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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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2
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Liu S, McCoy AB, Aldrich MC, Sandler KL, Reese TJ, Steitz B, Bian J, Wu Y, Russo E, Wright A. Leveraging natural language processing to identify eligible lung cancer screening patients with the electronic health record. Int J Med Inform 2023; 177:105136. [PMID: 37392712 DOI: 10.1016/j.ijmedinf.2023.105136] [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: 02/01/2023] [Revised: 05/27/2023] [Accepted: 06/25/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To develop and validate an approach that identifies patients eligible for lung cancer screening (LCS) by combining structured and unstructured smoking data from the electronic health record (EHR). METHODS We identified patients aged 50-80 years who had at least one encounter in a primary care clinic at Vanderbilt University Medical Center (VUMC) between 2019 and 2022. We fine-tuned an existing natural language processing (NLP) tool to extract quantitative smoking information using clinical notes collected from VUMC. Then, we developed an approach to identify patients who are eligible for LCS by combining smoking information from structured data and clinical narratives. We compared this method with two approaches to identify LCS eligibility only using smoking information from structured EHR. We used 50 patients with a documented history of tobacco use for comparison and validation. RESULTS 102,475 patients were included. The NLP-based approach achieved an F1-score of 0.909, and accuracy of 0.96. The baseline approach could identify 5,887 patients. Compared to the baseline approach, the number of identified patients using all structured data and the NLP-based algorithm was 7,194 (22.2 %) and 10,231 (73.8 %), respectively. The NLP-based approach identified 589 Black/African Americans, a significant increase of 119 %. CONCLUSION We present a feasible NLP-based approach to identify LCS eligible patients. It provides a technical basis for the development of clinical decision support tools to potentially improve the utilization of LCS and diminish healthcare disparities.
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Affiliation(s)
- Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melinda C Aldrich
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kim L Sandler
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Elise Russo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Armstrong M, Benda NC, Seier K, Rogers C, Ancker JS, Stetson PD, Peng Y, Diamond LC. Improving Cancer Care Communication: Identifying Sociodemographic Differences in Patient Portal Secure Messages Not Authored by the Patient. Appl Clin Inform 2023; 14:296-299. [PMID: 36657471 PMCID: PMC10115514 DOI: 10.1055/a-2015-8679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Misha Armstrong
- Department of Surgery, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Natalie C. Benda
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Kenneth Seier
- Department of Epidemiology- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher Rogers
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter D. Stetson
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yifan Peng
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
| | - Lisa C. Diamond
- Department of Population Health Science, Weill Cornell Medicine, New York, New York
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
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4
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Whitehead L, Talevski J, Fatehi F, Beauchamp A. Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review. J Med Internet Res 2023; 25:e42719. [PMID: 36853742 PMCID: PMC10015358 DOI: 10.2196/42719] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health care systems have become increasingly more reliant on patients' ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations. OBJECTIVE This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people. METHODS A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants' views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others. CONCLUSIONS This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health.
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Affiliation(s)
- Lara Whitehead
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia
| | - Jason Talevski
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia.,Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, Melbourne, Australia
| | - Farhad Fatehi
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alison Beauchamp
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia
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5
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Richwine C, Johnson C, Patel V. Disparities in patient portal access and the role of providers in encouraging access and use. J Am Med Inform Assoc 2023; 30:308-317. [PMID: 36451262 PMCID: PMC9846679 DOI: 10.1093/jamia/ocac227] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify racial and ethnic disparities in patient portal offers, access, and use and to examine the role of providers in facilitating access to electronic health information (EHI) by offering patient portals and encouraging their use. MATERIALS AND METHODS Using nationally representative survey data from 2019 and 2020 (N = 8028), we examined disparities in patients being offered access to a portal by their provider and differences in subsequent access and use. Using multivariable models, we estimated the effect of race and ethnicity on the likelihood of being offered, accessing or using a portal. Among those offered, we examined the relationship between provider encouragement and portal access; and for those who did not access their portal, we explored reasons for nonuse. RESULTS Black and Hispanic individuals were offered and accessed patient portals at significantly lower rates than White individuals. Compared to Whites, Black and Hispanic individuals were 5.2 percentage-points less likely to be offered a portal (P < .05) and, among those offered, 7.9 percentage-points less likely to access their portal (P < .05). Black and Hispanic individuals who were offered and accessed a portal were 12 percentage-points more likely than Whites to use it to download or transmit information (P < .01). Individuals who were offered a portal and encouraged to use it were 21 percentage-points more likely to access it. DISCUSSION Differences in patient portal access and use are likely driven by disparities in which groups of patients reported being offered a portal. CONCLUSIONS Providers play an important role in increasing access to EHI by facilitating access to patient portals.
