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Ong AKS, Prasetyo YT, Tapiceria RPKM, Nadlifatin R, Gumasing MJJ. Factors affecting the intention to use COVID-19 contact tracing application "StaySafe PH": Integrating protection motivation theory, UTAUT2, and system usability theory. PLoS One 2024; 19:e0306701. [PMID: 39088508 PMCID: PMC11293755 DOI: 10.1371/journal.pone.0306701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/21/2024] [Indexed: 08/03/2024] Open
Abstract
PURPOSE StaySafe PH is the Philippines' official contact tracing software for controlling the propagation of COVID-19 and promoting a uniform contact tracing strategy. The StaySafe PH has various features such as a social distancing system, LGU heat map and response system, real-time monitoring, graphs, infographics, and the primary purpose, which is a contact tracing system. This application is mandatory in establishments such as fast-food restaurants, banks, and malls. OBJECTIVE AND METHODOLOGY The purpose of this research was to determine the country's willingness to utilize StaySafe PH. Specifically, this study utilized 12 latent variables from the integrated Protection Motivation Theory (PMT), Unified Theory of Acceptance and Use of Technology (UTAUT2), and System Usability Scale (SUS). Data from 646 respondents in the Philippines were employed through Structural Equation Modelling (SEM), Deep Learning Neural Network (DLNN), and SUS. RESULTS Utilizing the SEM, it is found that understanding the COVID-19 vaccine, understanding the COVID-19 Delta variant, perceived vulnerability, perceived severity, performance expectancy, social influence, hedonic motivation, behavioral intention, actual use, and the system usability scale are major determinants of intent to utilize the application. Understanding of the COVID-19 Delta Variant was found to be the most important factor by DLNN, which is congruent with the results of SEM. The SUS score of the application is "D", which implies that the application has poor usability. IMPLICATIONS It could be implicated that large concerns stem from the trust issues on privacy, data security, and overall consent in the information needed. This is one area that should be promoted. That is, how the data is stored and kept, utilized, and covered by the system, how the assurance could be provided among consumers, and how the government would manage the information obtained. Building the trust is crucial on the development and deployment of these types of technology. The results in this study can also suggest that individuals in the Philippines expected and were certain that vaccination would help them not contract the virus and thus not be vulnerable, leading to a positive actual use of the application. NOVELTY The current study considered encompassing health-related behaviors using the PMT, integrating with the technology acceptance model, UTAUT2; as well as usability perspective using the SUS. This study was the first one to evaluate and assess a contact tracing application in the Philippines, as well as integrate the frameworks to provide a holistic measurement.
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Affiliation(s)
- Ardvin Kester S. Ong
- School of Industrial Engineering and Engineering Management, Mapúa University, Manila, Philippines
- E.T. Yuchengo School of Businseeess, Mapúa University, Makati, Philippines
| | - Yogi Tri Prasetyo
- International Bachelor Program in Engineering, Yuan Ze University, Chung-Li, Taiwan
- Department of Industrial Engineering and Management, Yuan Ze University, Chung-Li, Taiwan
| | | | - Reny Nadlifatin
- Department of Information Systems, Institut Teknologi Sepuluh Nopember, Kampus ITS Sukolilo, Surabaya, Indonesia
| | - Ma. Janice J. Gumasing
- Department of Industrial and Systems Engineering, Gokongwei College of Engineering, De La Salle University, Manila, Philippines
