal. Thirty-five participants had low use of the portal (1-9 interactions) and 18 participants had high usage (10+ interactions). There were also no differences in mental health functioning and recovery scores between low and high users of the portal. Qualitative interviews highlighted many opportunities where the portal can support overall functioning and mental health recovery.

CONCLUSIONS

Collectively, this study suggests that higher use of a portal had no impact, either positive or negative, on mental health outcomes. While it may offer convenience and improved patient satisfaction, adequate support is needed to fully enable these opportunities for patient care. As the type of interaction with the portal was not specifically addressed, future work should focus on looking at ways to support patient engagement and portal usage throughout their care journey.

Pre-implementation perceptions of clinicians regarding a patient portal in inpatient addictions settings: A qualitative descriptive study

BACKGROUND

Patient portals have been implemented in many organizations to support patient engagement and empowerment. However, their use in inpatient mental health and addiction settings is relatively new and has not been extensively studied. To address this gap, this study explored clinician perspectives of implementing a patient portal in inpatient addiction settings.

METHODS

The study followed qualitative descriptive methodology and used the Consolidated Framework for Implementation Research (CFIR) to guide the research. Interviews were conducted with clinicians working in an inpatient addictions service at a large mental health and addictions teaching hospital in Toronto, Canada. Data analysis was performed using directed content analysis and the CFIR domains.

RESULTS

Twelve clinicians participated in semi-structured interviews. Participants included prescribers (such as physicians and nurse practitioners), registered nurses, allied health clinicians, and leadership. Participants had positive attitudes toward the patient portal, believing it would benefit patients and support consistency in healthcare. However, they also expressed reservations about its relevance and value during short inpatient admissions. Clinicians perceived the patient portal as compatible with existing workflows, enhancing patient empowerment and facilitating access to medical documentation. Concerns were raised about potential negative impacts on therapeutic rapport, particularly if patients disagreed with or were upset by the contents of their notes. Adaptations to the portal, such as improving documentation templates and providing detailed medication information, were suggested. Participants also highlighted advantages of the portal, including secure communication and access to laboratory results.

CONCLUSIONS

Clinicians generally had positive attitudes toward implementing a patient portal. However, concerns about maintaining therapeutic rapport and the relevance of information to patients were identified, and adaptations were suggested to improve the utility of a portal in the context of short inpatient stays. The findings provide insights into clinician perspectives and can inform the implementation of patient portals in inpatient addiction settings.

Procurement of patient medical records from multiple health care facilities for public health research: feasibility, challenges, and lessons learned

Objectives

Studies that combine medical record and primary data are typically conducted in a small number of health care facilities (HCFs) covering a limited catchment area; however, depending on the study objectives, validity may be improved by recruiting a more expansive sample of patients receiving care across multiple HCFs. We evaluate the feasibility of a novel protocol to obtain patient medical records from multiple HCFs using a broad representative sampling frame.

Materials and Methods

In a prospective cohort study on HIV pre-exposure prophylaxis utilization, primary data were collected from a representative sample of community-dwelling participants; voluntary authorization was obtained to access participants' medical records from the HCF at which they were receiving care. Medical record procurement procedures were documented for later analysis.

Results

The cohort consisted of 460 participants receiving care from 122 HCFs; 81 participants were lost to follow-up resulting in 379 requests for medical records submitted to HCFs, and a total of 343 medical records were obtained (91% response rate). Less than 20% of the medical records received were in electronic form. On average, the cost of medical record acquisition was $120 USD per medical record.

Conclusions

Obtaining medical record data on research participants receiving care across multiple HCFs was feasible, but time-consuming and resulted in appreciable missing data. Researchers combining primary data with medical record data should select a sampling and data collection approach that optimizes study validity while weighing the potential benefits (more representative sample; inclusion of HCF-level predictors) and drawbacks (cost, missing data) of obtaining medical records from multiple HCFs.

Why are Patient Portals Important in the Age of COVID-19? Reflecting on Patient and Team Experiences From a Toronto Hospital Network

The COVID-19 pandemic has changed how care is being delivered in Canada. With conventional in-person care being transitioned to virtual care, the approach that patients are able to engage and access their care has dramatically changed. At the University Health Network (UHN), which is Canada's largest academic and teaching hospital network, we expanded the myUHN Patient Portal in 2017 after its early adopter phase to enable patients and family members to view parts of their clinical notes and test results. As the pandemic progressed, we observed high adoption of myUHN to support virtual care and rapid delivery of COVID-19 test results in real time. In this article, we share and reflect on our experience of adapting myUHN to support the demands of the pandemic, including portal adoption outcomes across multiple waves of the pandemic, the impetus for increased patient experience staff dedicated for myUHN support, and patients’ perceptions of the value of the portal and virtual care. Based on these reflections, we outline our perspectives on the future role of patient portals to support patient care and experience in a post-pandemic environment.

