Applying Multiple Methods to Comprehensively Evaluate a Patient Portal's Effectiveness to Convey Information to Patients

Quality of Answers of Generative Large Language Models Versus Peer Users for Interpreting Laboratory Test Results for Lay Patients: Evaluation Study

BACKGROUND

Although patients have easy access to their electronic health records and laboratory test result data through patient portals, laboratory test results are often confusing and hard to understand. Many patients turn to web-based forums or question-and-answer (Q&A) sites to seek advice from their peers. The quality of answers from social Q&A sites on health-related questions varies significantly, and not all responses are accurate or reliable. Large language models (LLMs) such as ChatGPT have opened a promising avenue for patients to have their questions answered.

OBJECTIVE

We aimed to assess the feasibility of using LLMs to generate relevant, accurate, helpful, and unharmful responses to laboratory test-related questions asked by patients and identify potential issues that can be mitigated using augmentation approaches.

METHODS

We collected laboratory test result-related Q&A data from Yahoo! Answers and selected 53 Q&A pairs for this study. Using the LangChain framework and ChatGPT web portal, we generated responses to the 53 questions from 5 LLMs: GPT-4, GPT-3.5, LLaMA 2, MedAlpaca, and ORCA_mini. We assessed the similarity of their answers using standard Q&A similarity-based evaluation metrics, including Recall-Oriented Understudy for Gisting Evaluation, Bilingual Evaluation Understudy, Metric for Evaluation of Translation With Explicit Ordering, and Bidirectional Encoder Representations from Transformers Score. We used an LLM-based evaluator to judge whether a target model had higher quality in terms of relevance, correctness, helpfulness, and safety than the baseline model. We performed a manual evaluation with medical experts for all the responses to 7 selected questions on the same 4 aspects.

RESULTS

Regarding the similarity of the responses from 4 LLMs; the GPT-4 output was used as the reference answer, the responses from GPT-3.5 were the most similar, followed by those from LLaMA 2, ORCA_mini, and MedAlpaca. Human answers from Yahoo data were scored the lowest and, thus, as the least similar to GPT-4-generated answers. The results of the win rate and medical expert evaluation both showed that GPT-4's responses achieved better scores than all the other LLM responses and human responses on all 4 aspects (relevance, correctness, helpfulness, and safety). LLM responses occasionally also suffered from lack of interpretation in one's medical context, incorrect statements, and lack of references.

CONCLUSIONS

By evaluating LLMs in generating responses to patients' laboratory test result-related questions, we found that, compared to other 4 LLMs and human answers from a Q&A website, GPT-4's responses were more accurate, helpful, relevant, and safer. There were cases in which GPT-4 responses were inaccurate and not individualized. We identified a number of ways to improve the quality of LLM responses, including prompt engineering, prompt augmentation, retrieval-augmented generation, and response evaluation.

How do opt-in versus opt-out settings nudge patients toward electronic health record adoption? An exploratory study of facilitators and barriers in Austria and France

BACKGROUND

Electronic health records (EHR) are becoming an integral part of the health system in many developed countries, though implementations and settings vary across countries. Some countries have adopted an opt-out policy, in which patients are enrolled in the EHR system following a default nudge, while others have applied an opt-in policy, where patients have to take action to opt into the system. While opt-in systems may exhibit lower levels of active user requests for access, this contrasts with opt-out systems where a notable percentage of users may passively retain access. Thus, our research endeavor aims to explore facilitators and barriers that contribute to explaining EHR usage (i.e., actively accessing the EHR system) in two countries with either an opt-in or opt-out setting, exemplified by France and Austria.

METHODS

A qualitative exploratory approach using a semi-structured interview guideline was undertaken in both countries: 1) In Austria, with four homogenously composed group discussions, and 2) in France, with 19 single patient interviews. The data were collected from October 2020 to January 2021.

RESULTS

Influencing factors were categorized into twelve subcategories. Patients have similar experiences in both countries with regard to all facilitating categories, for instance, the role of health providers, awareness of EHR and social norms. However, we highlighted important differences between the two systems regarding hurdles impeding EHR usage, namely, a lack of communication as well as transparency or information security about EHR.