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Hagström J, Hägglund M, Holmroos M, Lähteenmäki P, Hörhammer I. Minors' and guardian access to and use of a national patient portal: A retrospective comparative case study of Sweden and Finland. Int J Med Inform 2024; 187:105465. [PMID: 38692233 DOI: 10.1016/j.ijmedinf.2024.105465] [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: 02/09/2024] [Revised: 03/21/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Approaches to implementing online record access (ORA) via patient portals for minors and guardians vary internationally, as more countries continue to develop patient-accessible electronic health records (PAEHR) systems. Evidence of ORA usage and country-specific practices to allow or block minors' and guardians' access to minors' records during adolescence (i.e. access control practices) may provide a broader understanding of possible approaches and their implications for minors' confidentiality and guardian support. AIM To describe and compare minors' and guardian proxy users' PAEHR usage in Sweden and Finland. Furthermore, to investigate the use of country-specific access control practices. METHODS A retrospective, observational case study was conducted. Data were collected from PAEHR administration services in Sweden and Finland and proportional use was calculated based on population statistics. Descriptive statistics were used to analyze the results. RESULTS In both Sweden and Finland, the proportion of adolescents accessing their PAEHR increased from younger to older age-groups reaching the proportion of 59.9 % in Sweden and 84.8 % in Finland in the age-group of 17-year-olds. The PAEHR access gap during early adolescence in Sweden may explain the lower proportion of users among those who enter adulthood. Around half of guardians in Finland accessed their minor children's records in 2022 (46.1 %), while Swedish guardian use was the highest in 2022 for newborn children (41.8 %), and decreased thereafter. Few, mainly guardians, applied for extended access in Sweden. In Finland, where a case-by-case approach to access control relies on healthcare professionals' (HCPs) consideration of a minor's maturity, 95.8 % of minors chose to disclose prescription information to their guardians. CONCLUSION While age-based access control practices can hamper ORA for minors and guardians, case-by-case approach requires HCP resources and careful guidance to ensure equality between patients. Guardians primarily access minors' records during early childhood and adolescents show willingness to share their PAEHR with parents.
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Affiliation(s)
- Josefin Hagström
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, 752 37 Uppsala, Sweden; MedTech Science & Innovation Centre, Uppsala University Hospital, 751 85 Uppsala, Sweden.
| | - Maria Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, 752 37 Uppsala, Sweden; MedTech Science & Innovation Centre, Uppsala University Hospital, 751 85 Uppsala, Sweden.
| | - Mari Holmroos
- Kela, Nordenskiöldinkatu 12, 00250 Helsinki, Finland.
| | - Päivi Lähteenmäki
- Department of Women's and Children's Health, Karolinska Institute, 171 77 Stockholm, Sweden; Department of Pediatrics and Adolescent Medicine, Turku University, and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland.
| | - Iiris Hörhammer
- Department of Computer Science, Aalto University, Konemiehentie 2, 02150 Espoo, Finland.
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Bozorgmehr A, Thiem SK, Wild D, Reinsdorff M, Vollmar HC, Kappernagel A, Schloessler K, Weissbach S, Pentzek M, Dehnen D, Drexler J, Mueller BS, Pilic L, Lehmann L, Loescher S, Hohmann ED, Frank F, Ates G, Kersten S, Mortsiefer A, Aretz B, Weltermann B. Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study. JMIR Form Res 2024; 8:e53206. [PMID: 38767942 PMCID: PMC11148515 DOI: 10.2196/53206] [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: 10/04/2023] [Revised: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. OBJECTIVE This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany's largest state. METHODS In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. RESULTS In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system's emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. CONCLUSIONS Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI.