Characteristics of Patients and Proxy Caregivers Using Patient Portals in the Setting of Serious Illness and End of Life

Background: There are few studies examining the usage and utility of patient portals among seriously ill and end-of-life populations and their caregivers. Objective: The aim of this study was to describe portal user characteristics among patients and their caregivers (proxy login) at two time points: (1) the 12 months following an electronic medical record flag for serious illness and (2) during the last 12 months of life. Methods: A retrospective cohort analysis of Kaiser Permanente Colorado (KPCO) patients with serious illness, as defined by Kaiser Permanente's prognostic algorithm, and their proxy caregivers was performed for the two time periods. Use was characterized as (1) the discrete number of days the portal was used and (2) the number of days that portal features were accessed. Differences in use by user characteristics were assessed. Results: Patients flagged for serious illness (N = 6129) were 70.4 ± 14.2 years of age, and used the portal on average 50.4 days. Patients (N = 6517) in the last year of life were 76.7 ± 13.7 years of age and used the portal on average 43 days. Caregiver proxy use of the portal was low in both cohorts. Patients who were older, female, non-White, and healthier were less likely to use the portal. Conclusions: In comparison with overall KPCO portal use and recent patient portal studies examining use patterns, patient portal use was high among patients flagged with serious illness and nearing the end of life. However, because use was associated with age, gender, and race, addressing barriers to portal adoption among underserved populations and caregiver proxies is key to better leveraging patient portal systems for palliative and end-of-life care.

Assessing Patient Needs During Natural Disasters: Mixed Methods Analysis of Portal Messages Sent During Hurricane Harvey

BACKGROUND

Patient portals play an important role in connecting patients with their medical care team, which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients' needs increase, whereas available resources, specifically access to care, become limited.

OBJECTIVE

This study aims to examine patients' health needs during a natural crisis by analyzing the electronic messages sent during Hurricane Harvey to guide future disaster planning efforts.

METHODS

We explored patient portal use data from a large Greater Houston area health care system focusing on the initial week of the Hurricane Harvey disaster, beginning with the date of landfall, August 25, 2017, to August 31, 2017. A mixed methods approach was used to assess patients' immediate health needs and concerns during the disruption of access to routine and emergent medical care. Quantitative analysis used logistic regression models to assess the predictive characteristics of patients using the portal during Hurricane Harvey. This study also included encounters by type (emergency, inpatient, observation, outpatient, and outpatient surgery) and time (before, during, and after Hurricane Harvey). For qualitative analysis, the content of these messages was examined using the constant comparative method to identify emerging themes found within the message texts.

RESULTS

Out of a total of 557,024 patients, 4079 (0.73%) sent a message during Hurricane Harvey, whereas 31,737 (5.69%) used the portal. Age, sex, race, and ethnicity were predictive factors for using the portal and sending a message during the natural disaster. We found that prior use of the patient portal increased the likelihood of portal use during Hurricane Harvey (odds ratio 13.688, 95% CI 12.929-14.491) and of sending a portal message during the disaster (odds ratio 14.172, 95% CI 11.879-16.907). Having an encounter 4 weeks before or after Hurricane Harvey was positively associated with increased use of the portal and sending a portal message. Patients with encounters during the main Hurricane Harvey week had a higher increased likelihood of portal use across all five encounter types. Qualitative themes included: access, prescription requests, medical advice (chronic conditions, acute care, urgent needs, and Hurricane Harvey-related injuries), mental health, technical difficulties, and provider constraints.

CONCLUSIONS

The patient portal can be a useful tool for communication between patients and providers to address the urgent needs and concerns of patients as a natural disaster unfolds. This was the first known study to include encounter data to understand portal use compared with care provisioning. Prior use was predictive of both portal use and message sending during Hurricane Harvey. These findings could inform the types of demands that may arise in future disaster situations and can serve as the first step in intentionally optimizing patient portal usability for emergency health care management during natural disasters.

Improvement and Evaluation of the TOPCOP Taxonomy of Patient Portals: Taxonomy-Evaluation-Delphi Approach (TED)

Background

Patient portals have been introduced in many countries over the last 10 years, but many health information managers still feel they have too little knowledge of patient portals. A taxonomy can help them to better compare and select portals. This has led us to develop the TOPCOP taxonomy for classifying and comparing patient portals. However, the taxonomy has not been evaluated by users.

Objective

This study aimed to evaluate the taxonomy’s usefulness to support health information managers in comparing, classifying, defining a requirement profile for, and selecting patient portals and to improve the taxonomy where needed.

Methods

We used a modified Delphi approach. We sampled a heterogeneous panel of 13 health information managers from 3 countries using the criterion sampling strategy. We conducted 4 anonymous survey rounds with qualitative and quantitative questions. In round 1, the panelists assessed the appropriateness of each dimension, and we collected new ideas to improve the dimensions. In rounds 2 and 3, the panelists iteratively evaluated the taxonomy that was revised based on round 1. In round 4, the panelists assessed the need for a taxonomy and the appropriateness of patient engagement as a distinguishing concept. Then, they compared 2 real portals with the final taxonomy and evaluated its usefulness for comparing portals, creating an initial requirement profile, and selecting patient portals. To determine group consensus, we applied the RAND/UCLA Appropriateness Method.

