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Wang T, Zhu H, Qian S, Giunti G, Goossens R, Melles M. Designing digital patient experiences: The digital health design framework. APPLIED ERGONOMICS 2024; 119:104289. [PMID: 38688183 DOI: 10.1016/j.apergo.2024.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Digital health (DH) brings considerable benefits, but it comes with potential risks. Human Factors (HF) play a critical role in providing high-quality and acceptable DH solutions. Consultation with designers is crucial for reflecting on and improving current DH design practices. OBJECTIVES We investigated the general DH design processes, challenges, and corresponding strategies that can improve the digital patient experience (PEx). METHODS A semi-structured interview study with 24 design professionals. All audio recordings were transcribed, deidentified, grammatically corrected, and imported into ATLAS.ti for data analysis. Three coders participated in data coding following the thematic analysis approach. RESULTS We identified eight DH design stages and grouped them into four phases: preparation, problem-thinking, problem-solving, and implementation. The analysis presented twelve design challenges associated with contextual, practical, managerial, and commercial aspects that can hinder the design process. We identified eight common strategies used by respondents to tackle these challenges. CONCLUSIONS We propose a Digital Health Design (DHD) framework to improve the digital PEx. It provides an overview of design deliverables, activities, stakeholders, challenges, and corresponding strategies for each design stage.
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Affiliation(s)
- Tingting Wang
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands.
| | - Haiou Zhu
- Neuroscience, Ethics & Society, Department of Psychiatry, University of Oxford, Oxford, UK; School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Shuxian Qian
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Guido Giunti
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Clinical Medicine Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard Goossens
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marijke Melles
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
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Thielmann RR, Hoving C, Cals JW, Crutzen R. Patient online access to medical records in general practice: Perceived effects after one year follow-up. PATIENT EDUCATION AND COUNSELING 2024; 125:108309. [PMID: 38705022 DOI: 10.1016/j.pec.2024.108309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Online access to medical records is expected to foster patient empowerment and patient-centred healthcare. However, data on actual experienced effects remain limited. We aimed to examine the development of effects patients perceive from online access. METHODS A nationwide online survey (N = 1769) evaluated Dutch patients' use of online access and beliefs about its effects on 16 outcomes at baseline and one-year follow-up. Analyses of Variance (ANOVA) were used to examine within-person belief changes across three user groups: patients who 1) used online access before the study, 2) started use during the study, and 3) did not use it at all. RESULTS There was a small decline in five beliefs around online access facilitating patient empowerment and participation in participants who started using online access during the study compared to at least one other user group. Most changes in beliefs did not differ between groups. CONCLUSION No evidence of benefits from online access was found. The findings might indicate inadequacies in the current system of online access. Possibly, the benefits of online access are contingent upon portal improvements and changes in documentation practices. PRACTICE IMPLICATION Records need to be easily accessible and comprehensible for patients. Consultation practices should enable patient participation.
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Affiliation(s)
| | - Ciska Hoving
- Department of Health Promotion, Maastricht University, the Netherlands
| | - Jochen Wl Cals
- Department of Family Medicine, Maastricht University, the Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University, the Netherlands
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Aldis R, Rosenfeld LC, Mulvaney-Day N, Lanca M, Zona K, Lam JA, Asfour J, Meltzer JC, Leff HS, Fulwiler C, Wang P, Progovac AM. Determinants of remote measurement-based care uptake in a safety net outpatient psychiatry department as part of learning health system transition. Learn Health Syst 2024; 8:e10416. [PMID: 38883875 PMCID: PMC11176570 DOI: 10.1002/lrh2.10416] [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: 10/31/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation. Methods This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites. Results Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients. Conclusions There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations.
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Affiliation(s)
- Rajendra Aldis
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Lisa C Rosenfeld
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Margaret Lanca
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Kate Zona
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Jeffrey A Lam
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Julia Asfour
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - Jonah C Meltzer
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - H Stephen Leff
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Carl Fulwiler
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Philip Wang
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Ana M Progovac
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
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Armoundas AA, Ahmad FS, Bennett DA, Chung MK, Davis LL, Dunn J, Narayan SM, Slotwiner DJ, Wiley KK, Khera R. Data Interoperability for Ambulatory Monitoring of Cardiovascular Disease: A Scientific Statement From the American Heart Association. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e000095. [PMID: 38779844 DOI: 10.1161/hcg.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Wearable devices are increasingly used by a growing portion of the population to track health and illnesses. The data emerging from these devices can potentially transform health care. This requires an interoperability framework that enables the deployment of platforms, sensors, devices, and software applications within diverse health systems, aiming to facilitate innovation in preventing and treating cardiovascular disease. However, the current data ecosystem includes several noninteroperable systems that inhibit such objectives. The design of clinically meaningful systems for accessing and incorporating these data into clinical workflows requires strategies to ensure the quality of data and clinical content and patient and caregiver accessibility. This scientific statement aims to address the best practices, gaps, and challenges pertaining to data interoperability in this area, with considerations for (1) data integration and the scope of measures, (2) application of these data into clinical approaches/strategies, and (3) regulatory/ethical/legal issues.
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Khatib R, Glowacki N, Chang E, Lauffenburger J, Pletcher MJ, Siddiqi A. Disparities in Patient Portal Engagement Among Patients With Hypertension Treated in Primary Care. JAMA Netw Open 2024; 7:e2411649. [PMID: 38748420 PMCID: PMC11096988 DOI: 10.1001/jamanetworkopen.2024.11649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Patient portals are increasingly used for patient-clinician communication and to introduce interventions aimed at improving blood pressure control. Objective To characterize patient portal use among patients with hypertension managed in primary care. Design, Settings, and Participants This retrospective cohort study used electronic health records linked with patient portal log file data from a large, diverse Midwestern health care system. Patients with hypertension who had a primary care visit from January 1, 2021, to December 31, 2021, were included. The first visit in 2021 was considered the baseline visit; patient portal engagement was evaluated during the following year. Multivariate logistic regressions, presented as odds ratios (ORs) and 95% CIs, were used to evaluate associations between patient characteristics and patient portal engagement, adjusting for potential confounders. Exposures Primary exposures included 4 sociodemographic factors routinely collected in the electronic health record: race and ethnicity, insurance, preferred language, and smoking status. Main Outcomes and Measures Indicators of patient engagement with the patient portal included accessing the patient portal at least once, accessing the portal within 7 days of at least 50.0% of primary care physician (PCP) visits, frequent logins (<28 vs ≥28), messaging (<2 vs ≥2), and sharing home blood pressure readings. Results Among 366 871 patients (mean [SD], 63.5 [12.6] years), 52.8% were female, 3.4% were Asian, 7.8% were Hispanic, 19.7% were non-Hispanic Black, 66.9% were non-Hispanic White, and 2.3% were of other race or ethnicity. During the 1-year study period starting in 2021, 70.5% accessed the patient portal at least once, 60.2% accessed around the time of their PCP visits, 35.7% accessed the portal frequently, 28.9% engaged in messaging, and 8.7% shared home blood pressure readings. Compared with White patients, non-Hispanic Black and Hispanic patients had lower odds of any access (Black: OR, 0.53; 95% CI, 0.52-0.54; Hispanic: OR, 0.66; 95% CI, 0.64-0.68), access around PCP visit time (Black: OR, 0.49; 95% CI, 0.48-0.50; Hispanic: OR, 0.62; 95% CI, 0.60-0.64), frequent access (Black: OR, 0.56; 95% CI, 0.55-0.57; Hispanic: OR, 0.71; 95% CI, 0.69-0.73), and messaging (Black: OR, 0.63; 95% CI, 0.61-0.64); Hispanic: OR, 0.71; 95% CI, 0.69-0.73). Conclusions and Relevance This cohort study of patients with hypertension found clear sociodemographic disparities in patient portal engagement among those treated in primary care. Without special efforts to engage patients with portals, interventions that use patient portals to target hypertension may exacerbate disparities.
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Affiliation(s)
- Rasha Khatib
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Eva Chang
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Julie Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Health, Rolling Meadows, Illinois
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Holder K, Feinglass J, Niznik C, Yee LM. Use of Electronic Patient Messaging by Pregnant Patients Receiving Prenatal Care at an Academic Health System: Retrospective Cohort Study. JMIR Mhealth Uhealth 2024; 12:e51637. [PMID: 38686560 PMCID: PMC11146248 DOI: 10.2196/51637] [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: 08/06/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024] Open
Abstract
Background The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals. Objective The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic. Methods This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system's Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ≥3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (≤5 messages), moderate (6-14 messages), or frequent (≥15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse. Results Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non-English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity. Conclusions Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging.
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Affiliation(s)
- Kai Holder
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Charlotte Niznik
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL, United States
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Smeekens L, Verburg AC, Maas M, van Heerde R, van Kerkhof A, van der Wees PJ. Feasibility of a quality-improvement program based on routinely collected health outcomes in Dutch primary care physical therapist practice: a mixed-methods study. BMC Health Serv Res 2024; 24:509. [PMID: 38658939 PMCID: PMC11040789 DOI: 10.1186/s12913-024-10958-5] [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: 07/27/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This study evaluates the feasibility of a nine-month advanced quality-improvement program aimed at enhancing the quality of care provided by primary care physical therapists in the Netherlands. The evaluation is based on routinely collected health outcomes of patients with nonspecific low back pain, assessing three feasibility domains: (1) appropriateness, feasibility, and acceptability for quality-improvement purposes; (2) impact on clinical performance; and (3) impact on learning and behavioral change. METHODS A mixed-methods quality-improvement study using a concurrent triangulation design was conducted in primary care physical therapist practice. Feedback reports on the processes and outcomes of care, peer assessment, and self-assessment were used in a Plan-Do-Study-Act cycle based on self-selected goals. The program's appropriateness, feasibility, and acceptability, as well as the impact on clinical performance, were evaluated using the Intervention Appropriate Measure, Feasibility Intervention Measure, Acceptability Intervention Measure (for these three measure, possible scores range from 4 to 20), and with a self-assessment of clinical performance (scored 0-10), respectively. The impact on learning and behavioral change was evaluated qualitatively with a directed content analysis. RESULTS Ten physical therapists from two practices participated in this study. They rated the program with a mean of 16.5 (SD 1.9) for appropriateness, 17.1 (SD 2.2) for feasibility, and 16.4 (SD 1.5) for acceptability. Participants gave their development in clinical performance a mean score of 6.7 (SD 1.8). Participants became aware of the potential value of using outcome data and gained insight into their own routines and motivations. They changed their data collection routines, implemented data in their routine practice, and explored the impact on their clinical behavior. CONCLUSIONS This explorative study demonstrated that a quality-improvement program, using health outcomes from a national registry, is judged to be feasible. IMPACT STATEMENT This study provides preliminary evidence on how physical therapists may use health outcomes to improve their quality, which can be further used in initiatives to improve outcome-based care in primary physical therapy.
