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Jeong Y, Crowell T, Devon-Sand A, Sakata T, Sattler A, Shah S, Tsai T, Lin S. Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19. J Med Internet Res 2024; 26:e47667. [PMID: 38393776 PMCID: PMC10924259 DOI: 10.2196/47667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
On January 30, 2023, the Biden Administration announced its intention to end the existing COVID-19 public health emergency declaration. The transition to a "postpandemic" landscape presents a unique opportunity to sustain and strengthen pandemic-era changes in care delivery. With this in mind, we present 3 critical lessons learned from a primary care perspective during the COVID-19 pandemic. First, clinical workflows must support both in-person and internet-based care delivery. Second, the integration of asynchronous care delivery is critical. Third, planning for the future means planning for everyone, including those with potentially limited access to health care due to barriers in technology and communication. While these lessons are neither unique to primary care settings nor all-encompassing, they establish a grounded foundation on which to construct higher-quality, more resilient, and more equitable health systems.
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Affiliation(s)
- Yejin Jeong
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Trevor Crowell
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Anna Devon-Sand
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Theadora Sakata
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Amelia Sattler
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Shreya Shah
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Timothy Tsai
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
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2
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Ekeleme N, Yusuf A, Kastner M, Waite K, Montesanti S, Atherton H, Salvalaggio G, Langford L, Sediqzadah S, Ziegler C, Do Amaral T, Melamed OC, Selby P, Kelly M, Anderson E, O'Neill B. Guidelines and recommendations about virtual mental health services from high-income countries: a rapid review. BMJ Open 2024; 14:e079244. [PMID: 38388504 PMCID: PMC10884256 DOI: 10.1136/bmjopen-2023-079244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES This study reviewed existing recommendations for virtual mental healthcare services through the quadruple aim framework to create a set of recommendations on virtual healthcare delivery to guide the development of Canadian policies on virtual mental health services. DESIGN We conducted a systematic rapid review with qualitative content analysis of data from included manuscripts. The quadruple aim framework, consisting of improving patient experience and provider satisfaction, reducing costs and enhancing population health, was used to analyse and organise findings. METHODS Searches were conducted using seven databases from 1 January 2010 to 22 July 2022. We used qualitative content analysis to generate themes. RESULTS The search yielded 40 articles. Most articles (85%) discussed enhancing patient experiences, 55% addressed provider experiences and population health, and 25% focused on cost reduction. Identified themes included: screen patients for appropriateness of virtual care; obtain emergency contact details; communicate transparently with patients; improve marginalised patients' access to care; support health equity for all patients; determine the cost-effectiveness of virtual care; inform patients of insurance coverage for virtual care services; increase provider training for virtual care and set professional boundaries between providers and patients. CONCLUSIONS This rapid review identified important considerations that can be used to advance virtual care policy to support people living with mental health conditions in a high-income country.