CONCLUSION

Implementing additional safeguards to enhance privacy protection and supporting patients to improve their digital ability may help to diminish the perception of EHR-induced barriers and improve patients' health and commitment in the long term.

PRACTICAL IMPLICATIONS

Understanding the differences and similarities will help to develop practical implications to tackle the problem of low EHR usage rates in the long run. This problem is prevalent in countries with both types of EHR default settings.

Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication

BACKGROUND

Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China.

OBJECTIVE

We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care.

METHODS

We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero).

RESULTS

Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care.

CONCLUSIONS

This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.

Annotation and Information Extraction of Consumer-Friendly Health Articles for Enhancing Laboratory Test Reporting

Viewing laboratory test results is patients' most frequent activity when accessing patient portals, but lab results can be very confusing for patients. Previous research has explored various ways to present lab results, but few have attempted to provide tailored information support based on individual patient's medical context. In this study, we collected and annotated interpretations of textual lab result in 251 health articles about laboratory tests from AHealthyMe.com. Then we evaluated transformer-based language models including BioBERT, ClinicalBERT, RoBERTa, and PubMedBERT for recognizing key terms and their types. Using BioPortal's term search API, we mapped the annotated terms to concepts in major controlled terminologies. Results showed that PubMedBERT achieved the best F1 on both strict and lenient matching criteria. SNOMED CT had the best coverage of the terms, followed by LOINC and ICD-10-CM. This work lays the foundation for enhancing the presentation of lab results in patient portals by providing patients with contextualized interpretations of their lab results and individualized question prompts that they can, in turn, refer to during physician consults.

Defining and identifying laboratory literacy as a component of health literacy: An assessment of existing health literacy tools

Health literacy has been defined and studied as an important component of a patient's ability to understand and obtain appropriate healthcare. However, a laboratory component of health literacy, as it pertains to the understanding of laboratory tests and their results, has not been previously defined. An analysis of readily available health literacy tools was conducted to determine laboratory testing-specific content representation. One hundred and four health literacy tools from a publicly available database were analyzed. Many of the health literacy tools were found to be lacking items related to laboratory testing. Of the health literacy tools that did contain a laboratory component, they were categorized pertaining to the laboratory test/testing content. Emerging from this process, eight competencies were identified that encompassed the entire range of laboratory-related aspects of health literacy. We propose that these eight competencies form the basis of a set of competencies needed for one to access, interpret, and act on laboratory results-a capacity we are referring to as "laboratory literacy."

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

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.

A Process Related View on the Usage of Electronic Health Records from the Patients' Perspective: A Systematic Review

BACKGROUND

In recent years, there has been an increasing interest in electronic health record (EHR) systems and various approaches of encouraging acceptance. Multiple methods of EHR acceptance have been proposed. However, a systematic review of patient's perspectives of their role and challenges in processing EHR remains lacking. Moreover, so far, there has been little discussion about barriers and facilitators of EHR system acceptance and usage from the patients' perspective.

METHODS

The study was reported according to the PRISMA statement. Six databases were systematically searched using keywords for articles from 2002-2020. We reviewed these data and used an inductive approach to analyse findings.

RESULTS

A total of 36 studies met the inclusion criteria. Our systematic literature review results reveal a wide range of barriers and facilitators assigned to four distinct stages of EHR system usage: awareness, adoption, behaviour and perception, and consequences. Results were described in a narrative synthesis of the included empirical studies.

DISCUSSION

Results underline the necessity to put a particular emphasis - but not exclusively - on the initial stage of awareness in the future. Further research in the field is therefore strongly recommended in order to develop tailored mediated communication to foster EHR system usage in the long run.

Leveraging Electronic Health Records to Address Breast Cancer Disparities

Purpose of Review

Breast cancer is the most commonly diagnosed cancer in women, and the leading cause of cancer death. However, racial and ethnic minority groups, as well as rural and underserved populations, face disparities that limit their access to specialty care for breast cancer. To address these disparities, health care providers can leverage an electronic health record (EHR).