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Affiliation(s)
- Lsf Smeekens
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands.
| | - A C Verburg
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - Mjm Maas
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - R van Heerde
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - A van Kerkhof
- Leidsche Rijn Julius Gezondheidscentra, Utrecht, The Netherlands
| | - P J van der Wees
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
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Porterfield L, Ram M, Kuo YF, Gaither ZM, O'Connell KP, Roy K, Bhardwaj N, Fingado E. Disparities in the Timeliness of Addressing Patient-Initiated Telephone Calls in a Primary Care Clinic: The Impact of Quality Improvement Interventions. HEALTH COMMUNICATION 2024:1-9. [PMID: 38567512 DOI: 10.1080/10410236.2024.2335056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A timely response to patient-initiated telephone calls can affect many aspects of patient health, including quality of care and health equity. Historically, at a family medicine residency clinic, at least 1 out of 4 patient calls remained unresolved three days after the call was placed. We sought to explore whether there were differential delays in resolution of patient concerns for certain groups and how these were affected by quality improvement interventions to increase responsiveness to patient calls. A multidisciplinary team at a primary care residency clinic applied Lean education and tools to improve the timeliness of addressing telephone encounters. Telephone encounter data were obtained for one year before and nine months after the intervention. Data were stratified by race, ethnicity, preferred language, sex, online portal activation status, age category, zip code, patient risk category, and reason for call. Stratified data revealed consistently worse performance on telephone encounter closure by 72 hours for Black/African American patients compared to Hispanic and non-Hispanic White patients pre-intervention. Interventions resulted in statistically significant overall improvement, with an OR of 2.9 (95% CI: 2.62 to 3.21). Though interventions did not target a specific population, pre-intervention differences based on race and ethnicity resolved post-intervention. Telephone calls serve as an important means of patient communication with care teams. General interventions to improve the timeliness of addressing telephone encounters can lead to sustainable improvement in a primary care academic clinic and may also alleviate disparities.
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Affiliation(s)
| | - Mythili Ram
- System Optimization & Performance, University of Texas Medical Branch
| | - Yong Fang Kuo
- Department of Biostatistics and Data Science, University of Texas Medical Branch
| | - Zanita M Gaither
- Department of Family Medicine, University of Texas Medical Branch
| | | | - Khushali Roy
- School of Medicine, University of Texas Medical Branch
| | - Namita Bhardwaj
- Department of Family Medicine, University of Texas Medical Branch
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch
| | - Elizabeth Fingado
- System Optimization & Performance, University of Texas Medical Branch
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Wang J, Goldberg JE, Block T, Ostrow D, Carbone D, Recht M, Doshi A. Patterns of Access to Radiology Reports and Images Through a Patient Portal. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:504-509. [PMID: 38315344 PMCID: PMC11031551 DOI: 10.1007/s10278-024-00996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 02/07/2024]
Abstract
Access to radiology reports and images through a patient portal offers several advantages. The purpose of this study was to characterize patient's interactions with their radiology results. This was a retrospective study that evaluated radiography, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, exams performed between July 2020 and June 2021 for patients aged 12 and older. Exam information, access logs of radiology reports and images, and patient demographics were obtained from the electronic health record and image viewing software. Descriptive statistics were computed. The study included 1,685,239 exams. A total of 54.1% of reports were viewed. MRI and PET reports were viewed with the greatest frequency (70.2% and 67.6%, respectively); 25.5% of exam images were viewed, with the greatest frequency for MRI (40.1%). Exams were shared a total of 17,095 times and downloaded 8409 times; 64% of reports were viewed for patients aged 18-39 and 34% for patients aged 80 and greater. The rate of reports viewed was greater for patients with English as their preferred language (57.1%) compared to other languages (33.3%). Among those viewed, 56.5% of reports and 48.2% of images were viewed multiple times; 72.8% of images were viewed on smartphones, 25.8% on desktop computers, and 1.4% on tablets. Patients utilize a portal to view reports and view and share images. Continued efforts are warranted to promote the use of portals and create patient-friendly imaging results to help empower patients.
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Affiliation(s)
- Jason Wang
- Department of Radiology, New York University Langone Health, New York, NY, USA.
| | - Julia E Goldberg
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Tobias Block
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Dana Ostrow
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Dan Carbone
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Michael Recht
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Ankur Doshi
- Department of Radiology, New York University Langone Health, New York, NY, USA
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Bogulski CA, Andersen JA, Eswaran S, Willis DE, Edem D, McElfish PA. Factors Associated with Online Patient Portal Utilization Experience in an Arkansas Phone Survey. Telemed J E Health 2024; 30:e1148-e1156. [PMID: 38011711 PMCID: PMC11035923 DOI: 10.1089/tmj.2023.0490] [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: 09/19/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
Introduction: Accessing electronic health record information through a patient portal is associated with numerous benefits to both health care providers and patients. However, patient portal utilization remains low. Little is known about the factors associated with patient portal utilization following the onset of the COVID-19 pandemic. Methods: In March 2022, we conducted a random digit dial phone survey of both cell phones and landlines of adults living in Arkansas that asked numerous demographic and health-related measures, including patient portal utilization in the past 12 months. A total of 2,201 adult Arkansans completed the survey between March 1 and March 28, 2022. Weighted estimates were generated using rank ratio estimation to approximate the 2019 American Community Survey 1-year Arkansas estimates for race/ethnicity (72% White, 15% Black/African American, 7.8% Hispanic, 4.9% other race/ethnicity), age (73% 18-39, 32% 40-59, and 31% 60+), and gender (49% male, 51% female). We fit the data to a logistic regression model. Results: We found that education, employment, prior telehealth experience, having a check-up in the past 2 years, and having a primary care provider were all positively associated with patient portal utilization. We also found that non-Hispanic Black/African-American respondents were less likely to access a patient portal relative to non-Hispanic White respondents. Discussion: Patient portal utilization is related to several demographic and health-related factors among an adult population in Arkansas. Given that the documented benefits of patient portal utilization are broad, under-utilization by groups that already experience relatively worse health outcomes could reproduce or even exacerbate existing health disparities. Additional research is needed to further investigate what barriers to patient portal utilization remain for these populations.
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Affiliation(s)
- Cari A. Bogulski
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Surabhee Eswaran
- Department of Environmental Studies, Tulane University, New Orleans, Louisiana, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
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Azar R, Chan R, Sarkisian M, Burns RD, Marcin JP, Gotthardt C, De Guzman KR, Rosenthal JL, Haynes SC. Adapting telehealth to address health equity: Perspectives of primary care providers across the United States. J Telemed Telecare 2024:1357633X241238780. [PMID: 38515372 DOI: 10.1177/1357633x241238780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Telehealth has the potential to increase access to care for medically underserved patients. This qualitative study aimed to identify telecare practices used during the COVID-19 pandemic to meet the needs of patients experiencing homelessness, patients with disabilities, and patients with language preference other than English (LOE). METHODS We conducted a secondary qualitative data analysis of 47 clinician interviews at Federally Qualified Health Centers (FQHCs) around the country. Using thematic analysis, transcripts were coded by line-by-line by five qualitative researchers. A multidisciplinary team of telehealth experts, researchers and primary care clinicians reviewed memos and excerpts to generate major themes. RESULTS We identified six main areas demonstrating how community providers developed strategies or practices to improve access to care for vulnerable patients: reaching patients experiencing homelessness, serving deaf and hard of hearing patients, improving access for patients with disabilities, serving patients with LOE, improving access for mental and behavioral health services, and educating patients about telehealth. During the pandemic, FQHCs developed innovative solutions to provide access to care for the unhoused, including using telehealth in shelters, vans, and distributing devices like mobile phones and tablets. Telehealth reduced transportation burdens for patients with disabilities and reduced no-show rates for mental health services by adapting group therapy via telehealth features (like break-out rooms) and increasing provider capacity. CONCLUSION Our study identified strategies adopted by FQHCs to serve underserved populations during the COVID-19 pandemic. Our findings highlight the need for enduring strategies to improve health equity through telehealth..
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Affiliation(s)
- Rachel Azar
- UC Davis School of Medicine, Sacramento, CA, USA
| | - Rachel Chan
- UC Davis School of Medicine, Sacramento, CA, USA
| | | | | | - James P Marcin
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
| | | | - Keshia R De Guzman
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Jennifer L Rosenthal
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
| | - Sarah C Haynes
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
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12
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [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: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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13
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Schwartz MLB, McDonald WS, Hallquist MLG, Hu Y, McCormick CZ, Walters NL, Tsun J, Zimmerman K, Decker A, Gray C, Malinowski J, Sturm AC, Buchanan AH. Genetics Visit Uptake Among Individuals Receiving Clinically Actionable Genomic Screening Results. JAMA Netw Open 2024; 7:e242388. [PMID: 38488794 PMCID: PMC10943406 DOI: 10.1001/jamanetworkopen.2024.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/23/2024] [Indexed: 03/18/2024] Open
Abstract
Importance Screening unselected populations for clinically actionable genetic disease risk can improve ascertainment and facilitate risk management. Genetics visits may encourage at-risk individuals to perform recommended management, but little has been reported on genetics visit completion or factors associated with completion in genomic screening programs. Objective To identify factors associated with postdisclosure genetics visits in a genomic screening cohort. Design, Setting, and Participants This was a cohort study of biobank data in a health care system in central Pennsylvania. Participants' exome sequence data were reviewed for pathogenic or likely pathogenic (P/LP) results in all genes on the American College of Medical Genetics and Genomics Secondary Findings list. Clinically confirmed results were disclosed by phone and letter. Participants included adult MyCode biobank participants who received P/LP results between July 2015 and November 2019. Data were analyzed from May 2021 to March 2022. Exposure Clinically confirmed P/LP result disclosed by phone or letter. Main Outcomes and Measures Completion of genetics visit in which the result was discussed and variables associated with completion were assessed by electronic health record (EHR) review. Results Among a total of 1160 participants (703 [60.6%] female; median [IQR] age, 57.0 [42.1-68.5] years), fewer than half of participants (551 of 1160 [47.5%]) completed a genetics visit. Younger age (odds ratio [OR] for age 18-40 years, 2.98; 95% CI, 1.40-6.53; OR for age 41-65 years, 2.36; 95% CI, 1.22-4.74; OR for age 66-80 years, 2.60; 95% CI, 1.41-4.98 vs age ≥81 years); female sex (OR, 1.49; 95% CI, 1.14-1.96); being married (OR, 1.74; 95% CI, 1.23-2.47) or divorced (OR, 1.80; 95% CI, 1.11-2.91); lower Charlson comorbidity index (OR for score of 0-2, 1.76; 95% CI, 1.16-2.68; OR for score of 3-4, 1.73; 95% CI, 1.18-2.54 vs score of ≥5); EHR patient portal use (OR, 1.42; 95% CI, 1.06-1.89); living closer to a genetics clinic (OR, 1.64; 95% CI, 1.14-2.36 for <8.9 miles vs >20.1 miles); successful results disclosure (OR for disclosure by genetic counselor, 16.32; 95% CI, 8.16-37.45; OR for disclosure by research assistant, 20.30; 95% CI, 10.25-46.31 vs unsuccessful phone disclosure); and having a hereditary cancer result (OR, 2.13; 95% CI, 1.28-3.58 vs other disease risk) were significantly associated with higher rates of genetics visit completion. Preference to follow up with primary care was the most common reported reason for declining a genetics visit (68 of 152 patients [44.7%]). Conclusions and Relevance This cohort study of a biobank-based population genomic screening program suggests that targeted patient engagement, improving multidisciplinary coordination, and reducing barriers to follow-up care may be necessary for enhancing genetics visit uptake.