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Affiliation(s)
- Chelsea Richwine
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
| | - Christian Johnson
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
| | - Vaishali Patel
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
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6
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Leung T, Agrawal L, Sharman R. The Role of Access Type and Age Group in the Breadth of Use of Patient Portals: Observational Study. J Med Internet Res 2022; 24:e41972. [PMID: 36574284 PMCID: PMC9832356 DOI: 10.2196/41972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/06/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health care delivery and patient satisfaction are improved when patients engage with their medical information through patient portals. Despite their wide availability and multiple functionalities, patient portals and their functionalities are still underused. OBJECTIVE We seek to understand factors that lead to patient engagement through multiple portal functionalities. We provide recommendations that could lead to higher patients' usage of their portals. METHODS Using data from the Health Information National Trends Survey 5, Cycle 3 (N=2093), we performed descriptive statistics and used a chi-square test to analyze the association between the demographic variables and the use of mobile health apps for accessing medical records. We further fitted a generalized linear model to examine the association between access type and the use of portal functionalities. We further examined the moderation effects of age groups on the impact of access type on portal usage. RESULTS Our results show that accessing personal health records using a mobile health app is positively associated with greater patient usage of access capabilities (β=.52; P<.001), patient-provider interaction capabilities (β=.24, P=.006), and patient-personal health information interaction capabilities (β=.23, P=.009). Patients are more likely to interact with their records and their providers when accessing their electronic medical records using a mobile health app. The impacts of mobile health app usage fade with age for tasks consisting of viewing, downloading, and transmitting medical results to a third party (β=-.43, P=.005), but not for those involving patient-provider interaction (β=.05, P=.76) or patient-personal health information interaction (β=-.15, P=.19). CONCLUSIONS These findings provide insights on how to increase engagement with diverse portal functionalities for different age groups and thus improve health care delivery and patient satisfaction.
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Affiliation(s)
| | - Lavlin Agrawal
- State University of New York, University at Buffalo, Buffalo, NY, United States
| | - Raj Sharman
- State University of New York, University at Buffalo, Buffalo, NY, United States
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7
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Payán DD, Frehn JL, Garcia L, Tierney AA, Rodriguez HP. Telemedicine implementation and use in community health centers during COVID-19: Clinic personnel and patient perspectives. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100054. [PMID: 35169769 PMCID: PMC8830142 DOI: 10.1016/j.ssmqr.2022.100054] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/12/2023]
Abstract
In March 2020, federal and state telehealth policy changes catalyzed telemedicine adoption and use in community health centers. There is a dearth of evidence on telemedicine implementation and use in these safety net settings and a lack of information reflecting the perspectives of patients with limited English proficiency. We conducted in-depth interviews with clinic personnel and patients during the pandemic in two federally qualified health centers that primarily serve Chinese and Latino immigrants. Twenty-four interviews (clinic personnel = 15; patients who primarily speak a language other than English = 9) were completed remotely between December 2020 and April 2021. Interview scripts included questions about their telemedicine experiences, technology, resources and needs, barriers, facilitators, language access, and continued use, with a brief socio-demographic survey. Data analyses involved a primarily deductive approach and thematic analysis of transcript content. Both FQHCs adopted telemedicine in a few weeks and transitioned primarily to video and audio-only visits within two months. Findings reveal third-party language interpretation services were challenging to integrate into telemedicine video visits. Bilingual personnel who provided language concordant care were seen as essential for efficient and high-quality patient telemedicine experiences. Audio-only visits were of particular benefit to reach patients of older age, with limited English proficiency, and with limited digital literacy. Continued use of telemedicine is contingent on reimbursement policy decisions and interventions to increase patient digital literacy and technological resources. Results highlight the importance of reimbursing audio-only visits post-pandemic and investing in efforts to improve the quality of language services in telemedicine encounters.
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Affiliation(s)
- Denise D Payán
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Jennifer L Frehn
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Aaron A Tierney
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA
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Lee DC, Gefen D. The Interplay of Trust and Subjective Norms in Telemedicine Adoption by a Minority Community at Einstein Medical Center Philadelphia. DATA BASE FOR ADVANCES IN INFORMATION SYSTEMS 2022. [DOI: 10.1145/3571823.3571828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Telemedicine is not released into a social vacuum. In some communities - such as the underserved, low income, mostly minority community served by Einstein Medical Center Philadelphia (EMCP) - the social context presents the medical center with unique challenges centered on a strong community sense of historical discrimination. That context is manifested in people being less inclined to trust symbols of external authority and in their strong reliance on subjective norms. Analyzing 540 survey responses by EMCP emergency department (ED) patients shows that trust in the EMCP portal was the strongest predictor of its acceptance. Being an African American had no effect on portal acceptance compared to others in the community. Importantly, there was a negative interaction effect of subjective norms and trust on portal acceptance - meaning that increasing this trust can reduce the importance of subjective norms or, alternatively, that lower subjective norms may increase the importance of trust in determining acceptance. This moderation may have very practical implications for EMCP because, while it might be challenging for EMCP to change long established subjective norms, it is within their power to increase trust in the portal. Theoretical and practical implications are discussed.