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Affiliation(s)
- Arezoo Bozorgmehr
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Simon-Konstantin Thiem
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Dorothea Wild
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Melanie Reinsdorff
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Annika Kappernagel
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Kathrin Schloessler
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Sabine Weissbach
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Michael Pentzek
- Institute of General Practice/Family Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Dorothea Dehnen
- Institute of General Practice/Family Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Julia Drexler
- Institute of General Practice/Family Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Beate Sigrid Mueller
- Institute of General Practice, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Larisa Pilic
- Institute of General Practice, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Lion Lehmann
- Institute of General Practice, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Susanne Loescher
- Institute of General Practice/Family Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Elena Darinka Hohmann
- Institute of General Medicine, Faculty of Medicine, University of Münster, Münster, Germany
| | - Friederike Frank
- Institute for Digitalization and General Medicine, University Hospital Aachen, Aachen, Germany
| | - Gülay Ates
- Institute for Digitalization and General Medicine, University Hospital Aachen, Aachen, Germany
| | - Susanne Kersten
- Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Achim Mortsiefer
- Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Benjamin Aretz
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
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Kinnear N. Comment on 'Electronic medical records - a disappointing mirage for clinicians and research'. BJU Int 2024; 133 Suppl 4:68. [PMID: 37971329 DOI: 10.1111/bju.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Ned Kinnear
- Department of Urology, Flinders Medical Centre, Adelaide, South Australia, Australia
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Østervang C, Jensen CM, Coyne E, Dieperink KB, Lassen A. Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study. JMIR Hum Factors 2024; 11:e48445. [PMID: 38381502 PMCID: PMC10918535 DOI: 10.2196/48445] [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: 04/26/2023] [Revised: 11/30/2023] [Accepted: 12/17/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND A lack of information during an emergency visit leads to the experience of powerlessness for patients and their family members, who may also feel unprepared to cope with acute symptoms. The ever-changing nature and fast-paced workflow in the emergency department (ED) often affect how health care professionals can tailor information and communication to the needs of the patient. OBJECTIVE This study aimed to evaluate the usability and experience of a newly developed information system. The system was developed together with patients and their family members to help provide the information needed in the ED. METHODS We conducted a mixed methods study consisting of quantitative data obtained from the System Usability Scale questionnaire and qualitative interview data obtained from purposively selected participants included in the quantitative part of the study. RESULTS A total of 106 patients and 14 family members (N=120) answered the questionnaire. A total of 10 patients and 3 family members participated in the interviews. Based on the System Usability Scale score, the information system was rated close to excellent, with a mean score of 83.6 (SD 12.8). Most of the participants found the information system easy to use and would like to use it again. The participants reported that the system helped them feel in control, and the information was useful. Simplifications were needed to improve the user experience for the older individuals. CONCLUSIONS This study demonstrates that the usability of the information system is rated close to excellent. It was perceived to be useful as it enabled understanding and predictability of the patient's trajectory in the ED. Areas for improvement include making the system more usable by older individuals. The study provides an example of how a technological solution can be used to diminish the information gap in an ED context.
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Affiliation(s)
- Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Myhre Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Elisabeth Coyne
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Family Focused Healthcare Research Center (FACE), University of Southern Denmark, Odense, Denmark
| | - Annmarie Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Kujala S, Simola S, Wang B, Soone H, Hagström J, Bärkås A, Hörhammer I, Cajander Å, Johansen Fagerlund A, Kane B, Kharko A, Kristiansen E, Moll J, Rexphepi H, Hägglund M, Johansen MA. Benchmarking usability of patient portals in Estonia, Finland, Norway, and Sweden. Int J Med Inform 2024; 181:105302. [PMID: 38011806 DOI: 10.1016/j.ijmedinf.2023.105302] [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: 09/11/2023] [Revised: 10/24/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Poor usability is a barrier to widespread adoption of electronic health records (EHR). Providing good usability is especially challenging in the health care context, as there is a wide variety of patient users. Usability benchmarking is an approach for improving usability by evaluating and comparing the strength and weaknesses of systems. The main purpose of this study is to benchmark usability of patient portals across countries. METHODS A mixed-methods survey approach was applied to benchmark the national patient portals offering patient access to EHR in Estonia, Finland, Norway, and Sweden. These Nordic countries have similar public healthcare systems, and they are pioneers in offering patients access to EHR for several years. In a survey of 29,334 patients, both patients' quantitative ratings of usability and their qualitative descriptions of very positive and very negative peak experiences of portal use were collected. RESULTS The usability scores ranged from good to fair level of usability. The narratives of very positive and very negative experiences included the benefits of the patient portals and experienced usability issues. The regression analysis of results showed that very positive and negative experiences of patient portal use explain 19-35% of the variation of usability scores in the four countries. The percentage of patients who reported very positive or very negative experiences in each country was unrelated to the usability scores across countries. CONCLUSIONS The survey approach could be used to evaluate usability with a wide variety of users and it supported learning from comparison across the countries. The combination of quantitative and qualitative data provided an approximation of the level of the perceived usability, and identified usability issues to be improved and useful features that patients appreciate. Further work is needed to improve the comparability of the varied samples across countries.