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Affiliation(s)
- Marci L. B. Schwartz
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | | | | | - Jessica Tsun
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | | | - Amie Decker
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- University of Arkansas Medical Sciences, Little Rock
| | - Celia Gray
- Phenomics and Clinical Data Core, Geisinger, Danville, Pennsylvania
| | | | - Amy C. Sturm
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- 23andMe, Sunnyvale, California
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Nabil Y, Eldaw A, El-Shourbagy D, Ibrahim D, Alturkistani H, Alshahrani M, Farghaly M, AlMadhi S, Mansour R. Unmet Needs and Strategies to Promote Patient Engagement in the Arab World: Experts' Opinion. Cureus 2024; 16:e56804. [PMID: 38654792 PMCID: PMC11036113 DOI: 10.7759/cureus.56804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The significance of patient engagement (PE) is widely acknowledged as a crucial element in fostering positive health outcomes, elevating care quality, and streamlining healthcare systems. Despite its recognized advantages, the level of patient engagement in Arab nations remains suboptimal. METHODS A high-level assembly was convened in Dubai with 11 distinguished patient advocates from diverse Arab countries. Their collective aim was to dissect the obstacles hindering patient engagement in the Arab world and propose pragmatic strategies to surmount them. First, a series of five open-ended, comprehensive questions were posed and thoroughly deliberated upon. Second, the barriers to patient engagement within the experts' respective communities were debated. A qualitative thematic analysis was conducted and two reports were generated by two independent researchers from the original meeting recordings. RESULTS This paper highlights the importance of patient engagement in advancing healthcare and categorizes barriers to patient engagement as patient-related, provider-related, or system/government-related. The experts identified the primary gaps in patient engagement and proposed strategies to promote it, with a primary focus on motivating both patients and providers toward shared decision-making. CONCLUSIONS This paper amalgamates the insights and recommendations distilled from the expert gathering, juxtaposing them within the broader context of existing literature on patient engagement. Offering a comprehensive viewpoint, this article delves into the challenges and opportunities intrinsic to bolstering patient engagement in the Arab world. Moreover, it spotlights invaluable tools often overlooked within Arab countries. The practical insights provided here can serve as a roadmap for administrators and decision-makers, providing guidance to enhance patient engagement on both a national and institutional scale.
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Affiliation(s)
- Yehia Nabil
- Medical Affairs, Gilead Sciences Inc., Dubai, ARE
| | - Anwar Eldaw
- Infectious Disease/Public Health and Preventive Medicine, Ministry of Health, Riyadh, SAU
| | | | - Dima Ibrahim
- Transplant Infectious Diseases, Burjeel Medical Center, Abu Dhabi, ARE
| | | | - Mohammed Alshahrani
- Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, SAU
| | - Mohamed Farghaly
- Family Medicine/Public Health, Dubai Medical College, Dubai, ARE
| | - Sawsan AlMadhi
- Advocacy, AlignnEficient Health Consultancies, Dubai, ARE
| | - Romy Mansour
- Ophthalmology, Lebanese American University Medical Center-Rizk Hospital, Beirut, LBN
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15
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Upadhyay S, Bhandari N. Patient Engagement Functionalities' Influence on Quality Outcomes: The Road via EHR Presence. J Healthc Manag 2024; 69:118-131. [PMID: 38467025 DOI: 10.1097/jhm-d-23-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
GOAL Patients engaged in self-care through information technology can potentially improve the quality of healthcare they receive. This study aimed to examine how electronic health record (EHR) system functionalities help hospitals mediate the impact of patient engagement on quality outcomes-notably, readmission rates. METHODS A pooled cross-sectional study design employed data containing 3,547 observations from general acute care hospitals (2014-2018). The breadth of patient engagement functionalities adopted by a hospital was used as the independent variable and the degree of EHR presence was used as the mediating variable. Mean time to readmission for acute myocardial infarction (AMI), pneumonia, and heart failure were the dependent variables. The Baron and Kenny method was used to test mediation. PRINCIPAL FINDINGS Patient engagement was associated with reduced AMI readmission rates both directly and via EHR system presence. Mediation effects were present, in that a 1-unit increase in patient engagement through EHR system presence was associated with a 0.33% decrease in AMI readmission rates (p < .05). For other disease categories (heart failure and pneumonia), a significant effect was not found. PRACTICAL APPLICATIONS For hospitals with a comprehensive EHR system, patient engagement through information technology can potentially reduce readmission rates for some diseases. More research is needed to determine which specific clinical conditions are amenable to quality improvement through patient engagement. Synergies between patient engagement functionalities and an EHR system positively affect quality outcomes. Therefore, practitioners and hospital managers should leverage hospital investments made in their EHR system infrastructure and use it to engage patients in self-care.
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Affiliation(s)
| | - Neeraj Bhandari
- School of Public Health, University of Nevada, Las Vegas, Nevada
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16
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O'Sullivan-Steben K, Galarneau L, Judd S, Laizner AM, Williams T, Kildea J. Design and implementation of a prototype radiotherapy menu in a patient portal. J Appl Clin Med Phys 2024; 25:e14201. [PMID: 37942985 DOI: 10.1002/acm2.14201] [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: 10/03/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Radiotherapy patients often face undue anxiety due to misconceptions about radiation and their inability to visualize their upcoming treatments. Access to their personal treatment plans is one way in which pre-treatment anxiety may be reduced. But radiotherapy data are quite complex, requiring specialized software for display and necessitating personalized explanations for patients to understand them. Therefore, our goal was to design and implement a novel radiotherapy menu in a patient portal to improve patient access to and understanding of their radiotherapy treatment plans. METHODS A prototype radiotherapy menu was developed in our institution's patient portal following a participatory stakeholder co-design methodology. Customizable page templates were designed to render key radiotherapy data in the portal's patient-facing mobile phone app. DICOM-RT data were used to provide patients with relevant treatment parameters and generate pre-treatment 3D visualizations of planned treatment beams, while the mCODE data standard was used to provide post-treatment summaries of the delivered treatments. A focus group was conducted to gather initial patient feedback on the menu. RESULTS Pre-treatment: the radiotherapy menu provides patients with a personalized treatment plan overview, including a personalized explanation of their treatment, along with an interactive 3D rendering of their body, and treatment beams for visualization. Post-treatment: a summary of the delivered radiotherapy is provided, allowing patients to retain a concise personal record of their treatment that can easily be shared with future healthcare providers. Focus group feedback was overwhelmingly positive. Patients highlighted how the intuitive presentation of their complex radiotherapy data would better prepare them for their radiation treatments. CONCLUSIONS We successfully designed and implemented a prototype radiotherapy menu in our institution's patient portal that improves patient access to and understanding of their radiotherapy data. We used the mCODE data standard to generate post-treatment summaries in a way that is easily shareable and interoperable.
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Affiliation(s)
| | - Luc Galarneau
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Susie Judd
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea M Laizner
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Tristan Williams
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
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17
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Bell SK, Amat MJ, Anderson TS, Aronson MD, Benneyan JC, Fernandez L, Ricci DA, Salant T, Schiff GD, Shafiq U, Singer SJ, Sternberg SB, Zhang C, Phillips RS. Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study. J Am Med Inform Assoc 2024; 31:622-630. [PMID: 38164964 PMCID: PMC10873783 DOI: 10.1093/jamia/ocad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES The 2021 US Cures Act may engage patients to help reduce diagnostic errors/delays. We examined the relationship between patient portal registration with/without note reading and test/referral completion in primary care. MATERIALS AND METHODS Retrospective cohort study of patients with visits from January 1, 2018 to December 31, 2021, and order for (1) colonoscopy, (2) dermatology referral for concerning lesions, or (3) cardiac stress test at 2 academic primary care clinics. We examined differences in timely completion ("loop closure") of tests/referrals for (1) patients who used the portal and read ≥1 note (Portal + Notes); (2) those with a portal account but who did not read notes (Portal Account Only); and (3) those who did not register for the portal (No Portal). We estimated the predictive probability of loop closure in each group after adjusting for socio-demographic and clinical factors using multivariable logistic regression. RESULTS Among 12 849 tests/referrals, loop closure was more common among Portal+Note-readers compared to their counterparts for all tests/referrals (54.2% No Portal, 57.4% Portal Account Only, 61.6% Portal+Notes, P < .001). In adjusted analysis, compared to the No Portal group, the odds of loop closure were significantly higher for Portal Account Only (OR 1.2; 95% CI, 1.1-1.4), and Portal+Notes (OR 1.4; 95% CI, 1.3-1.6) groups. Beyond portal registration, note reading was independently associated with loop closure (P = .002). DISCUSSION AND CONCLUSION Compared to no portal registration, the odds of loop closure were 20% higher in tests/referrals for patients with a portal account, and 40% higher in tests/referrals for note readers, after controlling for sociodemographic and clinical factors. However, important safety gaps from unclosed loops remain, requiring additional engagement strategies.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Maelys J Amat
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Timothy S Anderson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Mark D Aronson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston, MA 02115, United States
| | - Leonor Fernandez
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Dru A Ricci
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
| | - Talya Salant
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Bowdoin Street Health Center, Dorchester, MA 02122, United States
| | - Gordon D Schiff
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Umber Shafiq
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Sara J Singer
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Scot B Sternberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Cancan Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Russell S Phillips
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
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18
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Aldosari B. Information Technology and Value-Based Healthcare Systems: A Strategy and Framework. Cureus 2024; 16:e53760. [PMID: 38465150 PMCID: PMC10921131 DOI: 10.7759/cureus.53760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Value-based healthcare offers a pathway for enhancing patient satisfaction and population health and reducing healthcare costs. In addition, it provides a means to enhance physicians' perception and experience in healthcare delivery. The foundation of the said system is the notion that community wellness can only be benefited when the health effects of many people are also addressed. The provision of healthcare services incurs costs. However, a value-based model addresses this issue by establishing teams that cater to individuals with similar needs. This approach fosters expertise and efficiency, ultimately leading to cost savings without rationing. Furthermore, entrusting decision-making authority regarding healthcare delivery to the clinical team enhances doctors' professionalism and the integrity of clinician-patient interactions, resulting in more effective and relevant treatments. Currently, various information technology (IT)-based solutions are the main focus for accomplishing the desired value-based healthcare system. The establishment of a coordinated framework that can help organizations create value-based healthcare systems is covered in the current article. Additionally listed are many IT-based solutions used to create a value-based healthcare system.