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Affiliation(s)
- Diane C. Lee
- Einstein Healthcare Network, Philadelphia, PA, USA
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9
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Sun EY, Alvarez C, Callahan LF, Sheikh SZ. The Disparities in Patient Portal Use Among Patients With Rheumatic and Musculoskeletal Diseases: Retrospective Cross-sectional Study. J Med Internet Res 2022; 24:e38802. [PMID: 36001872 PMCID: PMC9439379 DOI: 10.2196/38802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs. OBJECTIVE Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center. METHODS In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic's patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated. RESULTS We identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P<.001), suburban residence (P=.05), commercial/state insurance (P<.001), military insurance (P=.05), and median income >US $50,000 (P<.001) were associated with significantly higher odds of MyChart activation. Male sex (P<.001), being of Black or African American (P<.001) or "other" race (P<.001), Spanish as a primary language (P<.001), rural residence (P=.007), Medicaid insurance (P<.001), and median income of <US $25,000 (P=.01) were associated with lower odds of MyChart activation. Following COVID-19, younger age (P<.001), commercial insurance (P=.03), state insurance (P=.02), and median income of US $50,000-75,000 (P=.01) were associated with significantly higher odds of MyChart use. However, being of Black or African American (P<.001) or "other" race (P=.01), Spanish as a primary language (P=.002), male sex (P=.004), rural residence (P=.005), and having no insurance (P<.001) or Medicaid (P=.008) were associated with lower odds of MyChart use. CONCLUSIONS Residence in a rural area, being of minority race/ethnicity, older age, male sex, lower median income, Medicaid, being uninsured, and non-English primary language are associated with lower odds of patient portal activation and use. Future health policy and clinical practice measures should focus on reducing barriers to health technology adoption among these groups.
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Affiliation(s)
- Enid Y Sun
- Section of Rheumatology, Department of Medicine, Temple Lewis Katz School of Medicine, Philadelphia, PA, United States
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Saira Z Sheikh
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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10
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Leach B, Parkinson S, Gkousis E, Abel G, Atherton H, Campbell J, Clark C, Cockcroft E, Marriott C, Pitchforth E, Sussex J. Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. J Med Internet Res 2022; 24:e33911. [PMID: 35834301 PMCID: PMC9335178 DOI: 10.2196/33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation-referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services-may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. OBJECTIVE This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. METHODS Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. RESULTS A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients' trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. CONCLUSIONS Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019.
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Affiliation(s)
| | | | | | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Emma Cockcroft
- University of Exeter Medical School, Exeter, United Kingdom
| | - Christine Marriott
- National Institute of Health and Care Research Collaboration South West Peninsula Patient Engagement Group, University of Exeter Medical School, Exeter, United Kingdom
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11
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Lyles CR, Sharma AE, Fields JD, Getachew Y, Sarkar U, Zephyrin L. Centering Health Equity in Telemedicine. Ann Fam Med 2022; 20:362-367. [PMID: 35879077 PMCID: PMC9328712 DOI: 10.1370/afm.2823] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/22/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022] Open
Abstract
In the wake of the racial injustices laid bare in 2020, on top of centuries of systemic racism, it is clear we need actionable strategies to fundamentally restructure health care systems to achieve racial/ethnic health equity. This paper outlines the pillars of a health equity framework from the Institute for Healthcare Improvement, overlaying a concrete example of telemedicine equity. Telemedicine is a particularly relevant and important topic, given the growing evidence of disparities in uptake by racial/ethnic, linguistic, and socioeconomic groups in the United States during the COVID-19 pandemic, as well as the new standard of care that telemedicine represents post-pandemic. We present approaches for telemedicine equity across the domains of: (1) strategic priorities of a health care organization, (2) structures and processes to advance equity, (3) strategies to address multiple determinants of health, (4) elimination of institutional racism and oppression, and (5) meaningful partnerships with patients and communities.
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Affiliation(s)
- Courtney R Lyles
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Anjana E Sharma
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, California
| | - Jessica D Fields
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | | | - Urmimala Sarkar
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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12
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Korngiebel DM, West KM. Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet. JMIRX MED 2022; 3:e29706. [PMID: 37725563 PMCID: PMC10414314 DOI: 10.2196/29706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 01/29/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. RESULTS In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.
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13
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Acholonu RG, Raphael JL. The Influence of the Electronic Health Record on Achieving Equity and Eliminating Health Disparities for Children. Pediatr Ann 2022; 51:e112-e117. [PMID: 35293812 DOI: 10.3928/19382359-20220215-01] [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] [Indexed: 11/20/2022]
Abstract
The electronic health record (EHR) has been heralded as a transformative approach to modernizing health care and advancing health equity. Access to the EHR can facilitate shared clinical decision-making and improved communication with patients, families, and among health care providers. Recent legislative and regulatory efforts have been passed to increase the transparency as well as the initiatives to increase the meaningful use of the EHR. Yet despite these well-intended efforts, challenges to addressing health equity through the EHR persist. This article reviews three distinct challenges to addressing health equity related to the EHR. We discuss (1) both the implicit and explicit bias that exist in EHR documentation, (2) the gaps that remain between screening for social determinants of health and the effective inclusion and billing of that screening into the EHR, and (3) the disparities that exist with the use of patient portals. Addressing these three areas will enhance the opportunities to advance health equity through the use of the EHR and bring us one step closer to eliminating health disparities in pediatric health care. [Pediatr Ann. 2022;51(3):e112-e117.].