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Affiliation(s)
- Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland.
| | - Saija Simola
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Bo Wang
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Hedvig Soone
- E-Medicine Centre, Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Josefin Hagström
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Annika Bärkås
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Iiris Hörhammer
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Åsa Cajander
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Bridget Kane
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Karlstad University Business School, Karlstad, Sweden
| | - Anna Kharko
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden; Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Jonas Moll
- Center for Empirical Research on Information Systems, Örebro University, Örebro, Sweden
| | | | - Maria Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Monika A Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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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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Paulissen JM, Zegers CM, Nijsten IR, Reiters PH, Houben RM, Eekers DB, Roelofs E. Performance and usability evaluation of a mobile health data capture application in clinical cancer trials follow-up. Tech Innov Patient Support Radiat Oncol 2022; 24:107-112. [PMID: 36387779 PMCID: PMC9641052 DOI: 10.1016/j.tipsro.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022] Open
Abstract
A mobile health data capture application can improve quality of data collection in clinical cancer trials. The use of a mobile health data capture application optimizes the efficiency and effectivity of a trial participant’s visit to a clinic. A mobile health data capture application relieves participants from instant recall on possible health changes during visits. The use of a mobile health data capture application helps a healthcare provider in preparing a participant’s visit.
Mobile health data capture applications (mHDA’s) may improve communication between healthcare providers and patients. However, there is limited literature about the use of mHDA’s facilitating clinical trials. In this study, the effectiveness of an application, supporting follow-up visits of cancer trial participants was investigated. Twenty participants were provided with an e-questionnaire via the mHDA. Participants rated the usability of the application as high performing (mean Systems Usability Scale 87 points). The research team rated the mHDA as highly applicable and efficient in preparing visits. Anamnesis, physical examination and agreement on further policy were performed within an average of 31 min.
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Albrink K, Joos C, Schröder D, Müller F, Hummers E, Noack EM. Obtaining patients' medical history using a digital device prior to consultation in primary care: study protocol for a usability and validity study. BMC Med Inform Decis Mak 2022; 22:189. [PMID: 35854290 PMCID: PMC9297616 DOI: 10.1186/s12911-022-01928-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background With the help of digital tools patients’ medical histories can be collected quickly and transferred into their electronic medical records. This information can facilitate treatment planning, reduce documentation work, and improve care. However, it is still unclear whether the information collected from patients in this way is reliable. In this study, we assess the accuracy of the information collected by patients using an app for medical history taking by comparing it with the information collected in a face-to-face medical interview. We also study the app’s usability from the patients’ point of view and analysing usage data. Methods We developed a software application (app) for symptom-oriented medical history taking specialized for general practice. Medical history taking will take place involving patients with acute somatic or psychological complaints (1) using the app and (2) verbally with trained study staff. To assess the perceived usability, patients will complete a questionnaire for the System Usability Scale. We will collect sociodemographic data, information about media use and health literacy, and app usage data.
Discussion Digital tools offer the opportunity to improve patient care. However, it is not self-evident that the medical history taken by digital tools corresponds to the medical history that would be taken in an interview. If simply due to a design flaw patients answer questions about signs and symptoms that indicate possible serious underlying conditions ‘wrong’, this could have severe consequences. By additionally assessing the app’s usability as perceived by a diverse group of patients, potential weaknesses in content, design and navigation can be identified and subsequently improved. This is essential in order to ensure that the app meets the need of different groups of patients.