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Affiliation(s)
- Bakheet Aldosari
- Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, SAU
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Hegeman P, Vader D, Kamke K, El-Toukhy S. Patterns of digital health access and use among US adults: A latent class analysis. RESEARCH SQUARE 2024:rs.3.rs-3895228. [PMID: 38352382 PMCID: PMC10862941 DOI: 10.21203/rs.3.rs-3895228/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Background Digital technologies allow users to engage in health-related behaviors associated with positive outcomes. We aimed to identify classes of US adults with distinct digital technologies access and health use patterns and characterize class composition. Data came from Health Information National Trends Survey Wave 5 Cycles 1-4, a nationally representative cross-sectional survey of US adults ( N = 13,993). We used latent class analysis to identify digital technologies access and health use patterns based on 32 behaviors and access to requisite technologies and platforms that include the internet, internet-enabled devices, health monitors, and electronic health records (EHRs). We ran a multinomial logistic regression to identify sociodemographic and health correlates of class membership ( n = 10,734). Results Ten classes captured patterns of digital technology access and health use among US adults. This included a digitally isolated, a mobile-dependent, and a super user class, which made up 8.9%, 7.8%, and 13.6% of US adults, respectively, and captured access patterns from only basic cellphones and health monitors to near complete access to web-, mobile-, and EHR-based platforms. Half of US adults belonged to classes that lacked access to EHRs and relied on alternative web-based tools typical of patient portals. The proportion of class members who used digital technologies for health purposes varied from small to large. Older and less educated adults had lower odds of belonging to classes characterized by access or engagement in health behaviors. Hispanic and Asian adults had higher odds of belonging to the mobile-dependent class. Individuals without a regular healthcare provider and those who had not visited a provider in the past year were more likely to belong to classes with limited digital technologies access or health use. Discussion Only one third of US adults belonged to classes that had near complete access to digital technologies and whose members engaged in almost all health behaviors examined. Sex, age, and education were associated with membership in classes that lacked access to 1 + digital technologies or exhibited none to limited health uses of such technologies. Results can guide efforts to improve access and health use of digital technologies to maximize associated health benefits and minimize disparities.
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20
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Tengilimoğlu D, Orhan F, Şenel Tekin P, Younis M. Analysis of Publications on Health Information Management Using the Science Mapping Method: A Holistic Perspective. Healthcare (Basel) 2024; 12:287. [PMID: 38338175 PMCID: PMC10855699 DOI: 10.3390/healthcare12030287] [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: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE In the age of digital transformation, there is a need for a sustainable information management vision in health. Understanding the accumulation of health information management (HIM) knowledge from the past to the present and building a new vision to meet this need reveals the importance of understanding the available scientific knowledge. With this research, it is aimed to examine the scientific documents of the last 40 years of HIM literature with a holistic approach using science mapping techniques and to guide future research. METHODS This study used a bibliometric analysis method for science mapping. Co-citation and co-occurrence document analyses were performed on 630 academic publications selected from the Web of Science core collection (WoSCC) database using the keyword "Health Information Management" and inclusion criteria. The analyses were performed using the R-based software Bibliometrix (Version 4.0; K-Synth Srl), Python (Version 3.12.1; The Python Software Foundation), and Microsoft® Excel® 2016. RESULTS Co-occurrence analyses revealed the themes of personal health records, clinical coding and data quality, and health information management. The HIM theme consisted of five subthemes: "electronic records", "medical informatics", "e-health and telemedicine", "health education and awareness", and "health information systems (HISs)". As a result of the co-citation analysis, the prominent themes were technology acceptance, standardized clinical coding, the success of HISs, types of electronic records, people with HIM, health informatics used by consumers, e-health, e-mobile health technologies, and countries' frameworks and standards for HISs. CONCLUSIONS This comprehensive bibliometric study shows that structured information can be helpful in understanding research trends in HIM. This study identified critical issues in HIM, identified meaningful themes, and explained the topic from a holistic perspective for all health system actors and stakeholders who want to work in the field of HIM.
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Affiliation(s)
- Dilaver Tengilimoğlu
- School of Business, Department of Business, Atılım University, 06830 Ankara, Türkiye;
| | - Fatih Orhan
- Gülhane Vocational School of Health, University of Health Sciences, 06010 Ankara, Türkiye;
| | - Perihan Şenel Tekin
- Vocational School of Health Services, Ankara University, 06290 Ankara, Türkiye
| | - Mustafa Younis
- School of Public Health, Jackson State University, Jackson, MS 39213, USA;
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Fridriksdottir N, Ingadottir B, Skuladottir K, Zoëga S, Gunnarsdottir S. Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study. JMIR Form Res 2023; 7:e50550. [PMID: 38015268 PMCID: PMC10770793 DOI: 10.2196/50550] [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: 07/04/2023] [Revised: 09/22/2023] [Accepted: 11/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. OBJECTIVE This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. METHODS This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System-Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. RESULTS The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=-.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=-.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. CONCLUSIONS This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted.
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Affiliation(s)
- Nanna Fridriksdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Kristin Skuladottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigridur Zoëga
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Sigridur Gunnarsdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
- Cancer Registry, The Icelandic Cancer Society, Reykjavik, Iceland
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22
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Kwok A, Cheung D, Gordon M, Mudryk E, Manns PJ. Patient and therapist perspectives on physical therapy outcome measures and engagement after stroke: A case study. Physiother Theory Pract 2023; 39:2639-2650. [PMID: 35786128 DOI: 10.1080/09593985.2022.2092801] [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: 10/27/2021] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Outcome measures are highly recommended in stroke physical therapy, however, most of the existing research has been performed from the provider perspective. Understanding the patient perspective of outcome measures in conjunction with the therapist perspective may help to better support patient engagement and autonomy. PURPOSE The purpose of this study was to explore patient and therapist perspectives on physical therapy outcome measures post-stroke. METHODS This qualitative case study of a Canadian rehabilitation facility is based on patient-oriented research principles, with three patient partners embedded in the research team. Data collection included chart reviews, observations of physical therapy sessions, patient interviews, and therapist interviews. Field notes of observations and interview transcripts were analyzed using thematic analysis. RESULTS Ten patients and seven therapists participated. Analysis revealed the following two themes: 1) tracking progress; and 2) partnership. Tracking progress included the expectations patients had for improvement, the importance of objectively measuring change and the functional improvement observed day by day. Partnership described the relationship between therapist and patient including communication, encouragement and affirmation, the therapist as expert and the gradual shift in autonomy from therapist to patient. CONCLUSION Patients valued the objective results of outcome measures and were encouraged by measurable changes. Maximizing the use of physical therapy outcome measures may improve patient engagement and support relational autonomy.
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Affiliation(s)
- Alyson Kwok
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Healthcare Improvement Team, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Deacon Cheung
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maysyn Gordon
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Evan Mudryk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Matthews AK, Steffen A, Burke L, Harris Vilona B, Donenberg G. MiQuit: A Study Protocol to Link Low-Income Smokers to a State Tobacco Quitline. Ethn Dis 2023; DECIPHeR:44-51. [PMID: 38846727 PMCID: PMC11099521 DOI: 10.18865/ed.decipher.44] [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] [Indexed: 06/09/2024] Open
Abstract
Purpose To conduct a randomized controlled trial to compare 3 implementation strategies and the impact of facilitated referrals on linkage of Federally Qualified Health Center patients to the Illinois Tobacco Quitline (ITQL). Methods This study will be a hybrid type 3 implementation-effectiveness trial guided by 2 implementation science frameworks: reach, effectiveness, adoption, implementation, and maintenance and exploration preparation implementation sustainment. We will evaluate whether sending provider messages through the patient electronic health portal increases patient linkage to the ITQL. We will (1) randomly assign all eligible patients to receive 1 of 3 messages (information about quitting, advice to quit, and advice to quit or cut down), and (2) we will offer a facilitated linkage to the ITQL. For patients who opt into a facilitated referral, we will share their contact information with the ITQL, who will contact them. Four weeks after the initial message, patients who expressed interest in services but were not reached by the ITQL will be rerandomized to 1 of 2 arms, an offer to reconnect to the ITQL or an offer to engage a peer navigator who can help them reconnect to the ITQL. We will assess the implementation strategies' reach, adoption, linkage, and sustainability with the ITQL. Discussion This study will provide a new cost-effective and efficient model to link low-income smokers to state tobacco quitlines. Message delivery via patient health portals has important implications for addressing other tobacco-related morbidities.
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Affiliation(s)
- Alicia K. Matthews
- Behavioral Science, School of Nursing, Columbia University, New York, NY
| | - Alana Steffen
- College of Nursing, The University of Illinois Chicago, Chicago, IL
| | - Larisa Burke
- College of Nursing, The University of Illinois Chicago, Chicago, IL
| | - Brittany Harris Vilona
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL
| | - Geri Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL
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24
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Madanian S, Nakarada-Kordic I, Reay S, Chetty T. Patients' perspectives on digital health tools. PEC INNOVATION 2023; 2:100171. [PMID: 37384154 PMCID: PMC10294099 DOI: 10.1016/j.pecinn.2023.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
Objective Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake. Methods A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively. Results Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology. Conclusion Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies. Innovation Participatory design approaches have the potential to support the creation of patient-centred digital health tools.
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Affiliation(s)
- Samaneh Madanian
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), 6 St. Paul Street, AUT WZ Building, Auckland 1010, New Zealand
| | - Ivana Nakarada-Kordic
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
| | - Stephen Reay
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
| | - T'heniel Chetty
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
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25
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Villalobos-Quesada M, Ho K, Chavannes NH, Talboom-Kamp EPWA. Direct-to-patient digital diagnostics in primary care: Opportunities, challenges, and conditions necessary for responsible digital diagnostics. Eur J Gen Pract 2023; 29:2273615. [PMID: 37947197 PMCID: PMC10653613 DOI: 10.1080/13814788.2023.2273615] [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: 04/04/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Diagnostics are increasingly shifting to patients' home environment, facilitated by new digital technologies. Digital diagnostics (diagnostic services enabled by digital technologies) can be a tool to better respond to the challenges faced by primary care systems while aligning with patients' and healthcare professionals' needs. However, it needs to be clarified how to determine the success of these interventions. OBJECTIVES We aim to provide practical guidance to facilitate the adequate development and implementation of digital diagnostics. STRATEGY Here, we propose the quadruple aim (better patient experiences, health outcomes and professional satisfaction at lower costs) as a framework to determine the contribution of digital diagnostics in primary care. Using this framework, we critically analyse the advantages and challenges of digital diagnostics in primary care using scientific literature and relevant casuistry. RESULTS Two use cases address the development process and implementation in the Netherlands: a patient portal for reporting laboratory results and digital diagnostics as part of hybrid care, respectively. The third use case addresses digital diagnostics for sexually transmitted diseases from an international perspective. CONCLUSIONS We conclude that although evidence is gathering, the often-expected value of digital diagnostics needs adequate scientific evidence. We propose striving for evidence-based 'responsible digital diagnostics' (sustainable, ethically acceptable, and socially desirable digital diagnostics). Finally, we provide a set of conditions necessary to achieve it. The analysis and actionable guidance provided can improve the chance of success of digital diagnostics interventions and overall, the positive impact of this rapidly developing field.