Recent Findings

Few studies have evaluated the potential benefits of using EHRs to address breast cancer disparities, and none of them outlines a standard approach for this effort. However, these studies outline that EHRs can be used to identify and notify patients at risk for breast cancer. These systems can also automate referrals and scheduling for screening and genetic testing, as well as recruit eligible patients for clinical trials. EHRs can also provide educational materials to reduce risks associated with modifiable risk factors, such as physical activity, obesity, and smoking. These systems can also support telemedicine visits and centralize inter-institutional communication to improve treatment adherence and the quality of care.

Summary

EHRs have tremendous potential to increase accessibility and communication for patients with breast cancer by augmenting patient engagement, improving communication between patients and providers, and strengthening communication among providers. These efforts can reduce breast cancer disparities by increasing breast cancer screening, improving treatment adherence, expanding access to specialty care, and promoting risk-reducing habits among racial and ethnic minority groups and other underserved populations.

User-Centered System Design for Communicating Clinical Laboratory Test Results: Design and Evaluation Study

Background

Personal clinical data, such as laboratory test results, are increasingly being made available to patients via patient portals. However, laboratory test results are presented in a way that is difficult for patients to interpret and use. Furthermore, the indications of laboratory test results may vary among patients with different characteristics and from different medical contexts. To date, little is known about how to design patient-centered technology to facilitate the interpretation of laboratory test results.

Objective

The aim of this study is to explore design considerations for supporting patient-centered communication and comprehension of laboratory test results, as well as discussions between patients and health care providers.

Methods

We conducted a user-centered, multicomponent design research consisting of user studies, an iterative prototype design, and pilot user evaluations, to explore design concepts and considerations that are useful for supporting patients in not only viewing but also interpreting and acting upon laboratory test results.

Results

The user study results informed the iterative design of a system prototype, which had several interactive features: using graphical representations and clear takeaway messages to convey the concerning nature of the results; enabling users to annotate laboratory test reports; clarifying medical jargon using nontechnical verbiage and allowing users to interact with the medical terms (eg, saving, favoriting, or sorting); and providing pertinent and reliable information to help patients comprehend test results within their medical context. The results of a pilot user evaluation with 8 patients showed that the new patient-facing system was perceived as useful in not only presenting laboratory test results to patients in a meaningful way but also facilitating in situ patient-provider interactions.

Conclusions

We draw on our findings to discuss design implications for supporting patient-centered communication of laboratory test results and how to make technology support informative, trustworthy, and empathetic.

Patients' perceptions of using artificial intelligence (AI)-based technology to comprehend radiology imaging data

Results of radiology imaging studies are not typically comprehensible to patients. With the advances in artificial intelligence (AI) technology in recent years, it is expected that AI technology can aid patients' understanding of radiology imaging data. The aim of this study is to understand patients' perceptions and acceptance of using AI technology to interpret their radiology reports. We conducted semi-structured interviews with 13 participants to elicit reflections pertaining to the use of AI technology in radiology report interpretation. A thematic analysis approach was employed to analyze the interview data. Participants have a generally positive attitude toward using AI-based systems to comprehend their radiology reports. AI is perceived to be particularly useful in seeking actionable information, confirming the doctor's opinions, and preparing for the consultation. However, we also found various concerns related to the use of AI in this context, such as cyber-security, accuracy, and lack of empathy. Our results highlight the necessity of providing AI explanations to promote people's trust and acceptance of AI. Designers of patient-centered AI systems should employ user-centered design approaches to address patients' concerns. Such systems should also be designed to promote trust and deliver concerning health results in an empathetic manner to optimize the user experience.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Effect of AI Explanations on Human Perceptions of Patient-Facing AI-Powered Healthcare Systems