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14
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Nguyen MLT, Garcia F, Juarez J, Zeng B, Khoong EC, Nijagal MA, Sarkar U, Su G, Lyles CR. Satisfaction can co-exist with hesitation: qualitative analysis of acceptability of telemedicine among multi-lingual patients in a safety-net healthcare system during the COVID-19 pandemic. BMC Health Serv Res 2022; 22:195. [PMID: 35164746 PMCID: PMC8842908 DOI: 10.1186/s12913-022-07547-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/25/2022] [Indexed: 12/26/2022] Open
Abstract
Background The COVID-19 pandemic triggered unprecedented expansion of outpatient telemedicine in the United States in all types of health systems, including safety-net health systems. These systems generally serve low-income, racially/ethnically/linguistically diverse patients, many of whom face barriers to digital health access. These patients’ perspectives are vital to inform ongoing, equitable implementation efforts. Methods Twenty-five semi-structured interviews exploring a theoretical framework of technology acceptability were conducted from March through July 2020. Participants had preferred languages of English, Spanish, or Cantonese and were recruited from three clinics (general medicine, obstetrics, and pulmonary) within the San Francisco Health Network. Both deductive and inductive coding were performed. In a secondary analysis, qualitative data were merged with survey data to relate perspectives to demographic factors and technology access/use. Results Participants were diverse with respect to language (52% non-English-speaking), age (range 23-71), race/ethnicity (24% Asian, 20% Black, 44% Hispanic/Latinx, 12% White), & smartphone use (80% daily, 20% weekly or less). All but 2 had a recent telemedicine visit (83% telephone). Qualitative results revealed that most participants felt telemedicine visits fulfilled their medical needs, were convenient, and were satisfied with their telemedicine care. However, most still preferred in-person visits, expressing concern that tele-visits relied on patients’ abilities to access telemedicine, as well as monitor and manage their own health without in-person physical evaluation. Conclusions High satisfaction with telemedicine can co-exist with patient-expressed hesitations surrounding the perceived effectiveness, self-efficacy, and digital access barriers associated with a new model of care. More research is needed to guide how healthcare systems and clinicians make decisions and communicate about visit modalities to support high-quality care that responds to patients’ needs and circumstances. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07547-9.
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Affiliation(s)
- Michelle-Linh T Nguyen
- Medicine, Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | - Faviola Garcia
- Medicine, Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Jennifer Juarez
- Obstetrics & Gynecology, University of California San Francisco, San Francisco, CA, USA
| | - Billy Zeng
- Medicine, Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Elaine C Khoong
- Medicine, Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Malini A Nijagal
- Obstetrics & Gynecology, University of California San Francisco, San Francisco, CA, USA
| | - Urmimala Sarkar
- Medicine, Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - George Su
- Medicine, Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Medicine, Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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15
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Casillas A, Valdovinos C, Wang E, Abhat A, Mendez C, Gutierrez G, Portz J, Brown A, Lyles CR. Perspectives from leadership and frontline staff on telehealth transitions in the Los Angeles safety net during the COVID-19 pandemic and beyond. Front Digit Health 2022; 4:944860. [PMID: 36016601 PMCID: PMC9398195 DOI: 10.3389/fdgth.2022.944860] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The start of the COVID-19 pandemic led the Los Angeles safety net health system to dramatically reduce in-person visits and transition abruptly to telehealth/telemedicine services to deliver clinical care (remote telephone and video visits). However, safety net patients and the settings that serve them face a "digital divide" that could impact effective implementation of such digital care. The study objective was to examine attitudes and perspectives of leadership and frontline staff regarding telehealth integration in the Los Angeles safety net, with a focus on telemedicine video visits. Methods This qualitative study took place in the Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net health system in the US. This system disproportionately serves the uninsured, Medicaid, racial/ethnic minority, low-income, and Limited English Proficient (LEP) patient populations of Los Angeles County. Staff and leadership personnel from each of the five major LAC DHS hospital center clinics, and community-based clinics from the LAC DHS Ambulatory Care Network (ACN) were individually interviewed (video or phone calls), and discussions were recorded. Interview guides were based on the Consolidated Framework for Implementation Research (CFIR), and included questions about the video visit technology platform and its usability, staff resources, clinic needs, and facilitators and barriers to general telehealth implementation and use. Interviews were analyzed for summary of major themes. Results Twenty semi-structured interviews were conducted in August to October 2020. Participants included LAC DHS physicians, nurses, medical assistants, and physical therapists with clinical and/or administrative roles. Narrative themes surrounding telehealth implementation, with video visits as the case study, were identified and then categorized at the patient, clinic (including provider), and health system levels. Conclusions Patient, clinic, and health system level factors must be considered when disseminating telehealth services across the safety net. Participant discussions illustrated how multilevel facilitators and barriers influenced the feasibility of video visits and other telehealth encounters. Future research should explore proposed solutions from frontline stakeholders as testable interventions towards advancing equity in telehealth implementation: from patient training and support, to standardized workflows that leverage the expertise of multidisciplinary teams.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, United States
- Correspondence: Alejandra Casillas
| | - Cristina Valdovinos
- UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Elizabeth Wang
- UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Anshu Abhat
- Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, California, United States
| | - Carmen Mendez
- Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, California, United States
| | - Griselda Gutierrez
- Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, California, United States
| | - Jennifer Portz
- University of Colorado School of Medicine, Denver, Colorado, United States
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, United States
| | - Courtney R. Lyles
- UCSF Departments of Medicine and Epidemiology and Statistics, San Francisco, California, United States
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, United States
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16
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Dickman Portz J, Powers JD, Casillas A, Baldwin M, Bekelman DB, Palen TE, Bull S, Kutner JS, Bayliss E. Characteristics of Patients and Proxy Caregivers Using Patient Portals in the Setting of Serious Illness and End of Life. J Palliat Med 2021; 24:1697-1704. [PMID: 34061675 PMCID: PMC9022132 DOI: 10.1089/jpm.2020.0667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background: There are few studies examining the usage and utility of patient portals among seriously ill and end-of-life populations and their caregivers. Objective: The aim of this study was to describe portal user characteristics among patients and their caregivers (proxy login) at two time points: (1) the 12 months following an electronic medical record flag for serious illness and (2) during the last 12 months of life. Methods: A retrospective cohort analysis of Kaiser Permanente Colorado (KPCO) patients with serious illness, as defined by Kaiser Permanente's prognostic algorithm, and their proxy caregivers was performed for the two time periods. Use was characterized as (1) the discrete number of days the portal was used and (2) the number of days that portal features were accessed. Differences in use by user characteristics were assessed. Results: Patients flagged for serious illness (N = 6129) were 70.4 ± 14.2 years of age, and used the portal on average 50.4 days. Patients (N = 6517) in the last year of life were 76.7 ± 13.7 years of age and used the portal on average 43 days. Caregiver proxy use of the portal was low in both cohorts. Patients who were older, female, non-White, and healthier were less likely to use the portal. Conclusions: In comparison with overall KPCO portal use and recent patient portal studies examining use patterns, patient portal use was high among patients flagged with serious illness and nearing the end of life. However, because use was associated with age, gender, and race, addressing barriers to portal adoption among underserved populations and caregiver proxies is key to better leveraging patient portal systems for palliative and end-of-life care.
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Affiliation(s)
- Jennifer Dickman Portz
- Division of General Internal Medicine, University of Colorado Anschutz Medical, Aurora, Colorado, USA
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - John David Powers
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Megan Baldwin
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - David B. Bekelman
- Division of General Internal Medicine, University of Colorado Anschutz Medical, Aurora, Colorado, USA
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Ted E. Palen
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Sheana Bull
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Jean S. Kutner
- Division of General Internal Medicine, University of Colorado Anschutz Medical, Aurora, Colorado, USA
| | - Elizabeth Bayliss
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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17
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Abstract
Many telemedicine interventions fail to be implemented in medical care with non-use and discontinued use by patients being among the major reasons. The aim of this scoping review was to provide an overview of barriers associated with non-use and discontinued use of telemedicine. An electronic search was conducted in Pubmed in October 2019 and updated in November 2020, followed by a hand search in the beginning of 2021. All potential articles were screened by two independent reviewers based on predefined inclusion and exclusion criteria. A qualitative content analysis according to Mayring was carried out. The topics 'intervention', 'context of use' and 'user' were chosen as overarching themes. Out of 1377 potentially relevant articles, 73 were included. User-related barriers were mentioned in most of the analysed studies, followed by barriers related to the intervention. The analysis provides the basis for overcoming non-use issues in telemedicine.
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Affiliation(s)
| | - Peter Eh Schwarz
- Technische Universität Dresden, Germany; German Center for Diabetes Research (DZD), Germany
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18
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Localio AM, Klusaritz H, Morales KH, Ruggieri DG, Han X, Apter AJ. Primary language and the electronic health record patient portal: Barriers to use among Spanish-speaking adults with asthma. J Asthma 2021; 59:2081-2090. [PMID: 34634975 DOI: 10.1080/02770903.2021.1989462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess electronic health record patient portal use among Spanish-speaking patients with asthma compared to English-speaking patients and identify barriers to use. METHODS Using data collected for a PCORI-funded randomized controlled trial to increase patient portal use in low-income adults with uncontrolled asthma, we estimated the association between portal use, measured using surveys and actual user login data, and primary language. Open-ended survey responses were grouped into common themes. RESULTS Among 301 adults with asthma: age 18-87, 90% female, 17% Spanish speakers; 44% had no portal use during the study. Spanish speakers were less likely to have ever heard of the patient portal than English speakers (p=.001) and reported more difficulty navigating the portal (p<.001). Spanish speakers with low health literacy had less portal use (31%) than their English-speaking counterparts (51%) (p=.02). Compared to high-literacy English speakers, the odds of using the portal for low-literacy Spanish speakers were 0.34 (95% CI 0.14, 0.84) (p=.02). Three-quarters of Spanish speakers cited barriers to portal use compared to one-quarter of English speakers, and many suggested creating a Spanish version to improve user-friendliness. CONCLUSIONS English-only patient portals may not meet the needs of Spanish-speaking patients with uncontrolled asthma. Health systems serving Spanish-speaking communities should implement patient portals in Spanish.