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Affiliation(s)
- María Villalobos-Quesada
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kendall Ho
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Cloud Innovation Centre for Community Health and Wellbeing, University of British Columbia, Vancouver, Canada
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - Esther PWA Talboom-Kamp
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
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26
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Kc S, Tewolde S, Laverty AA, Costelloe C, Papoutsi C, Reidy C, Gudgin B, Shenton C, Majeed A, Powell J, Greaves F. Uptake and adoption of the NHS App in England: an observational study. Br J Gen Pract 2023; 73:e932-e940. [PMID: 37783512 PMCID: PMC10562999 DOI: 10.3399/bjgp.2022.0150] [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: 05/29/2022] [Accepted: 05/30/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Technological advances have led to the use of patient portals that give people digital access to their personal health information. The NHS App was launched in January 2019 as a 'front door' to digitally enabled health services. AIM To evaluate patterns of uptake of the NHS App, subgroup differences in registration, and the impact of COVID-19. DESIGN AND SETTING An observational study using monthly NHS App user data at general-practice level in England was conducted. METHOD Descriptive statistics and time-series analysis explored monthly NHS App use from January 2019-May 2021. Interrupted time-series models were used to identify changes in the level and trend of use of different functionalities, before and after the first COVID-19 lockdown. Negative binomial regression assessed differences in app registration by markers of general-practice level sociodemographic variables. RESULT Between January 2019 and May 2021, there were 8 524 882 NHS App downloads and 4 449 869 registrations, with a 4-fold increase in App downloads when the COVID Pass feature was introduced. Analyses by sociodemographic data found 25% lower registrations in the most deprived practices (P<0.001), and 44% more registrations in the largest sized practices (P<0.001). Registration rates were 36% higher in practices with the highest proportion of registered White patients (P<0.001), 23% higher in practices with the largest proportion of 15-34-year-olds (P<0.001) and 2% lower in practices with highest proportion of people with long-term care needs (P<0.001). CONCLUSION The uptake of the NHS App substantially increased post-lockdown, most significantly after the NHS COVID Pass feature was introduced. An unequal pattern of app registration was identified, and the use of different functions varied. Further research is needed to understand these patterns of inequalities and their impact on patient experience.
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Affiliation(s)
- Sukriti Kc
- Department of Primary Care and Public Health, Imperial College London
| | - Salina Tewolde
- Department of Primary Care and Public Health, Imperial College London
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Claire Reidy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Bernard Gudgin
- Patient and public involvement representative and a member of the University of Oxford Advanced Research Computing board
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, UK
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27
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Conroy M, Kamaraju S, Powell M, Harris A, Beckius A, Nagavally S, Dawson A, Min H, Wright T, Wainaina N, Binder AF. Racial and Ethnic Differences in the Use of Electronic Medical Record Messaging Among Patients With Breast Cancer: A Quality Improvement Study. Clin Breast Cancer 2023; 23:e434-e440. [PMID: 37482498 DOI: 10.1016/j.clbc.2023.07.001] [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: 05/25/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Despite evidence that use of electronic medical record (EMR) messaging positively impacts patients with cancer, there is little research on utilization patterns. The objective of this study is to describe the use of EMR messaging among breast cancer patients so that future interventions may be developed and targeted appropriately. MATERIALS AND METHODS Sociodemographic and MyChart usage data were collected. Study eligibility included patients who completed a visit at an academic breast center and sent at least one message to a provider during the study period (May 2021-May 2022). Chi-square and t-tests were used to describe differences between users and nonusers of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity. RESULTS A total of 4069 patients with activated MyChart accounts were included in the analysis. About 3575 (87.9%) were messaging users and 494 (12.1%) were nonusers. The mean age of users was significantly lower compared to the nonusers (57.7 vs 61.2, P< .001). Compared to non-Hispanic White (NHW) individuals, non-Hispanic Black (NHB) (odds ratio [OR]: 0.38, CI [0.21, 0.37]) and Hispanic individuals (OR: 0.35, CI [0.22, 0.57]) were significantly less likely to use electronic messaging. There were statistically significant racial/ethnic differences in the types of messages sent among EMR users. CONCLUSION Our study shows disparate EMR messaging utilization based on age, race, and primary language. As the availability of patient portals and electronic messaging increase, it is important to understand the barriers that patients face so that they can be addressed.
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Affiliation(s)
| | - Sailaja Kamaraju
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Froedtert Hospital, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Anna Beckius
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sneha Nagavally
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Aprill Dawson
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Heun Min
- Medical College of Wisconsin, Milwaukee, WI
| | | | - Njeri Wainaina
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Adam F Binder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Kuppanda PM, Jenkins J. Evaluation of Experiences and Attitudes of Patients Towards Patient Portal-Enabled Access to Their Health Information or Medical Records: A Qualitative Grounded Theory Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1080-1090. [PMID: 37575030 PMCID: PMC10552347 DOI: 10.1177/10497323231192379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The demand for patient-centred care and patient engagement in their healthcare has driven patient portal introduction. The widespread adoption and use of patient portals, however, has been a rather slow process in the United Kingdom. Hence, a limited number of studies have explored patient perceptions and experiences of general portal use, which forms a foundation for successful implementation of a portal. This study, therefore, focuses on the experiences and attitudes of patients regarding use of patient portals and access to their health information. It further explores various factors perceived by patients that may influence portal use and uptake. The overall findings from this study highlight positive patient perceptions of portal use. Nevertheless, it demonstrates various areas of improvement essential to ensure future success of portal implementation and acceptance.
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Affiliation(s)
| | - Judy Jenkins
- Swansea University Medical School, Sketty, Swansea, Wales, UK
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29
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Zhao X, Cai X, Malterud A. Framing Effects in Youth E-Cigarette Use Prevention: Individual Text Messages Versus Simulated Text Exchanges. HEALTH EDUCATION & BEHAVIOR 2023; 50:683-692. [PMID: 36722218 DOI: 10.1177/10901981221148965] [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] [Indexed: 02/02/2023]
Abstract
Electronic cigarettes are the most widely used tobacco product among youth in the United States. Although rapidly growing, research on effective message strategies for e-cigarette use prevention is still limited. This study examined the relative effectiveness of gain framing versus loss framing in youth-targeting prevention text messages delivered either as individual expository texts or simulated text exchanges between a youth patient and a pediatrician. A national sample of 1,084 youth susceptible to future e-cigarette use was randomized to condition in an online message testing experiment featuring a 2 (framing: gain vs. loss) × 2 (format: individual texts vs. simulated exchange) factorial design. Results revealed a consistent interaction between framing and messaging format in message liking, positive affect, attitude toward e-cigarette use, and future e-cigarette use intentions. The gain frame outperformed the loss frame in the simulated exchange conditions while the reverse trend was true for the individual text conditions. Furthermore, the main effect of messaging format was significant on multiple outcomes in favor of simulated text exchanges. The main effect of framing was only significant on negative affective response with the loss frame eliciting stronger responses. These findings suggest that the relative effectiveness of gain framing versus loss framing depends on how messages are presented in youth-targeting text messaging interventions. When messages are likely to be delivered in a discrete manner, the loss frame should be preferred. When greater interactivity and narrative development are possible, the gain frame should be favored. E-cigarette prevention efforts should leverage these insights to enhance message effectiveness.
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Bourgeois FC, Hart NJ, Dong Z, Ngo LH, DesRoches CM, Thomas EJ, Bell SK. Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference. Appl Clin Inform 2023; 14:903-912. [PMID: 37967936 PMCID: PMC10651368 DOI: 10.1055/s-0043-1776055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them. OBJECTIVES This study aimed to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage patients and families in the diagnostic process (DxP). METHODS Cross-sectional study of 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, codeveloped and tested with patients and families. Prior to each visit, patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns. We used logistic regression to determine factors associated with patient-reported diagnostic concerns. We conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. RESULTS Participants provided a similar mean number of contributions regardless of patient race, ethnicity, or language preference. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70; 95% confidence interval [CI]: [1.18, 2.43]) or "other" race (OR: 1.48; 95% CI: [1.08, 2.03]) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53; 95% CI: [1.78, 3.59]. There were no significant differences in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference. CONCLUSION Participants self-identifying as Black or "other" race, or those who prefer a language other than English were 1.5 to 2.5 times more likely than their counterparts to report potential diagnostic concerns when proactively asked to provide this information prior to a visit. Actively engaging patients and families in the DxP may uncover opportunities to reduce the risk of diagnostic errors and potential safety disparities.
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Affiliation(s)
- Fabienne C. Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Nicholas J. Hart
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Zhiyong Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Long H. Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Catherine M. DesRoches
- Harvard Medical School, Boston, Massachusetts, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Eric J. Thomas
- Department of Medicine, University of Texas at Houston Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, United States
- McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas, United States
| | - Sigall K. Bell
- Harvard Medical School, Boston, Massachusetts, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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31
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Lee K, Lee Y, Lee JH. Evaluating the Landscape of Personal Health Records in Korea: Results of the National Health Informatization Survey. Healthc Inform Res 2023; 29:386-393. [PMID: 37964460 PMCID: PMC10651406 DOI: 10.4258/hir.2023.29.4.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES This study examined the adoption and utilization of personal health records (PHR) across Korean medical institutions using data from the 2020 National Health and Medical Informatization Survey. METHODS Spearheaded by the Ministry of Health and Welfare and prominent academic societies, this study surveyed PHR utilization in 574 medical institutions. RESULTS Among these institutions, 84.9% (487 hospitals) maintained medical portals. However, just 14.1% (81 hospitals) had web-based or mobile PHRs, with 66.7% (28 of 42) of tertiary care hospitals adopting them. Tertiary hospitals led in PHR services: 87.8% offered certification issuance, 51.2% provided educational information, 63.4% supported online payment, and 95.1% managed appointment reservations. In contrast, general and smaller hospitals had lower rates. Online medical information viewing was prominent in tertiary hospitals (64.3%). Most patients accessed test results via PHRs, but other data types were less frequent, and only a few allowed downloads. Despite the widespread access to medical data through PHRs, integration with wearables and biometric data transfers to electronic medical records remained low, with limited plans for expansion in the coming three years. CONCLUSIONS Approximately two-thirds of the surveyed medical institutions provided PHRs, but hospitals and clinics in charge of community care had very limited PHR implementation. Government-led leadership is required to invigorate the use of PHRs in medical institutions.
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Affiliation(s)
- Kyehwa Lee
- Department of Biomedical Informatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Yura Lee
- Department of Biomedical Informatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jae-Ho Lee
- Department of Biomedical Informatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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32
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Choi S, Powers T. Engaging and informing patients: Health information technology use in community health centers. Int J Med Inform 2023; 177:105158. [PMID: 37494783 DOI: 10.1016/j.ijmedinf.2023.105158] [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: 02/27/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This paper aims to address the relationship between the community health center (CHC) patient mix and the level of patient engagement health information technology (HIT) comprehensiveness. PARTICIPANTS The study was conducted on sample CHCs (n = 3,592 CHC-years) active between 2016 and 2018. METHODS Patient engagement HIT comprehensiveness was measured based on a framework of patient engagement through HIT that includes a two-part dichotomy of patient engagement and patient informing. Univariate analysis was used to describe CHC characteristics and multivariable ordered logistic regression analysis was used to test hypothesized relationships. RESULTS The study identified four levels of patient engagement HIT comprehensiveness: 1) to neither engage nor inform, 2) to primarily inform, 3) to primarily engage, and 4) to engage and inform. It was found that CHCs serving disproportionate shares of patients with disadvantageous socioeconomic characteristics are less likely to incorporate more comprehensive patient engagement HIT. CONCLUSION The results highlight the different levels of patient engagement HIT use among CHCs and a negative association between CHC's higher proportion of patients with a disadvantageous sociodemographic background and patient engagement HIT comprehensiveness.