Ongoing research efforts have been examining how to utilize artificial intelligence technology to help healthcare consumers make sense of their clinical data, such as diagnostic radiology reports. How to promote the acceptance of such novel technology is a heated research topic. Recent studies highlight the importance of providing local explanations about AI prediction and model performance to help users determine whether to trust AI's predictions. Despite some efforts, limited empirical research has been conducted to quantitatively measure how AI explanations impact healthcare consumers' perceptions of using patient-facing, AI-powered healthcare systems. The aim of this study is to evaluate the effects of different AI explanations on people's perceptions of AI-powered healthcare system. In this work, we designed and deployed a large-scale experiment (N = 3,423) on Amazon Mechanical Turk (MTurk) to evaluate the effects of AI explanations on people's perceptions in the context of comprehending radiology reports. We created four groups based on two factors-the extent of explanations for the prediction (High vs. Low Transparency) and the model performance (Good vs. Weak AI Model)-and randomly assigned participants to one of the four conditions. Participants were instructed to classify a radiology report as describing a normal or abnormal finding, followed by completing a post-study survey to indicate their perceptions of the AI tool. We found that revealing model performance information can promote people's trust and perceived usefulness of system outputs, while providing local explanations for the rationale of a prediction can promote understandability but not necessarily trust. We also found that when model performance is low, the more information the AI system discloses, the less people would trust the system. Lastly, whether human agrees with AI predictions or not and whether the AI prediction is correct or not could also influence the effect of AI explanations. We conclude this paper by discussing implications for designing AI systems for healthcare consumers to interpret diagnostic report.

Providing Medical Information to Older Adults in a Web-Based Environment: Systematic Review

Background

Cancer is a disease that predominantly affects older adults, and several organizations recommend the completion of a geriatric assessment to help with cancer treatment decision-making. Owing to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, a web-based geriatric assessment may improve access to geriatric assessment for older adults. We systematically reviewed the literature to obtain the latest evidence for the design of our web-based geriatric assessment tool Comprehensive Health Assessment for My Plan.

Objective

This review aimed to probe the following questions: what is the impact of providing health test results to older adults in a web-based environment without the presence of a health care provider for patient-centered outcomes, including satisfaction, perceived harm, empowerment, quality of life, and health care use (eg, hospitalization, physician visits, emergency room visits, and costs), and what recommendations do older adults and developers have for designing future apps or websites for older adults?

Methods

This systematic review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement. Studies were limited to publications in English that examined a web-based tool that provided test results to older adults (aged ≥65 years) without the presence of a health care provider. A health sciences librarian performed the search on November 29, 2019, on the following electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool Version 2018. The findings are summarized narratively and in tabular format.

Results

A total of 26,898 titles and abstracts were screened by 2 independent reviewers, of which 94 studies were selected for a full-text review, and 9 studies were included in this review. There were only 2 randomized controlled trials of high quality that explored the effects of receiving health care results on the web via eHealth tools for older adults or provided evidence-based recommendations for designing such tools. Older adults were generally satisfied with receiving screening results via eHealth tools, and several studies suggested that receiving health screening results electronically improved participants’ quality of life. However, user interfaces that were not designed with older adults in mind and older adults’ lack of confidence in navigating eHealth tools proved challenging to eHealth uptake and use. All 9 studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults.

Conclusions

eHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without the presence of a health care provider for patient-centered outcomes in this target population.

Interventions to increase patient portal use in vulnerable populations: a systematic review

BACKGROUND

More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit all populations.

OBJECTIVE

To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use.

MATERIALS AND METHODS

A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias.

RESULTS

Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias.

CONCLUSION

Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.

Health Care Professionals' Experiences of Patient-Professional Communication Over Patient Portals: Systematic Review of Qualitative Studies

Background

The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals’ experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care.

Objective

This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals.

Methods

Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals’ experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute’s quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers.

Results

A total of 6 analytical themes concerning health care professionals’ experiences of web-based patient-professional communication were identified. The themes were related to health care professionals’ work, change in communication over patient portals, patients’ use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles.

Conclusions

Health care professionals’ experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals’ negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals.

Patient Challenges and Needs in Comprehending Laboratory Test Results: Mixed Methods Study

Background

Patients are increasingly able to access their laboratory test results via patient portals. However, merely providing access does not guarantee comprehension. Patients could experience confusion when reviewing their test results.

Objective

The aim of this study is to examine the challenges and needs of patients when comprehending laboratory test results.