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Affiliation(s)
- Anna M Localio
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Heather Klusaritz
- Master of Public Health Program, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominique G Ruggieri
- Master of Public Health Program, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiaoyan Han
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea J Apter
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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19
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Harst L, Wollschlaeger B, Birnstein J, Fuchs T, Timpel P. Evaluation is Key: Providing Appropriate Evaluation Measures for Participatory and User-Centred Design Processes of Healthcare IT. Int J Integr Care 2021; 21:24. [PMID: 34220388 PMCID: PMC8231460 DOI: 10.5334/ijic.5529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The increasing availability of healthcare IT has the potential to improve the integration of health services. Existing projects developing healthcare IT mostly disregard the potential and importance of incorporating user feedback and proper evaluation measures to gain user feedback throughout the development process. We therefore provide methodological guidance for evaluation in a stepwise user-centred design process. METHODS Based on a literature review we propose adequate methods for data collection in each phase of participatory and user-centred healthcare IT development. In order to provide an orientation within the plethora of development processes used in practice, we consolidate a generic blueprint process from the literature review. The applicability of our methodological guidance is shown in three diverse use cases from the field of integrated care. RESULTS From 14 literature items, we identified common evaluation methods including, among others, interviews, focus groups, and surveys. These methods can be associated to six typical development phases that could be derived from research: State of the Art Research, Requirement Analysis, Conceptual Prototype, Preliminary Prototype, Full Prototype, Full Application. The use cases demonstrate the value of qualitative methods and mixed methods designs. DISCUSSION Our methodological guidance has proven applicable for designing healthcare IT solutions from scratch - both for patient and professional settings - and to develop a platform for combining existing component-based solutions. In integrated care settings, where a wide range of stakeholders with multiple needs exist, we thus provide methodological guidance on how to involve users in the development process. CONCLUSION Our stepwise methodological guidance helps to design and properly evaluate healthcare IT solutions, which meet the user needs and requirements, for integrated care settings.
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Affiliation(s)
- Lorenz Harst
- Center for Evidence-based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, DE
| | | | | | - Tina Fuchs
- Chair of Technical Information Systems, Technische Universität Dresden, DE
| | - Patrick Timpel
- Center for Evidence-based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, DE
- Prevention and Care of Diabetes, Department of Medicine III, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, DE
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20
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Ordaz OH, Croff RL, Robinson LD, Shea SA, Bowles NP. Optimization of Primary Care Among Black Americans Using Patient Portals: Qualitative Study. J Med Internet Res 2021; 23:e27820. [PMID: 34081016 PMCID: PMC8212618 DOI: 10.2196/27820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/17/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Reduced patient portal use has previously been reported among Black Americans when compared with that of the general population. This statistic is concerning because portals have been shown to improve the control of chronic conditions that are more prevalent and severe in Black Americans. At their very simplest, portals allow patients to access their electronic health records and often provide tools for patients to interact with their own health information, treatment team members, and insurance companies. However, research suggests that Black American patients have greater concerns over a lack of support, loss of privacy, and reduced personalization of care compared with other Americans, which results in a disparity of portal use. OBJECTIVE This qualitative investigation of primary care experiences of Black Americans from across the United States who participated in remote focus groups in April and May 2020 aims to explore the use and perceived value of patient portals to better understand any barriers to optimized treatment in the primary care setting. METHODS We performed an inductive thematic analysis of 8 remote focus group interviews with 29 Black American patients aged 30-60 years to qualitatively assess the experiences of Black American patients with regular access to portals. RESULTS Thematic analysis uncovered the following interrelated themes regarding patient portals in primary care: the optimization of care, patient empowerment, patient-provider communication, and patient burden. CONCLUSIONS In contrast to what has been described regarding the reluctance of Black Americans to engage with patient portals, our focus groups revealed the general acceptance of patient portals, which were described overwhelmingly as tools with the potential for providing exceptional, personalized care that may even work to mitigate the unfair burden of disease for Black Americans in primary care settings. Thus, opportunities for better health care will clearly arise with increased communication, experience, and adoption of remote health care practices among Black Americans.