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Affiliation(s)
- Seongwon Choi
- Department of Management, California State University Los Angeles, College of Business and Economics, 5154 University Dr, Los Angeles, CA 90032, USA.
| | - Thomas Powers
- Department of Marketing, Industrial Distribution and Economics, University of Alabama at Birmingham, Collat School of Business, 710 13th St S, Birmingham, AL 35294, USA
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Wang R, Huang Y, Zhang X, Yao Y. Online dialogue with medical professionals: An empirical study of an online "Ask the Doctor" platform. Int J Med Inform 2023; 177:105123. [PMID: 37329764 DOI: 10.1016/j.ijmedinf.2023.105123] [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: 01/08/2023] [Revised: 04/13/2023] [Accepted: 06/03/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Accessing medical resources has been a challenging issue in China, particularly for people who do not live in big cities. Online "Ask the doctor" (AtD) services are gaining popularity rapidly. On AtDs, patients or their caregivers can ask questions to medical professionals and receive medical advice without going through the hassles of visiting local hospitals or doctors' offices. However, the communication patterns and remaining challenges of this tool are understudied. OBJECTIVE The purpose of this study was to (1) explore the dialogue patterns between the patients and the doctors on an AtD service in China, (2) identify issues and remaining challenges in this new form of communication. METHODS We conducted an exploratory study to analyze the dialogues between patients and doctors as well as patients' reviews. To analyze the dialogue data, we took inspiration from the discourse analysis and focus on the various components of the dialogues. We also used thematic analysis to discover the underlying themes embedded in each dialogue, and identify themes from patient complaints. RESULTS We identified four stages in the dialogues between the patients and doctors, including the initiating stage, continuing stage, ending stage, and following up stage. We also summarized the common patterns in the first three stages and reasons for sending follow-up messages. Moreover, we identified 6 unique challenges of the AtD service, including (1) inefficient communication in the initial stage, (2) unfinished conversation in the ending stage, (3) communication is perceived as real-time by the patients, not by the doctors, (4) drawbacks of voice messages, (5) verge of the illegal behaviors, and (6) consultation is not worth the payment. CONCLUSIONS The AtD service provides the follow-up communication pattern which is considered as a good supplement of Chinese traditional health care. However, several barriers, such as ethical problems, mismatched perceptions and expectations, cost-effectiveness issue still need further investigation.
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Affiliation(s)
- Ruojia Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, China.
| | - Yun Huang
- School of Information Science, University of Illinois Urbana-Champaign, Chicago, IL, United States
| | - Xinyi Zhang
- School of Information Studies, Syracuse University, Syracuse, NY, United States
| | - Yaxing Yao
- Department of Information Systems, University of Maryland, Baltimore County, MD, United States
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Scheckel B, Schmidt K, Stock S, Redaèlli M. Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability. J Med Internet Res 2023; 25:e38447. [PMID: 37624629 PMCID: PMC10492174 DOI: 10.2196/38447] [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: 04/02/2022] [Revised: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features. OBJECTIVE This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability. METHODS We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design. RESULTS After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support. CONCLUSIONS The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
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Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katharina Schmidt
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Fix GM, Haltom TM, Cogan AM, Shimada SL, Davila JA. Understanding Patients' Preferences and Experiences During an Electronic Health Record Transition. J Gen Intern Med 2023:10.1007/s11606-023-08338-6. [PMID: 37580637 DOI: 10.1007/s11606-023-08338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The Department of Veterans Affairs (VA) has embarked on the largest system-wide electronic health record (EHR) transition in history. To date, most research on EHR-to-EHR transitions has focused on employee and system transition-related needs, with limited focus on how patients experience transitions. OBJECTIVE (1) Understand patients' preferences for information and support prior to an EHR transition, and (2) examine actual patient experiences that occurred at facilities that implemented a new EHR. DESIGN We used a two-step approach. We had discussions with geographically diverse patient advisory groups. Discussions informed semi-structured, qualitative interviews with patients. PARTICIPANTS Patients affected by the EHR transition. MAIN MEASURES We met with four patient advisory groups at sites that had not transitioned their EHR. Interviews were conducted with patients who received care at one of two facilities that recently transitioned to the new EHR. KEY RESULTS Patient advisors identified key areas important to patients during an EHR transition. 1) Use a range of communication strategies to reach diverse populations, especially older, rural patients. 2) Information about the EHR transition should be clear and reinforce trustworthiness. 3) Patients will need guidance using the new patient portal. From the patient interviews, we learned if and how these key areas mapped onto patients' experiences. Patients at the sites that had transitioned learned about the new EHR through a variety of modalities, including letters and banners on the patient portal. However, their experiences varied in terms of information quality, leading to frustrations during and between healthcare encounters. Patient portal issues exacerbated frustrations. These raised concerns about the accuracy and security of the overall EHR. CONCLUSIONS Maintaining clear communication across patients, local leadership, and providers throughout an EHR transition is essential for successful implementation. Patient-facing communications can set expectations, and help patients receive adequate support, particularly related to the patient portal.
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Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Rd., Bedford, MA, USA.
- Chobanian & Avedisian School of Medicine, Boston University, 72 E Concord St, Boston, MA, USA.
- Boston University School of Public Health, 715 Albany St., Boston, MA, USA.
| | - Trenton M Haltom
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Houston, Houston, TX, USA
- Department of Medicine-Health Services Research, Baylor College of Medicine, One Baylor Plaza Houston, Houston, TX, USA
| | - Alison M Cogan
- Center for the Study of Health Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 Alcazar St, Los Angeles, CA, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Rd., Bedford, MA, USA
- Boston University School of Public Health, 715 Albany St., Boston, MA, USA
- UMass Chan Medical School, 55 N Lake Ave, Worcester, MA, USA
| | - Jessica A Davila
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Houston, Houston, TX, USA
- Department of Medicine-Health Services Research, Baylor College of Medicine, One Baylor Plaza Houston, Houston, TX, USA
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Mai F, Ko DG, Shan Z, Zhang D. The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study. J Med Internet Res 2023; 25:e44981. [PMID: 37384810 PMCID: PMC10414031 DOI: 10.2196/44981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. OBJECTIVE We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19-induced digital acceleration? Does the effect differ across racial lines? METHODS We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). RESULTS Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=-.158; P<.001; RE, β=-.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=-.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=-.004; P<.001; RE, β=-.004; P<.001; FE, β=-.003; P=.001). CONCLUSIONS Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.
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Affiliation(s)
- Feng Mai
- School of Business, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Dong-Gil Ko
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, United States
| | - Zhe Shan
- Department of Information Systems and Analytics, Miami University, Oxford, OH, United States
| | - Dawei Zhang
- Department of Decision and Technology Analytics, Lehigh University, Bethlehem, PA, United States
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Reynolds TL, Cobb JG, Steitz BD, Ancker JS, Rosenbloom ST. The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating. Appl Clin Inform 2023; 14:654-669. [PMID: 37611795 PMCID: PMC10446914 DOI: 10.1055/s-0043-1770901] [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: 02/20/2023] [Accepted: 05/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Recent external factors-the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic-have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. METHODS To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. RESULTS Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). CONCLUSION Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.
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Affiliation(s)
- Tera L. Reynolds
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, United States
| | - Jared Guthrie Cobb
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - S. Trent Rosenbloom
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Chivela FL, Burch AE, Asagbra O. An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis. J Med Internet Res 2023; 25:e44399. [PMID: 37526967 PMCID: PMC10427930 DOI: 10.2196/44399] [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: 12/13/2022] [Revised: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. OBJECTIVE This study aimed to explore the factors associated with portal messaging use by rural patients. METHODS We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. RESULTS A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. CONCLUSIONS Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.
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Affiliation(s)
- Fernando L Chivela
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
| | - Ashley E Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Oghale Asagbra
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
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Durocher K, Shin HD, Lo B, Chen S, Ma C, Strudwick G. Understanding the Role of Patient Portals in Fostering Interprofessional Collaboration Within Mental Health Care Settings: Mixed Methods Study. JMIR Hum Factors 2023; 10:e44747. [PMID: 37467024 PMCID: PMC10398557 DOI: 10.2196/44747] [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: 12/02/2022] [Revised: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Patient portals are web-based systems through which patients can access their personal health information and communicate with their clinicians. The integration of patient portals into mental health care settings has been evolving over the past decade, as cumulated research to date has highlighted the potential role of portals in facilitating positive health outcomes. However, it is currently unknown whether portal use can foster interprofessional collaboration between clinicians and patients or whether the portal is a tool to support an already established collaborative relationship. OBJECTIVE This mixed methods study aimed to understand how the use of a patient portal within mental health settings can impact the level of interprofessional collaboration between clinicians and patients. METHODS This study was conducted in a large mental health care organization in Ontario, Canada. A convergent mixed methods design was used, where the primary data collection methods included questionnaires and semistructured interviews with patients who had experience using a portal for their mental health care. For the quantitative strand, participants completed the Health Care Communication Questionnaire and the Self-Empowerment subscale of the Mental Health Recovery Measure at 3 time points (baseline, 3 months of use, and 6 months of use) to measure changes in scores over time. For the qualitative strand, semistructured interviews were conducted at the 3-month time point to assess the elements of interprofessional collaboration associated with the portal. RESULTS For the quantitative strand, 113 participants completed the questionnaire. For the Health Care Communication Questionnaire scores, the raw means of the total scores at the 3 time points were as follows: baseline, 43.01 (SD 7.28); three months, 43.19 (SD 6.65); and 6 months, 42.74 (SD 6.84). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.70). For the Mental Health Recovery Measure scores, the raw mean total scores at the 3 time points were as follows: baseline, 10.77 (SD 3.63); three months, 11.09 (SD 3.81); and 6 months, 11.10 (SD 3.33). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.34). For the qualitative strand, 10 participants were interviewed and identified various elements of how interprofessional collaboration can be supplemented through the use of a patient portal, including improved team functioning, communication, and conflict resolution. CONCLUSIONS Although the quantitative data produced nonsignificant findings in interprofessional collaboration scores over time, the patients' narrative accounts described how the portal can support various interprofessional collaboration concepts, such as communication, leadership, and conflict resolution. This provides useful information for clinicians to support the interprofessional relationship when using a portal within a mental health setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-025508.