Methods

We conducted a web-based survey with 203 participants and a set of semistructured interviews with 13 participants. We assessed patients’ perceived challenges and needs (both informational and technological needs) when they attempted to comprehend test results, factors associated with patients’ perceptions, and strategies for improving the design of patient portals to communicate laboratory test results more effectively. Descriptive and correlation analysis and thematic analysis were used to analyze the survey and interview data, respectively.

Results

Patients face a variety of challenges and confusion when reviewing laboratory test results. To better comprehend laboratory results, patients need different types of information, which are grouped into 2 categories—generic information (eg, reference range) and personalized or contextual information (eg, treatment options, prognosis, what to do or ask next). We also found that several intrinsic factors (eg, laboratory result normality, health literacy, and technology proficiency) significantly impact people’s perceptions of using portals to view and interpret laboratory results. The desired enhancements of patient portals include providing timely explanations and educational resources (eg, a health encyclopedia), increasing usability and accessibility, and incorporating artificial intelligence–based technology to provide personalized recommendations.

Conclusions

Patients face significant challenges in interpreting the meaning of laboratory test results. Designers and developers of patient portals should employ user-centered approaches to improve the design of patient portals to present information in a more meaningful way.

Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices

Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.

Real-Time Access to Electronic Health Record via a Patient Portal: Is it Harmful? A Retrospective Observational Study

BACKGROUND

The rapid implementation of patient portals, through which patients can view their electronic health record, creates possibilities for information exchange and communication between patients and health care professionals. However, real-time disclosure of test results and clinical reports poses a source of concern.

OBJECTIVE

This study aimed to examine negative experiences resulting from real-time disclosure of medical information through a patient portal.

METHODS

Data were collected over a 2-year period in 4 datasets consisting of incidents reported by health care professionals, complaints of patients, patient issues at a portal helpdesk, and a survey among health care professionals. Incidents, complaints, issues, and answers on the survey were counted and analyzed through an iterative process of coding.

RESULTS

Within the chosen time frame of 2 years, on average, 7978 patients per month logged into the portal at least once. The amount of negative incidents and complaints was limited. A total of 6 incidents, 4 complaints, and 2506 issues at the helpdesk concerning the patient portal were reported, of which only 2, 1, and 3 cases of these respective databases concerned real-time disclosure of medical information through the patient portal. Moreover, 32 out of 216 health care professionals reported patients that had negative experiences with real-time disclosure. Most negative consequences concerned confused and anxious patients when confronted with unexpected or incomprehensible results.

CONCLUSIONS

Real-time access through a patient portal did not substantially result in negative consequences. The negative consequences that did occur can be mitigated by adequate preparation and instruction of patients concerning the various functionalities of the patient portal, real-time disclosure of test results in particular, and can also be managed through educating health care professionals about the patient portal and making adjustments in the daily practice of health care professionals.

The role of patient portals in enhancing self-care in patients with renal conditions

Web-based portals enable patients to access their electronic health records, including test results and clinical documents, from anywhere with Internet access. Some portals also serve as a means of two-way communication between patients and healthcare professionals and provide a platform for the recording of patient-entered data such as home blood pressure readings. Such systems are designed to encourage patient participation in the management of their condition, and ultimately to increase patient empowerment and self-management, which are associated with improved clinical outcomes. As an example of portal use in patients with renal conditions, we discuss the PatientView portal, which is offered free of cost to patients under the care of renal physicians in the UK. We present an account of its various features and briefly describe the user experience. Previous studies examining the impact of this portal on patient care have been very positive; it appears to be popular among users and overall levels of satisfaction with the service are high. As the use of patient portals increases, we discuss barriers to the more widespread use of portals. We offer suggestions on how the care of patients with renal conditions can be enhanced in the future by further developing the existing features, learning from experiences of other patient portals and providing better integration of portal use into the current model of care.