Trial registration German Clinical Trials Register DRKS00026659, registered Nov 03 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx? TrialID = DRKS00026659.
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Affiliation(s)
- Klara Albrink
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Carla Joos
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Georg-August-University of Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
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Kujala S, Hörhammer I, Väyrynen A, Holmroos M, Nättiaho-Rönnholm M, Hägglund M, Johansen MA. Patients' Experiences of Web-Based Access to Electronic Health Records in Finland: Cross-sectional Survey. J Med Internet Res 2022; 24:e37438. [PMID: 35666563 PMCID: PMC9210208 DOI: 10.2196/37438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 02/06/2023] Open
Abstract
Background Patient portals that provide access to electronic health records offer a means for patients to better understand and self-manage their health. Yet, patient access to electronic health records raises many concerns among physicians, and little is known about the use practices and experiences of patients who access their electronic health records via a mature patient portal that has been available for citizens for over five years. Objective We aimed to identify patients’ experiences using a national patient portal to access their electronic health records. In particular, we focused on understanding usability-related perceptions and the benefits and challenges of reading clinical notes written by health care professionals. Methods Data were collected from 3135 patient users of the Finnish My Kanta patient portal through a web-based survey in June 2021 (response rate: 0.7%). Patients received an invitation to complete the questionnaire when they logged out of the patient portal. Respondents were asked to rate the usability of the patient portal, and the ratings were used to calculate approximations of the System Usability Scale score. Patients were also asked about the usefulness of features, and whether they had discussed the notes with health professionals. Open-ended questions were used to ask patients about their experiences of the benefits and challenges related to reading health professionals’ notes. Results Overall, patient evaluations of My Kanta were positive, and its usability was rated as good (System Usability Scale score approximation: mean 72.7, SD 15.9). Patients found the portal to be the most useful for managing prescriptions and viewing the results of examinations and medical notes. Viewing notes was the most frequent reason (978/3135, 31.2%) for visiting the portal. Benefits of reading the notes mentioned by patients included remembering and understanding what was said by health professionals and the instructions given during an appointment, the convenience of receiving information about health and care, the capability to check the accuracy of notes, and using the information to support self-management. However, there were challenges related to difficulty in understanding medical terminology, incorrect or inadequate notes, missing notes, and usability. Conclusions Patients actively used medical notes to receive information to follow professionals' instructions to take care of their health, and patient access to electronic health records can support self-management. However, for the benefits to be realized, improvements in the quality and availability of medical professionals’ notes are necessary. Providing a standard information structure could help patients find the information they need. Furthermore, linking notes to vocabularies and other information sources could also improve the understandability of medical terminology; patient agency could be supported by allowing them to add comments to their notes, and patient trust of the system could be improved by allowing them to control the visibility of the professionals’ notes.
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Affiliation(s)
- Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Iiris Hörhammer
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Akseli Väyrynen
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Mari Holmroos
- Kela, The Social Insurance Institution of Finland, Helsinki, Finland
| | | | - Maria Hägglund
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Monika Alise Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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11
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Louch G, Albutt A, Smyth K, O'Hara JK. What do primary care staff think about patients accessing electronic health records? A focus group study. BMC Health Serv Res 2022; 22:581. [PMID: 35488233 PMCID: PMC9053556 DOI: 10.1186/s12913-022-07954-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients have expressed a growing interest in having easy access to their personal health information, and internationally there has been increasing policy focus on patient and care records being more accessible. Limited research from the UK has qualitatively explored this topic from the primary care staff perspective. This study aimed to understand what primary care staff think about patients accessing electronic health records, highlighting errors in electronic health records, and providing feedback via online patient portals. METHODS A focus group study involving 19 clinical and non-clinical primary care staff. Primary care practices were purposively sampled based on practice size and the percentage of patients using online services. Data were analysed inductively using reflexive thematic analysis. RESULTS Three themes were generated: (1) Information - what, why and when? (2) Changing behaviours and protecting relationships, and (3) Secure access and safeguarding. The emotional considerations and consequences for staff and patients featured prominently in the data as an overarching theme. CONCLUSIONS Primary care staff described being invested and supportive of patients accessing their electronic health records, and acknowledged the numerous potential benefits for safety. Uncertainty around the parameters of access, the information available and what this might look like in the future, processes for patients highlighting errors in records, relational issues, security and safeguarding and equitable access, were key areas warranting examination in future research.