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Affiliation(s)
- Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
- School of Health, Community Services, and Creative Design, Lambton College, Sarnia, ON, Canada
| | - Hwayeon Danielle Shin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement Ma
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Nair US, Kue J, Athilingam P, Rodríguez CS, Menon U. Application of the ConNECT Framework to achieve digital health equity. Nurs Outlook 2023; 71:101991. [PMID: 37302261 DOI: 10.1016/j.outlook.2023.101991] [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: 01/01/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The emphasis on digital technology and informatics in health care (digital health) has introduced innovative ways to deliver health care and engage populations in health research. However, inadequate attention to the development and implementation of digital health interventions can exacerbate health disparities. PURPOSE We applied the transdisciplinary ConNECT Framework principles within the context of digital health, with an aim to describe strategies to achieve digital health equity. METHODS We described the five ConNECT principles of (a) integrating context, (b) fostering a norm of inclusion, (c) ensuring equitable diffusion of innovations, (d) harnessing communication technology, and (e) prioritizing specialized training within the framework of achieving digital health equity. FINDINGS AND DISCUSSION We describe proactive, actionable strategies for the systematic application of the ConNECT Framework principles to address digital health equity. Recommendations to reduce the digital health divide in nursing research and practice are also described.
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Affiliation(s)
- Uma S Nair
- College of Nursing, University of South Florida, Tampa, FL.
| | - Jennifer Kue
- College of Nursing, University of South Florida, Tampa, FL
| | | | | | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL
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Thielmann RRLC, Hoving C, Cals JWL, Crutzen R. The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study. J Med Internet Res 2023; 25:e47659. [PMID: 37266981 DOI: 10.2196/47659] [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: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested. OBJECTIVE This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients. METHODS A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders. RESULTS Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between -0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects. CONCLUSIONS Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality.
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Affiliation(s)
- Rosa R L C Thielmann
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jochen W L Cals
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Abstract
This Viewpoint discusses the impersonalization of delivering bad news to patients through a patient portal rather than in person.
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Affiliation(s)
- Keith M Bellizzi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs
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Geerts P, Eijsink J, Moser A, Ter Horst P, Boersma C, Postma M. Rationale and development of an e-health application to deliver patient-centered care during treatment for recently diagnosed multiple myeloma patients: pilot study of the MM E-coach. Pilot Feasibility Stud 2023; 9:85. [PMID: 37210584 DOI: 10.1186/s40814-023-01307-0] [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: 01/31/2023] [Accepted: 04/21/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Patients with multiple myeloma (MM) increasingly face complicated treatment regimens. E-health may support patients and healthcare providers in enhancing a patient-centered healthcare approach. Therefore, we aimed to develop a patient-centered multi-modality e-health application, to assess the application for usability and end-user experiences. METHODS The application was developed following an iterative "action-based" methodology using the design thinking approach. Key end users participated, and relevant stakeholders were consulted in the development process. First, the care pathway was evaluated, the focus of development was determined, and a solution ideated during recurring multidisciplinary meetings. Second, a prototype was tested and improved. Third, a subsequent prototype was evaluated during a pilot study with patients and healthcare professionals on usability, usage, and experiences. RESULTS The multi-modality application, named the "MM E-coach," consisted of a newly developed medication module, patient-reported outcome (PRO) questionnaire assessments, a messaging service, alerts, information provision, and a personal care plan. The median system usability score was 60 on a scale of 0-100. Patients appreciated the medication overview, healthcare professionals appreciated the outpatient clinic preparation module, and both appreciated the messaging service. Additional recommendations for improvement mostly revolved around the flexibility of functionalities and look and feel of the application. CONCLUSIONS The MM E-coach has the potential to provide patient-centered care by supporting patients and caregivers during MM treatment and is a promising application to be implemented in the MM care pathway. A randomized clinical trial was initiated to study its clinical effectiveness.
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Affiliation(s)
- Paul Geerts
- Department of Internal Medicine, Isala Klinieken, Zwolle, Netherlands.
- Division of Hematology, Department of Internal Medicine, Research School GROW, Maastricht University Medical Centre, Maastricht, Netherlands.
- Department of Family Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.
| | - Job Eijsink
- Department of Clinical Pharmacy, Isala Klinieken, Zwolle, Netherlands
- Department of Health Sciences, University Medical Centre Groningen, Groningen, Netherlands
| | - Albine Moser
- Department of Family Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands
- Zuyd University of Applied Sciences, Heerlen, Netherlands
| | - Peter Ter Horst
- Department of Clinical Pharmacy, Isala Klinieken, Zwolle, Netherlands
| | - Cornelis Boersma
- Department of Health Sciences, University Medical Centre Groningen, Groningen, Netherlands
- Faculty of Management Sciences, Open University, Heerlen, Netherlands
| | - Maarten Postma
- Department of Health Sciences, University Medical Centre Groningen, Groningen, Netherlands
- Unit of Pharmacotherapy, Epidemiology & Economics, Groningen Research Institute Pharmacy, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
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DeCamp LR, Williams L, Palmer C, Gorman C, Olson C, Thompson DA. Mixed methods evaluation of pediatric telehealth equity for patients/families who communicate in languages other than English. Mhealth 2023; 9:24. [PMID: 37492119 PMCID: PMC10364007 DOI: 10.21037/mhealth-22-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 07/27/2023] Open
Abstract
Background Emerging research demonstrates telehealth disparities for patients who communicate in languages other than English. A better understanding of pediatric telehealth use with families who communicate in languages other than English is needed to inform interventions to promote telehealth equity. Methods We conducted a mixed methods study of telehealth care in a children's hospital health system using electronic health record data for outpatient video telehealth encounters from April 2020 to July 2021 and qualitative interviews with clinical staff and Spanish-speaking parents of telehealth patients. Results The 16-month study period included 102,387 telehealth encounters; 5% of which were encounters in languages other than English. 83% of languages other than English encounters were with patients/families with a preferred healthcare language of Spanish. 11% of providers conducted ≥10 languages other than English telehealth encounters. This subset of providers conducted 71% of all languages other than English encounters. We conducted 25 interviews with clinical staff (n=13) and parents (n=12). Common themes identified across interviews were: (I) technology barriers affect access to and quality of telehealth; (II) clinical staff and parents are uncertain about the future role of telehealth for patients/families who communicate in languages other than English; (III) the well-known impact of language barriers on in-person healthcare access and quality for patients who communicate in languages other than English is also evident in telehealth. Conclusions Patients who communicate in languages other than English were underrepresented among telehealth encounters and encounters were concentrated among few providers. Promoting equitable telehealth care requires investment to address technology barriers, increase the readiness of providers and clinics to provide telehealth care in languages other than English, and continued attention to reducing the healthcare impact of language barriers.
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Affiliation(s)
- Lisa Ross DeCamp
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Leah Williams
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Claire Palmer
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol Gorman
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Christina Olson
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Darcy A. Thompson
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
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Foumakoye M, Britton MC, Ansari E, Saunders M, McCall T, Wang EA, Puglisi LB, Workman TE, Zeng-Treitler Q, Ying Y, Shavit S, Brandt CA, Wang KH. Personal Health Libraries for People Returning From Incarceration: Protocol for a Qualitative Study. JMIR Res Protoc 2023; 12:e44748. [PMID: 37133907 PMCID: PMC10193212 DOI: 10.2196/44748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Individuals released from carceral facilities have high rates of hospitalization and death, especially in the weeks immediately after their return to community settings. During this transitional process, individuals leaving incarceration are expected to engage with multiple providers working in separate, complex systems, including health care clinics, social service agencies, community-based organizations, and probation and parole services. This navigation is often complicated by individuals' physical and mental health, literacy and fluency, and socioeconomic status. Personal health information technology, which can help people access and organize their health information, could improve the transition from carceral systems to the community and mitigate health risks upon release. Yet, personal health information technologies have not been designed to meet the needs and preferences of this population nor tested for acceptability or use. OBJECTIVE The objective of our study is to develop a mobile app to create personal health libraries for individuals returning from incarceration to help bridge the transition from carceral settings to community living. METHODS Participants were recruited through Transitions Clinic Network clinic encounters and professional networking with justice-involved organizations. We used qualitative research methods to assess the facilitators and barriers to developing and using personal health information technology for individuals returning from incarceration. We conducted individual interviews with people just released from carceral facilities (n=~20) and providers (n=~10) from the local community and carceral facilities involved with the transition for returning community members. We used rigorous rapid qualitative analysis to generate thematic output characterizing the unique circumstances impacting the development and use of personal health information technology for individuals returning from incarceration and to identify content and features for the mobile app based on the preferences and needs of our participants. RESULTS As of February 2023, we have completed 27 qualitative interviews with individuals recently released from carceral systems (n=20) and stakeholders (n=7) who support justice-involved individuals from various organizations in the community. CONCLUSIONS We anticipate that the study will characterize the experiences of people transitioning from prison and jails to community settings; describe the information, technology resources, and needs upon reentry to the community; and create potential pathways for fostering engagement with personal health information technology. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44748.
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Affiliation(s)
- Marisol Foumakoye
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Meredith Campbell Britton
- Equity Research and Innovation Center, Yale School of Medicine, Yale University, New Haven, CT, United States
- Community Alliance for Research & Engagement, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Emile Ansari
- Equity Research and Innovation Center, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Monya Saunders
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Terika McCall
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Emily A Wang
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Lisa B Puglisi
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - T Elizabeth Workman
- Center for Biomedical Informatics, George Washington University, Washington, DC, United States
- Department of Veterans Affairs, VA Healthcare Systems, West Haven, CT, United States
| | - Qing Zeng-Treitler
- Center for Biomedical Informatics, George Washington University, Washington, DC, United States
- Department of Veterans Affairs, VA Healthcare Systems, West Haven, CT, United States
| | - Yin Ying
- Center for Biomedical Informatics, George Washington University, Washington, DC, United States
| | - Shira Shavit
- Transitions Clinic Network, San Francisco, CA, United States
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Cynthia A Brandt
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, United States
- Department of Veterans Affairs, VA Healthcare Systems, West Haven, CT, United States
| | - Karen H Wang
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
- Equity Research and Innovation Center, Yale School of Medicine, Yale University, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, United States
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Radparvar I, Ross MK. Barriers and facilitators of electronic patient portal uptake for asthma management. J Asthma 2023; 60:635-646. [PMID: 35726134 PMCID: PMC9763543 DOI: 10.1080/02770903.2022.2087190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/28/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE An active patient-practitioner partnership is a key aspect of asthma management and patient-reported data helps with shared decision making. Technological advances such as the electronic patient portal can facilitate partnership, with the goal of improved asthma outcomes. However, uptake of portals by end-users for asthma management has been low. We studied portal-based asthma interventions to understand barriers and facilitators to its use. DATA SOURCES We searched within the PubMed, Web of Science, Scopus, MEDLINE, and Google Scholar databases. STUDY SELECTIONS We used the PRISMA extension for scoping reviews to guide our analysis of studies related to asthma and patient portals. We summarized relevant studies in terms of barriers and facilitators as well as study characteristics. RESULTS Sixteen studies were included in our final analysis. Common barriers to patient portal use for asthma management were lack of perceived value by the end-user, low end-user technological literacy, and limited resources. Facilitators of portal use included ease of use, personalization, and adequate technical support. Patient portals in these studies were used for a variety of applications related to core asthma management concepts of assessment and monitoring, education for a partnership in asthma care, environmental factors, co-morbidities, and medications. CONCLUSIONS Patient portal use for asthma management can be encouraged by ensuring the portal is easy to access and navigate, demonstrates values, as well as has readily available technical support. Involving end-users closely in the design process and implementation may help address barriers. Special attention is needed for groups with technological resource limitations.