Identifying How Patient Portals Impact Communication in Oncology

Patient portals are becoming widespread throughout health-care systems. Initial research has demonstrated that they positively impact patient-provider communication and patients' health knowledge, but little is known about the impact of patient portals in the cancer setting, where highly complex and uncertain medical data are available for patients to view. To better understand communicative behaviors and perceptions of the patient portal and how it is utilized in oncology, in-depth, semi-structured interviews were conducted with 48 participants: 35 patients and 13 oncologists. Thematic analysis identified that portals help to enhance participation during in-person consultations, increase patients' self-advocacy, and build rapport with providers. However, patients' comfort level with reviewing information via the portal depended upon the severity of the test. Oncologists worried about patient anxiety and widening health disparities, but acknowledged that the portal can motivate them to expedite communication about laboratory and scan results. As patient portals become more widely used in all medical settings, oncologists should become more engaged with how patients are viewing their medical information and consider the portal within the framework of patient-centered care by valuing patients' communication preferences.

Understanding Patient Information Needs About Their Clinical Laboratory Results: A Study of Social Q&A Site

Clinical data, such as laboratory test results, is increasingly being made available to patients through patient portals. However, patients often have difficulties understanding and acting upon the clinical data presented in portals. As such, many turn to online resources to fill their knowledge gaps and obtain actionable advice. In this work, we present a content analysis of the questions posted in a major social Q&A site to characterize lay people's general information needs concerning laboratory test results and to inform the design of patient portals for supporting patients' understanding of clinical data. We identified 15 information needs related to laboratory test results, and clustered them under four themes: understanding the results of lab test, interpreting doctor's diagnosis, learning about lab tests, and consulting the next steps. We draw on our findings to discuss design opportunities for supporting the understanding of laboratory results.

Identifying Attrition Phases in Survey Data: Applicability and Assessment Study

BACKGROUND

Although Web-based questionnaires are an efficient, increasingly popular mode of data collection, their utility is often challenged by high participant dropout. Researchers can gain insight into potential causes of high participant dropout by analyzing the dropout patterns.

OBJECTIVE

This study proposed the application of and assessed the use of user-specified and existing hypothesis testing methods in a novel setting-survey dropout data-to identify phases of higher or lower survey dropout.

METHODS

First, we proposed the application of user-specified thresholds to identify abrupt differences in the dropout rate. Second, we proposed the application of 2 existing hypothesis testing methods to detect significant differences in participant dropout. We assessed these methods through a simulation study and through application to a case study, featuring a questionnaire addressing decision-making surrounding cancer screening.

RESULTS

The user-specified method set to a low threshold performed best at accurately detecting phases of high attrition in both the simulation study and test case application, although all proposed methods were too sensitive.

CONCLUSIONS

The user-specified method set to a low threshold correctly identified the attrition phases. Hypothesis testing methods, although sensitive at times, were unable to accurately identify the attrition phases. These results strengthen the case for further development of and research surrounding the science of attrition.

Patient perceptions and interactions with their web portal-based laboratory results

Background

The movement to improve patient-centred care, combined with the development of user-friendly technology has led to the spread of electronic patient portals (EPP). Little research has examined the effects of providing patients with access to their laboratory results on their healthcare and health behaviours.

Objective

The purpose of this study was to gain insight into the use of EPPs, understand why patients use EPPs to access their laboratory results and explore its impact on their health.

Method

Semistructured interviews were conducted with 21 patients who used the laboratory results section of an EPP. Interviews were analysed using a grounded theory approach.

Results

Participant interactions with their laboratory results varied based on their level of understanding of their results. Benefits of EPP-based access to test results included convenience, fewer appointments and decreased anxiety. Some participants described increased engagement in their healthcare and positive health changes. However, some were concerned about receiving alarming test results.

Conclusion

Healthcare providers using EPPs to provide patients with their test results should try to ensure their patients understand their test results. Patient comprehension of test results may be improved by having providers comment on the meaning of test results and by encouraging patients to use specific websites and search options within EPPs.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Promoting patient comprehension of relevant health information

Patient understanding of health care recommendations provided by health care professionals is essential to enabling active and informed patient participation in care. Unfortunately, evidence suggests that patients often seriously misunderstand relevant health information provided to them, leading to errant patient decisions about their care. This commentary examines key communication factors that influence patient understanding and argues for a comprehensive approach to assessing and promoting patient comprehension.