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Affiliation(s)
- Omar H Ordaz
- Oregon Institute of Occupational Health Sciences, Oregon Health Sciences University, Portland, OR, United States
| | - Raina L Croff
- Department of Neurology, School of Medicine, Oregon Health Sciences University, Portland, OR, United States
| | - LaTroy D Robinson
- Oregon Institute of Occupational Health Sciences, Oregon Health Sciences University, Portland, OR, United States
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health Sciences University, Portland, OR, United States
| | - Nicole P Bowles
- Oregon Institute of Occupational Health Sciences, Oregon Health Sciences University, Portland, OR, United States
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21
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Eriksson-Backa K, Hirvonen N, Enwald H, Huvila I. Enablers for and barriers to using My Kanta - A focus group study of older adults' perceptions of the National Electronic Health Record in Finland. Inform Health Soc Care 2021; 46:399-411. [PMID: 33787438 DOI: 10.1080/17538157.2021.1902331] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To explicate how experiences with patient-accessible electronic health records correspond to the expectations of the users, we present qualitative results of older adults' experiences with the Finnish national patient-accessible health record My Kanta and similar services. 24 persons, 17 women and 7 men aged 55-73, took part in the study. We interviewed six focus groups of 3-5 participants with previous experience of My Kanta, in two cities in Finland. We used a convenience sample and video- and audio-recording as well as note taking. The interviews were transcribed verbatim. The inductive analysis was based on content analysis. We identified major uses, enablers, barriers, and outcomes of My Kanta. In addition to earlier reported barriers and enablers, the findings show that launch-time lack of useful content and features in systems still under development can cause frustration and hinder their effective use at the time and in the long run. Concerns and barriers relating to use were socio-techno-informational and tightly associated with the contents of the system. Improved security, usability and additional information and functions might increase use. Furthermore, coherent and timely information from health-care providers should be available in the e-health services.
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Affiliation(s)
| | - Noora Hirvonen
- Information Studies, Åbo Akademi University, Turku, Finland.,Information Studies, University of Oulu, Oulu, Finland
| | - Heidi Enwald
- Information Studies, Åbo Akademi University, Turku, Finland.,Information Studies, University of Oulu, Oulu, Finland
| | - Isto Huvila
- Information Studies, Åbo Akademi University, Turku, Finland.,Department of ALM, Uppsala University, Uppsala, Sweden
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22
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Freise L, Neves AL, Flott K, Harrison P, Kelly J, Darzi A, Mayer EK. Assessment of Patients' Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey. JMIR Form Res 2021; 5:e19074. [PMID: 33635277 PMCID: PMC7954650 DOI: 10.2196/19074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 12/01/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care.
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Affiliation(s)
- Lisa Freise
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.,Center for Health Technology and Services Research / Department of Community Medicine, Health Information and Decision (CINTESIS/MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Kelsey Flott
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Paul Harrison
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John Kelly
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Erik K Mayer
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Casillas A, Perez-Aguilar G, Abhat A, Gutierrez G, Olmos-Ochoa TT, Mendez C, Mahajan A, Brown A, Moreno G. Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net. J Am Med Inform Assoc 2021; 26:1525-1535. [PMID: 31373362 DOI: 10.1093/jamia/ocz115] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 06/13/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP). MATERIALS AND METHODS The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. RESULTS Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. CONCLUSIONS Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Giselle Perez-Aguilar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anshu Abhat
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Griselda Gutierrez
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Carmen Mendez
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Anish Mahajan
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Javier SJ, Troszak LK, Shimada SL, McInnes DK, Ohl ME, Avoundjian T, Erhardt TA, Midboe AM. Racial and ethnic disparities in use of a personal health record by veterans living with HIV. J Am Med Inform Assoc 2021; 26:696-702. [PMID: 30924875 DOI: 10.1093/jamia/ocz024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine sociodemographic characteristics associated with use of My HealtheVet (MHV) by veterans living with HIV. MATERIALS AND METHODS Veterans Health Administration administrative data were used to identify a cohort of veterans living with HIV in fiscal years 2011-2017. Descriptive analyses were conducted to examine demographic characteristics and racial/ethnic differences in MHV registration and tool use. Chi-Square tests were performed to assess associations between race/ethnicity and MHV registration and tool use. RESULTS The highest proportion of registrants were non-Hispanic White veterans living with HIV (59%), followed by Hispanic/Latino (55%) and Black veterans living with HIV (40%). Chi-Square analyses revealed that: (1) MHV account registration was significantly lower for both Black and Hispanic/Latino veterans in comparison to White veterans and (2) Black MHV registrants were less likely to utilize any MHV tool compared with White MHV registrants including Blue Button record download, medication refills, secure messaging, lab, and appointment views. DISCUSSION In line with prior research on personal health record (PHR) use among non-veteran populations, these findings show racial and ethnic inequities in MHV use among veterans living with HIV. Racial and ethnic minorities may be less likely to use PHRs for a myriad of reasons, including PHR privacy concerns, decreased educational attainment, and limited access to the internet. CONCLUSION This is the first study to examine racial and ethnic disparities in use of MHV tools by veterans living with HIV and utilizing Veterans Health Administration health care. Future research should examine potential moderating factors linked to decreased PHR use among racial and ethnic minority veterans, which could inform strategies to increase PHR use among vulnerable populations.