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Affiliation(s)
- Ngozichukwuka Ekeleme
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Karen Waite
- Population Health and Value-based Health Systems, Ontario Health, Toronto, Ontario, Canada
| | | | | | | | - Lucie Langford
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Saadia Sediqzadah
- Department of Psychiatry, Unity Health Toronto, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Health Sciences Library, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tamara Do Amaral
- Population Health and Value-based Health Systems, Ontario Health, Toronto, Ontario, Canada
| | - Osnat C Melamed
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Addiction Programs, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Martina Kelly
- Department of Family Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | | | - Braden O'Neill
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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El Yaman N, Zeitoun J, Diab R, Mdaihly M, Diab R, Kobeissi L, Abou Ljoud S, Antoun J, Bardus M. Utilization of patient portals: a cross-sectional study investigating associations with mobile app quality. BMC Med Inform Decis Mak 2023; 23:177. [PMID: 37670277 PMCID: PMC10481578 DOI: 10.1186/s12911-023-02252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Mobile apps facilitate patients' access to portals and interaction with their healthcare providers. The COVID-19 pandemic accelerated this trend globally, but little evidence exists on patient portal usage in the Middle East, where internet access and digital literacy are limited. Our study aimed to explore how users utilize a patient portal through its related mobile app (MyChart by EPIC). METHODS We conducted a cross-sectional survey of MyChart users, recruited from a tertiary care center in Lebanon. We collected MyChart usage patterns, perceived outcomes, and app quality, based on the Mobile Application Rating Scale (user version, uMARS), and sociodemographic factors. We examined associations between app usage, app quality, and sociodemographic factors using Pearson's correlations, Chi-square, ANOVA, and t-tests. RESULTS 428 users completed the survey; they were primarily female (63%), aged 41.3 ± 15.6 years, with a higher education level (87%) and a relatively high crowding index of 1.4 ± 0.6. Most of the sample was in good and very good health (78%) and had no chronic illnesses (67%), and accessed the portal through MyChart once a month or less (76%). The most frequently used features were accessing health records (98%), scheduling appointments (67%), and messaging physicians (56%). According to uMARS completers (n = 200), the objective quality score was 3.8 ± 0.5, and the subjective quality was 3.6 ± 0.7. No significant association was found between overall app usage and the mobile app quality measured via uMARS. Moreover, app use frequency was negatively associated with education, socioeconomic status, and perceived health status. On the other hand, app use was positively related to having chronic conditions, the number of physician visits and subjective app quality. CONCLUSION The patient portal usage was not associated with app quality but with some of the participants' demographic factors. The app offers a user-friendly, good-quality interface to patient health records and physicians, appreciated chiefly by users with relatively low socioeconomic status and education. While this is encouraging, more research is needed to capture the usage patterns and perceptions of male patients and those with even lower education and socioeconomic status, to make patient portals more inclusive.
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Affiliation(s)
- Noha El Yaman
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jad Zeitoun
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rawan Diab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Mdaihly
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Razan Diab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lynn Kobeissi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Salwa Abou Ljoud
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jumana Antoun
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Marco Bardus
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Woods L, Dendere R, Eden R, Grantham B, Krivit J, Pearce A, McNeil K, Green D, Sullivan C. Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study. J Med Internet Res 2023; 25:e45868. [PMID: 37463008 PMCID: PMC10394505 DOI: 10.2196/45868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes. OBJECTIVE We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity. METHODS A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker's facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience. RESULTS DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites. CONCLUSIONS This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim.
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Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Ronald Dendere
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Rebekah Eden
- UQ Business School, The University of Queensland, Brisbane, Australia
| | - Brittany Grantham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Jenna Krivit
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Andrew Pearce
- Healthcare Information and Management Systems Society, Singapore, Singapore
| | - Keith McNeil
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Metro North Hospital and Health Service, Brisbane, Australia
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5
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Hahne J, Carpenter BD, Epstein AS, Prigerson HG, Derry-Vick HM. Communication Skills Training for Oncology Clinicians After the 21st Century Cures Act: The Need to Contextualize Patient Portal-Delivered Test Results. JCO Oncol Pract 2023; 19:99-102. [PMID: 36356282 PMCID: PMC10022885 DOI: 10.1200/op.22.00567] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Hahne