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Affiliation(s)
- Gemma Louch
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, BD9 6RJ, UK.
| | - Abigail Albutt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, BD9 6RJ, UK
| | - Kate Smyth
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, BD9 6RJ, UK
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jane K O'Hara
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, BD9 6RJ, UK
- School of Healthcare, University of Leeds, Leeds, LS2 9DA, UK
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12
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Kainiemi E, Vehko T, Kyytsönen M, Hörhammer I, Kujala S, Jormanainen V, Heponiemi T. Factors Associated with Non-use of and Dissatisfaction with the National Patient Portal in Finland in the Era of COVID-19: A Population-based Cross-sectional Survey Study (Preprint). JMIR Med Inform 2022; 10:e37500. [PMID: 35404831 PMCID: PMC9037616 DOI: 10.2196/37500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 12/29/2022] Open
Abstract
Background In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. Objective The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. Methods A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. Results In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. Conclusions Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public’s confidence in the protection of their confidential data.
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Affiliation(s)
- Emma Kainiemi
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuulikki Vehko
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Iiris Hörhammer
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
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13
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Hägglund M, Scandurra I. Usability of the Swedish Accessible Electronic Health Record: a Qualitative Study (Preprint). JMIR Hum Factors 2022; 9:e37192. [PMID: 35737444 PMCID: PMC9264119 DOI: 10.2196/37192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
Background Patient portals are increasingly being implemented worldwide to ensure that patients have timely access to their health data, including patients’ access to their electronic health records. In Sweden, the e-service Journalen is a national patient-accessible electronic health record (PAEHR), accessible on the web through the national patient portal. User characteristics and perceived benefits of using a PAEHR will influence behavioral intentions to use and adoption; however, poor usability, which increases effort expectancy, may have a negative impact. Therefore, it is of interest to further explore how users of the PAEHR Journalen perceive its usability and usefulness. Objective On the basis of the analysis of the survey respondents’ experiences of the usability of the Swedish PAEHR, this study aimed to identify specific usability problems that may need to be addressed in the future. Methods A survey study was conducted to elicit opinions and experiences of patients using Journalen. Data were collected from June to October 2016. The questionnaire included a free-text question regarding the usability of the system, and the responses were analyzed using content analysis with a sociotechnical framework as guidance when grouping identified usability issues. Results During the survey period, 423,141 users logged into Journalen, of whom 2587 (0.61%) completed the survey (unique users who logged in; response rate 0.61%). Of the 2587 respondents, 186 (7.19%) provided free-text comments on the usability questions. The analysis resulted in 19 categories, which could be grouped under 7 of the 8 dimensions in the sociotechnical framework of Sittig and Singh. The most frequently mentioned problems were related to regional access limitations, structure and navigation of the patient portal, and language and understanding. Conclusions Although the survey respondents, who were also end users of the PAEHR Journalen, were overall satisfied with its usability, they also experienced important challenges when accessing their records. For all patients to be able to reap the benefits of record access, it is essential to understand both the usability challenges they encounter and, more broadly, how policies, regulations, and technical implementation decisions affect the usefulness of record access. The results presented here are specific to the Swedish PAEHR Journalen but also provide important insights into how design and implementation of record access can be improved in any context.
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Affiliation(s)
- Maria Hägglund
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isabella Scandurra
- Centre of Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
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