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Affiliation(s)
- Ilana Radparvar
- College of Letters and Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Mindy K. Ross
- University Of California Los Angeles, David Geffen School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
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Holmes C, Holmes K, Scarborough J, Hunt J, d'Etienne JP, Ho AF, Alanis N, Kirby R, Schrader CD, Wang H. The status of patient portal use among Emergency Department patients experiencing houselessness: A large-scale single-center observational study. Am J Emerg Med 2023; 66:118-123. [PMID: 36739786 DOI: 10.1016/j.ajem.2023.01.029] [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: 10/27/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Patient portal (PP) use has rapidly increased in recent years. However, the PP use status among houseless patients is largely unknown. We aim to determine 1) the PP use status among Emergency Department (ED) patients experiencing houselessness, and 2) whether PP use is linked to the increase in patient clinic visits. METHODS This is a single-center retrospective observational study. From March 1, 2019, to February 28, 2021, houseless patients who presented at ED were included. Their PP use status, including passive PP use (log-on only PP) and effective PP use (use PP of functions) was compared between houseless and non-houseless patients. The number of clinic visits was also compared between these two groups. Lastly, a multivariate logistic regression was analyzed to determine the association between houseless status and PP use. RESULTS We included a total of 236,684 patients, 13% of whom (30,956) were houseless at time of their encounter. Fewer houseless patients had effective PP use in comparison to non-houseless patients (7.3% versus 11.6%, p < 0.001). In addition, a higher number of clinic visits were found among houseless patients who had effective PP use than those without (18 versus 3, p < 0.001). The adjusted odds ratio of houseless status associated with PP use was 0.48 (95% CI 0.46-0.49, p < 0.001). CONCLUSIONS Houselessness is a potential risk factor preventing patient portal use. In addition, using patient portals could potentially increase clinic visits among the houseless patient population.
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Affiliation(s)
- Chad Holmes
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Katherine Holmes
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Jon Scarborough
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Joel Hunt
- Department of Family Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - James P d'Etienne
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Amy F Ho
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Naomi Alanis
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Ryan Kirby
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Chet D Schrader
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Hao Wang
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
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Bell SK, Dong ZJ, Desroches CM, Hart N, Liu S, Mahon B, Ngo LH, Thomas EJ, Bourgeois F. Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool. J Am Med Inform Assoc 2023; 30:692-702. [PMID: 36692204 PMCID: PMC10018262 DOI: 10.1093/jamia/ocad003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Patients and families are key partners in diagnosis, but methods to routinely engage them in diagnostic safety are lacking. Policy mandating patient access to electronic health information presents new opportunities. We tested a new online tool ("OurDX") that was codesigned with patients and families, to determine the types and frequencies of potential safety issues identified by patients/families with chronic health conditions and whether their contributions were integrated into the visit note. METHODS Patients/families at 2 US healthcare sites were invited to contribute, through an online previsit survey: (1) visit priorities, (2) recent medical history/symptoms, and (3) potential diagnostic concerns. Two physicians reviewed patient-reported diagnostic concerns to verify and categorize diagnostic safety opportunities (DSOs). We conducted a chart review to determine whether patient contributions were integrated into the note. We used descriptive statistics to report implementation outcomes, verification of DSOs, and chart review findings. RESULTS Participants completed OurDX reports in 7075 of 18 129 (39%) eligible pediatric subspecialty visits (site 1), and 460 of 706 (65%) eligible adult primary care visits (site 2). Among patients reporting diagnostic concerns, 63% were verified as probable DSOs. In total, probable DSOs were identified by 7.5% of pediatric and adult patients/families with underlying health conditions, respectively. The most common types of DSOs were patients/families not feeling heard; problems/delays with tests or referrals; and problems/delays with explanation or next steps. In chart review, most clinician notes included all or some patient/family priorities and patient-reported histories. CONCLUSIONS OurDX can help engage patients and families living with chronic health conditions in diagnosis. Participating patients/families identified DSOs and most of their OurDX contributions were included in the visit note.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhiyong J Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine M Desroches
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Hart
- Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Liu
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brianna Mahon
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric J Thomas
- Department of Medicine, UT Houston—Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
- McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Fabienne Bourgeois
- Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Wubante SM, Tegegne MD, Melaku MS, Mengiste ND, Fentahun A, Zemene W, Fikadie M, Musie B, Keleb D, Bewoketu H, Adem S, Esubalew S, Mihretie Y, Ferede TA, Walle AD. Healthcare professionals' knowledge, attitude and its associated factors toward electronic personal health record system in a resource-limited setting: A cross-sectional study. Front Public Health 2023; 11:1114456. [PMID: 37006546 PMCID: PMC10050470 DOI: 10.3389/fpubh.2023.1114456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/23/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionElectronic personal health record (e-PHR) system enables individuals to access their health information and manage it themselves. It helps patient engagement management of health information that is accessed and shared with their healthcare providers using the platform. This improves individual healthcare through the exchange of health information between patients and healthcare providers. However, less is known about e-PHRs among healthcare professionals.ObjectiveTherefore, this study aimed to assess Health professionals' Knowledge and attitude and its associated factors toward e-PHR at the teaching hospital in northwest Ethiopia.MethodsAn institution-based cross-sectional study design was used to determine healthcare professionals' knowledge and attitude and their associated factors toward e-PHR systems in teaching hospitals of Amhara regional state, Ethiopia, from 20 July to 20 August 2022. Pretested structured self-administered questionnaires were used to collect the data. Descriptive statistic was computed based on sociodemographic and other variables presented in the form of table graphs and texts. Bivariable and multivariable logistic analyses were performed with an adjusted odds ratio (AOR) and 95% CI to identify predictor variables.ResultOf the total study participants, 57% were males and nearly half of the respondents had a bachelor's degree. Out of 402 participants, ~65.7% [61–70%] and 55.5% [50–60%] had good knowledge and favorable attitude toward e-PHR systems, respectively. Having a social media account 4.3 [AOR = 4.3, 95% CI (2.3–7.9)], having a smartphone 4.4 [AOR = 4.4, 95% CI (2.2–8.6)], digital literacy 8.8 [(AOR = 8.8, 95% CI (4.6–15.9)], being male 2.7 [AOR = 2.7, 95% CI (1.4–5.0)], and perceived usefulness 4.5 [(AOR = 4.5, 95% CI (2.5–8.5)] were positively associated with knowledge toward e-PHR systems. Similarly, having a personal computer 1.9 [AOR = 1.9, 95% CI (1.1–3.5)], computer training 3.9 [AOR = 3.9, 95% CI (1.8–8.3)], computer skill 19.8 [AOR = 19.8, 95% CI (10.7–36.9)], and Internet access 6.0 [AOR = 6.0, 95% CI (3.0–12.0)] were predictors for attitude toward e-PHR systems.ConclusionThe findings from the study showed that healthcare professionals have good knowledge and a favorable attitude toward e-PHRs. Providing comprehensive basic computer training to improve healthcare professionals' expectation on the usefulness of e-PHR systems has a paramount contribution to the advancement of their knowledge and attitude toward successfully implementing e-PHRs.
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Affiliation(s)
- Sisay Maru Wubante
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Sisay Maru Wubante
| | - Masresha Derese Tegegne
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebyu Demeke Mengiste
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Fentahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondosen Zemene
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Makida Fikadie
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Basazinew Musie
- North Shewa Zonal Health Department, Department of Monitoring and Evaluation, Shewa, Ethiopia
| | - Derso Keleb
- Department of Health Informatics, Bahirdar Health Science College, Bahir Dar, Ethiopia
| | | | - Seid Adem
- South Wollo Zonal Health Department, Akesta Primary Hospital, Akesta, Ethiopia
| | - Simegne Esubalew
- North Shewa Zonal Health Department, Department of Monitoring and Evaluation, Shewa, Ethiopia
| | - Yohannes Mihretie
- South Gondar Zonal Health Department, Nifas Mewocha Primary Hospital, Nefas Mewucha, Ethiopia
| | - Tigist Andargie Ferede
- Department of Epidemiology, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
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Steitz BD, Turer RW, Lin CT, MacDonald S, Salmi L, Wright A, Lehmann CU, Langford K, McDonald SA, Reese TJ, Sternberg P, Chen Q, Rosenbloom ST, DesRoches CM. Perspectives of Patients About Immediate Access to Test Results Through an Online Patient Portal. JAMA Netw Open 2023; 6:e233572. [PMID: 36939703 PMCID: PMC10028486 DOI: 10.1001/jamanetworkopen.2023.3572] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/17/2023] [Indexed: 03/21/2023] Open
Abstract
Importance The 21st Century Cures Act Final Rule mandates the immediate electronic availability of test results to patients, likely empowering them to better manage their health. Concerns remain about unintended effects of releasing abnormal test results to patients. Objective To assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal. Design, Setting, and Participants This large, multisite survey study was conducted at 4 geographically distributed academic medical centers in the US using an instrument adapted from validated surveys. The survey was delivered in May 2022 to adult patients and care partners who had accessed test results via an online patient portal account between April 5, 2021, and April 4, 2022. Exposures Access to test results via a patient portal between April 5, 2021, and April 4, 2022. Main Outcomes and Measures Responses to questions related to demographics, test type and result, reaction to result, notification experience and future preferences, and effect on health and well-being were aggregated. To evaluate characteristics associated with patient worry, logistic regression and pooled random-effects models were used to assess level of worry as a function of whether test results were perceived by patients as normal or not normal and whether patients were precounseled. Results Of 43 380 surveys delivered, there were 8139 respondents (18.8%). Most respondents were female (5129 [63.0%]) and spoke English as their primary language (7690 [94.5%]). The median age was 64 years (IQR, 50-72 years). Most respondents (7520 of 7859 [95.7%]), including 2337 of 2453 individuals (95.3%) who received nonnormal results, preferred to immediately receive test results through the portal. Few respondents (411 of 5473 [7.5%]) reported that reviewing results before they were contacted by a health care practitioner increased worry, though increased worry was more common among respondents who received abnormal results (403 of 2442 [16.5%]) than those whose results were normal (294 of 5918 [5.0%]). The result of the pooled model for worry as a function of test result normality was statistically significant (odds ratio [OR], 2.71; 99% CI, 1.96-3.74), suggesting an association between worry and nonnormal results. The result of the pooled model evaluating the association between worry and precounseling was not significant (OR, 0.70; 99% CI, 0.31-1.59). Conclusions and Relevance In this multisite survey study of patient attitudes and preferences toward receiving immediately released test results via a patient portal, most respondents preferred to receive test results via the patient portal despite viewing results prior to discussion with a health care professional. This preference persisted among patients with nonnormal results.
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Affiliation(s)
- Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert W. Turer
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Scott MacDonald
- Department of Clinical Informatics, University of California Davis Health, Sacramento
| | - Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christoph U. Lehmann
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
| | - Karen Langford
- Department of Insights and Operations, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel A. McDonald
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
| | - Thomas J. Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul Sternberg
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Catherine M. DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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