Understanding Patient Questions about their Medical Records in an Online Health Forum: Opportunity for Patient Portal Design

There are many benefits of online patient access to their medical records through technologies such as patient portals. However, patients often have difficulties understanding the clinical data presented in portals. In response, increasingly, patients go online to make sense of this data. One commonly used online resource is health forums. In this pilot study, we focus on one type of clinical data, laboratory results, and one popular forum, MedHelp. We examined patient question posts that contain laboratory results to gain insights into the nature of these questions and of the answers. Our analyses revealed a typology of confusion (i.e., topics of their questions) and potential gaps in traditional healthcare supports (i.e., patients' requests and situational factors), as well as the supports patients may gain through the forum (i.e., what the community provides). These results offer preliminary evidence of opportunities to redesign patient portals, and will inform our future work.

Variation in Results Release and Patient Portal Access to Diagnostic Test Results at an Academic Medical Center

BACKGROUND

Electronic health records (EHRs) are commonplace in industrialized countries. Many hospitals are granting their patients access to their medical information through online patient portals. In this report, we describe a retrospective analysis of patient access to diagnostic test results released through the patient portal (MyChart; Epic, Inc.) at a state academic medical center.

METHODS

We analyzed 6 months of data for anatomic pathology, clinical laboratory, and radiology test results to evaluate variations in results release (automated vs. manual) and subsequent patient access to the institutional patient portal. During this period, diagnostic test results were released for all patient encounters including inpatient units, outpatient clinics, and the emergency department.

RESULTS

Manual results release by providers before automated release time occurred most commonly in the outpatient setting. The highest rates of access of diagnostic test results occurred for outpatients (about 30% overall view rate), females (two times or more compared to males in nearly every age bracket), and 20-45-year-old. Access rates of diagnostic tests in the emergency department or inpatient units were <10% across all populations. Access of diagnostic test results was very low for 12-17-year-old, likely influenced by institutional policies limiting parental proxy access within this pediatric age range. Approximately 20% of outpatient laboratory results were viewed by patients within 8 h of release from the EHR to the patient portal and 10% within 2 h of release.

CONCLUSIONS

Patient accessing of diagnostic test results were generally higher for females, outpatients, and 20-45-year-old. Approximately, 20% of outpatient results were viewed quickly by patients after release to the EHR.

Objective Assessment of Functional Information Requirements for Patient Portals

There has been an increase in the usage of electronic health records by healthcare providers as a result of recent federal incentive programs. One benefit of electronic systems is providing patients remote access to their records and an online interface with their healthcare provider via a patient portal. Patients, however, have been slow to adopt these systems and many studies have been conducted in attempts to investigate such slow adoption. It is not clear if the users were involved in the design of such systems and if the functionality meets user expectation. This paper aims to address this issue by documenting a comprehensive and systematically-derived set of functional and information requirements for patient portals based on a review of literature and interviews with patients.

Methods for Evaluating Respondent Attrition in Web-Based Surveys

BACKGROUND

Electronic surveys are convenient, cost effective, and increasingly popular tools for collecting information. While the online platform allows researchers to recruit and enroll more participants, there is an increased risk of participant dropout in Web-based research. Often, these dropout trends are simply reported, adjusted for, or ignored altogether.

OBJECTIVE

To propose a conceptual framework that analyzes respondent attrition and demonstrates the utility of these methods with existing survey data.

METHODS

First, we suggest visualization of attrition trends using bar charts and survival curves. Next, we propose a generalized linear mixed model (GLMM) to detect or confirm significant attrition points. Finally, we suggest applications of existing statistical methods to investigate the effect of internal survey characteristics and patient characteristics on dropout. In order to apply this framework, we conducted a case study; a seventeen-item Informed Decision-Making (IDM) module addressing how and why patients make decisions about cancer screening.

RESULTS

Using the framework, we were able to find significant attrition points at Questions 4, 6, 7, and 9, and were also able to identify participant responses and characteristics associated with dropout at these points and overall.

CONCLUSIONS

When these methods were applied to survey data, significant attrition trends were revealed, both visually and empirically, that can inspire researchers to investigate the factors associated with survey dropout, address whether survey completion is associated with health outcomes, and compare attrition patterns between groups. The framework can be used to extract information beyond simple responses, can be useful during survey development, and can help determine the external validity of survey results.