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, MO
| | - Brian D. Carpenter
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, MO
| | | | - Holly G. Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY
| | - Heather M. Derry-Vick
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ
- Department of Psychiatry and Behavioral Health, Hackensack Meridian School of Medicine, Nutley, NJ
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Chung EM, Zhang SC, Nguyen AT, Atkins KM, Sandler HM, Kamrava M. Feasibility and acceptability of ChatGPT generated radiology report summaries for cancer patients. Digit Health 2023; 9:20552076231221620. [PMID: 38130802 PMCID: PMC10734360 DOI: 10.1177/20552076231221620] [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: 05/08/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Objective Patients now have direct access to their radiology reports, which can include complex terminology and be difficult to understand. We assessed ChatGPT's ability to generate summarized MRI reports for patients with prostate cancer and evaluated physician satisfaction with the artificial intelligence (AI)-summarized report. Methods We used ChatGPT to summarize five full MRI reports for patients with prostate cancer performed at a single institution from 2021 to 2022. Three summarized reports were generated for each full MRI report. Full MRI and summarized reports were assessed for readability using Flesch-Kincaid Grade Level (FK) score. Radiation oncologists were asked to evaluate the AI-summarized reports via an anonymous questionnaire. Qualitative responses were given on a 1-5 Likert-type scale. Fifty newly diagnosed prostate cancer patient MRIs performed at a single institution were additionally assessed for physician online portal response rates. Results Fifteen summarized reports were generated from five full MRI reports using ChatGPT. The median FK score for the full MRI reports and summarized reports was 9.6 vs. 5.0, (p < 0.05), respectively. Twelve radiation oncologists responded to our questionnaire. The mean [SD] ratings for summarized reports were factual correctness (4.0 [0.6], understanding 4.0 [0.7]), completeness (4.1 [0.5]), potential for harm (3.5 [0.9]), overall quality (3.4 [0.9]), and likelihood to send to patient (3.1 [1.1]). Current physician online portal response rates were 14/50 (28%) at our institution. Conclusions We demonstrate a novel application of ChatGPT to summarize MRI reports at a reading level appropriate for patients. Physicians were likely to be satisfied with the summarized reports with respect to factual correctness, ease of understanding, and completeness. Physicians were less likely to be satisfied with respect to potential for harm, overall quality, and likelihood to send to patients. Further research is needed to optimize ChatGPT's ability to summarize radiology reports and understand what factors influence physician trust in AI-summarized reports.
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Affiliation(s)
- Eric M Chung
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel C Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anthony T Nguyen
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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7
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Poot CC, Meijer E, Bruil A, Venema M, Vegt NJH, Donkel N, van Noort V, Chavannes NH, Roest AAW. How to use participatory design to develop an eHealth intervention to reduce preprocedural stress and anxiety among children visiting the hospital: The Hospital Hero app multi-study and pilot report. Front Pediatr 2023; 11:1132639. [PMID: 36865696 PMCID: PMC9971988 DOI: 10.3389/fped.2023.1132639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Medical procedures can cause considerable stress and anxiety among children. Current interventions mainly diminish stress and anxiety during procedures, while stress and anxiety often build up at home. Moreover, interventions often focus on either distraction or preparation. eHealth can combine multiple strategies and provide a low-cost solution that can be used outside the hospital. OBJECTIVE To develop an eHealth solution to diminish preprocedural stress and anxiety, and to evaluate the app on use, usability and user experience in practice. We also aimed to gain in-depth insights in children's and caregivers' opinions and experiences to inform future improvements. METHODS This is a multi-study report on the development (Study 1) and evaluation (Study 2) of a first version of the developed app. In study 1 we adopted a participatory design approach in which children's experiences were central to the design process. We performed an experience journey session with stakeholders (n = 13) to map the child's outpatient journey, identify pains and gains, and formulate the desired experience journey. Iterative development and testing with children (n = 8) and caregivers (n = 6) resulted in a working prototype. The prototype was tested with children, resulting in a first version of the Hospital Hero app. The app was evaluated on use, user-experience and usability during an eight-week pilot study in practice (Study 2). We triangulated data from online interviews with children and caregivers (n = 21) and online questionnaires (n = 46). RESULTS Multiple stress and anxiety experience touchpoints were identified. The Hospital Hero app supports children in their hospital journey by facilitating preparation at home and providing distraction at the hospital. The pilot study showed that the app was evaluated positively on usability and user-experience and is considered feasible. Qualitative data showed five themes: (1) user-friendliness, (2) coherence and power of storytelling, (3) motivation and reward, (4) fit with real hospital journey, (5) procedural comfort. DISCUSSION Using participatory design, we developed a child-centered solution that supports children in the entire hospital journey and may diminish preprocedural stress and anxiety. Future efforts should create a more tailored journey, define an optimal engagement window and formulate implementation strategies.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands
| | | | - Melanie Venema
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Niko J H Vegt
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands.,Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Nicole Donkel
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Veronique van Noort
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands
| | - Arno A W Roest
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
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8
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Shucard H, Muller E, Johnson J, Walker J, Elmore JG, Payne TH, Berman J, Jackson SL. Clinical Use of an Electronic Pre-Visit Questionnaire Soliciting Patient Visit Goals and Interim History: A Retrospective Comparison Between Safety-net and Non-Safety-net Clinics. Health Serv Res Manag Epidemiol 2022; 9:23333928221080336. [PMID: 35198655 PMCID: PMC8859650 DOI: 10.1177/23333928221080336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction/Objectives We examined an initial step towards co-generation of clinic notes by inviting patients to complete a pre-visit questionnaire that could be inserted into clinic notes by providers and describe the experience in a safety-net and non-safety-net clinic. Methods We sent an electronic pre-visit questionnaire on visit goals and interim history to patients at a safety-net clinic and a non-safety-net clinic before clinic visits. We compared questionnaire utilization between clinics during a one-year period and performed a chart review of a sample of patients to examine demographics, content and usage of patient responses to the questionnaire. Results While use was low in both clinics, it was lower in the safety-net clinic (3%) compared to the non-safety-net clinic (10%). We reviewed a sample of respondents and found they were more likely to be White compared to the overall clinic populations ( p < 0.05). There were no statistically significant differences in patient-typed notes (word count and number of visit goals) between the safety-net and non-safety-net samples however, patients at the safety-net clinic were less likely to have all of their goals addressed within the PCP documentation, compared to the non-safety-net clinic. Conclusions Given potential benefits of this questionnaire as a communication tool, addressing barriers to use of technology among vulnerable patients is needed, including access to devices and internet, and support from caregivers or culturally concordant peer navigators.
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Affiliation(s)
| | - Emily Muller
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jan Walker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Joann G. Elmore
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas H. Payne
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jacob Berman
- University of Washington School of Medicine, Seattle, WA, USA
| | - Sara L. Jackson
- University of Washington School of Medicine, Seattle, WA, USA
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9
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Lo B, Charow R, Laberge S, Bakas V, Williams L, Wiljer D. Why are Patient Portals Important in the Age of COVID-19? Reflecting on Patient and Team Experiences From a Toronto Hospital Network. J Patient Exp 2022; 9:23743735221112216. [PMID: 35899103 PMCID: PMC9310255 DOI: 10.1177/23743735221112216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Brian Lo
- UHN Digital, University Health Network, Toronto, ON, Canada
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rebecca Charow
- UHN Digital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sarah Laberge
- myUHN Patient Portal, Patient Experience, University Health Network, Toronto, ON, Canada
| | - Vasiliki Bakas
- myUHN Patient Portal, Patient Experience, University Health Network, Toronto, ON, Canada
| | - Laura Williams
- myUHN Patient Portal, Patient Experience, University Health Network, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - David Wiljer
- UHN Digital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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10
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Baek J, Simon-Friedt B, Lopez A, Kolman JM, Nicolas J, Jones SL, Phillips RA, Menser T. Assessing Patient Needs During Natural Disasters: Mixed Methods Analysis of Portal Messages Sent During Hurricane Harvey. J Med Internet Res 2021; 23:e31264. [PMID: 34468328 PMCID: PMC8444041 DOI: 10.2196/31264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Juha Baek
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | | | - Adriana Lopez
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Juan Nicolas
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Stephen L Jones
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Surgery, Houston Methodist, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Robert A Phillips
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Cardiology, Houston Methodist, Houston, TX, United States.,Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Surgery, Houston Methodist, Houston, TX, United States.,Department of Surgery, Weill Cornell Medical College, New York, NY, United States.,Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States
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