Results

The final taxonomy consists of 25 dimensions with 65 characteristics. Five new dimensions were added to the original taxonomy, with 8 characteristics added to already existing dimensions. Group consensus was achieved on the need for such a taxonomy to compare portals, on patient engagement as an appropriate distinguishing concept, and on the comprehensibility of the taxonomy’s form. Further, consensus was achieved on the taxonomy’s usefulness for classifying and comparing portals, assisting users in better understanding portals, creating a requirement profile, and selecting portals. This allowed us to test the usefulness of the final taxonomy with the intended users.

Conclusions

The TOPCOP taxonomy aims to support health information managers in comparing and selecting patient portals. By providing a standardized terminology to describe various aspects of patient portals independent of clinical setting or country, the taxonomy will also be useful for advancing research and evaluation of patient portals.

Development and Validation of a Useful Taxonomy of Patient Portals Based on Characteristics of Patient Engagement

Objective  Taxonomies are classification systems used to reduce complexity and better understand a domain. The present research aims to develop a useful taxonomy for health information managers to classify and compare patient portals based on characteristics appropriate to promote patient engagement. As a result, the taxonomy should contribute to understanding the differences and similarities of the portals. Further, the taxonomy shall support health information managers to more easily define which general type and functionalities of patient portals they need and to select the most suitable solution offered on the market.

Methods  We followed the formal taxonomy-building method proposed by Nickerson et al. Based on a literature review, we created a preliminary taxonomy following the conceptional approach of the model. We then evaluated each taxa's appropriateness by analyzing and classifying 17 patient portals offered by software vendors and 11 patient portals offered by health care providers. After each iteration, we examined the achievement of the determined objective and subjective ending conditions.

Results  After two conceptional approaches to create our taxonomy, and two empirical approaches to evaluate it, the final taxonomy consists of 20 dimensions and 49 characteristics. To make the taxonomy easy to comprehend, we assigned to the dimensions seven aspects related to patient engagement. These aspects are (1) portal design, (2) management, (3) communication, (4) instruction, (5) self-management, (6) self-determination, and (7) data management. The taxonomy is considered finished and useful after all ending conditions that defined beforehand have been fulfilled. We demonstrated that the taxonomy serves to understand the differences and similarities by comparing patient portals. We call our taxonomy “Taxonomy of Patient Portals based on Characteristics of Patient Engagement (TOPCOP).”

Conclusion  We developed the first useful taxonomy for health information managers to classify and compare patient portals. The taxonomy is based on characteristics promoting patient engagement. With 20 dimensions and 49 characteristics, our taxonomy is particularly suitable to discriminate among patient portals and can easily be applied to compare portals. The TOPCOP taxonomy enables health information managers to better understand the differences and similarities of patient portals. Further, the taxonomy may help them to define the type and general functionalities needed. But it also supports them in searching and comparing patient portals offered on the market to select the most suitable solution.

Patient Portal Functionalities and Patient Outcomes Among Patients With Diabetes: Systematic Review

BACKGROUND

Patient portal use could help improve the care and health outcomes of patients with diabetes owing to functionalities, such as appointment booking, electronic messaging (e-messaging), and repeat prescription ordering, which enable patient-centered care and improve patient self-management of the disease.

OBJECTIVE

This review aimed to summarize the evidence regarding patient portal use (portals that are connected to electronic health care records) or patient portal functionality use (eg, appointment booking and e-messaging) and their reported associations with health and health care quality outcomes among adult patients with diabetes.

METHODS

We searched the MEDLINE, Embase, and Scopus databases and reported the review methodology using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent reviewers screened titles and abstracts, and two reviewers assessed the full texts of relevant studies and performed data extraction and quality assessments of the included studies. We used the Cochrane Collaboration Risk of Bias Tool and the National Heart, Lung and Blood Institute (NHLBI) Study Quality Assessment Tool to assess the risk of bias of the included studies. Data were summarized through narrative synthesis.

RESULTS

Twelve studies were included in this review. Five studies reported overall patient portal use and its association with diabetes health and health care quality outcomes. Six studies reported e-messaging or email use-associated outcomes, and two studies reported prescription refill-associated outcomes. The reported health outcomes included the associations of patient portal use with blood pressure, low-density lipoprotein cholesterol, and BMI. Few studies reported health care utilization outcomes such as office visits, emergency department visits, and hospitalizations. A limited number of studies reported overall quality of care for patients with diabetes who used patient portals.

CONCLUSIONS

The included studies mostly reported improved glycemic control outcomes for patients with diabetes who used patient portals. However, limitations of studying the effects of patient portals exist, which do not guarantee whether the outcomes reported are completely the result of patient portal use or if confounding factors exist. Randomized controlled trials and mixed-methods studies could help understand the mechanisms involved in health outcome improvements and patient portal use among patients with diabetes.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141131.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/14975.