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Affiliation(s)
- Sarah J Javier
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Lara K Troszak
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - D Keith McInnes
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael E Ohl
- Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA, Iowa City, Iowa, USA.,Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Tigran Avoundjian
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,University of Washington School of Public Health, University of Washington, Seattle, Washington, USA
| | - Taryn A Erhardt
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
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25
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Escobar N, Crown A, Pocock B, Joseph KA. The Devastating Impact of the COVID-19 Pandemic on Breast Cancer Care Among Medically Underserved Populations at Two New York City Public Hospitals. ANNALS OF SURGERY OPEN 2020; 1:e018. [PMID: 37637441 PMCID: PMC10455062 DOI: 10.1097/as9.0000000000000018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022] Open
Abstract
The COVID-19 pandemic has stretched hospitals to their capacities and has forced them to restructure and divert resources to accommodate the influx of critically ill patients. Surgical specialties are particularly vulnerable to restructuring given the need for highly trained personnel with intensive care unit (ICU) experience and procedural skills and need for ventilators and spaces that can function as ICUs. The diversion of hospital resources and redeployment of staff to the care of COVID patients has led to unintended consequences, including delays in care for patients with oncologic diagnoses, such as breast cancer. These unintended consequences are illustrated by the COVID-19 experiences of 2 New York City public hospitals: Bellevue Hospital and Elmhurst Hospital. The Breast Services of both hospitals treat the city's vulnerable, medically underserved breast cancer patients. Despite similar patient populations, Bellevue and Elmhurst had divergent COVID-19 experiences. With a larger surge capacity and an affiliation with New York University, the Breast Service at Bellevue Hospital was able to continue to offer essential breast operations, albeit at reduced volumes, whereas the Breast Service at Elmhurst Hospital was completely shut down. These experiences serve as a harbinger of the continually widening health care disparities and force hospital systems and policymakers to critically examine the impact of the COVID-19 pandemic on underserved patient populations that receive care at smaller public hospitals.
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Affiliation(s)
- Natalie Escobar
- From the Department of Surgery, Bellevue Hospital Medical Center, NYU Langone Medical Center, New York, NY
| | - Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - Ben Pocock
- Department of Surgery, Elmhurst Hospital Medical Center, Elmhurst, NY
| | - Kathie-Ann Joseph
- From the Department of Surgery, Bellevue Hospital Medical Center, NYU Langone Medical Center, New York, NY
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26
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Cemballi AG, Karter AJ, Schillinger D, Liu JY, McNamara DS, Brown W, Crossley S, Semere W, Reed M, Allen J, Lyles CR. Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study. J Am Med Inform Assoc 2020; 28:1252-1258. [PMID: 33236117 DOI: 10.1093/jamia/ocaa281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
The substantial expansion of secure messaging (SM) via the patient portal in the last decade suggests that it is becoming a standard of care, but few have examined SM use longitudinally. We examined SM patterns among a diverse cohort of patients with diabetes (N = 19 921) and the providers they exchanged messages with within a large, integrated health system over 10 years (2006-2015), linking patient demographics to SM use. We found a 10-fold increase in messaging volume. There were dramatic increases overall and for patient subgroups, with a majority of patients (including patients with lower income or with self-reported limited health literacy) messaging by 2015. Although more physicians than nurses and other providers messaged throughout the study, the distribution of health professions using SM changed over time. Given this rapid increase in SM, deeper understanding of optimizing the value of patient and provider engagement, while managing workflow and training challenges, is crucial.
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Affiliation(s)
- Anupama Gunshekar Cemballi
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Andrew J Karter
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - William Brown
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
| | - Scott Crossley
- Department of Applied Linguistics and ESL, Georgia State University, Atlanta, Georgia, USA
| | - Wagahta Semere
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jill Allen
- Kaiser Research Insights and Operations, Kaiser Permanente, Pleasanton, California, USA
| | - Courtney Rees Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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27
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Lin SC, Lyles CR, Sarkar U, Adler-Milstein J. Are Patients Electronically Accessing Their Medical Records? Evidence From National Hospital Data. Health Aff (Millwood) 2020; 38:1850-1857. [PMID: 31682494 DOI: 10.1377/hlthaff.2018.05437] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Substantial policy effort has been directed at improving patients' ability to access and use electronic health records. Using nationwide data from 2,410 hospitals for the period 2014-16, we examined associations between patient- and hospital-level characteristics and access to and use of electronic health record data among discharged patients. On average, hospitals gave 95 percent of discharged patients access to view, download, and transmit their information, but only about 10 percent of those with access used it-levels that were stagnant during the study period. Access rates were highest among system-member, teaching, and for-profit hospitals. In contrast, access rates were lower for hospitals in the highest quartile for disproportionate share hospital status and for hospitals located in counties with high proportions of residents who were dually eligible for Medicare and Medicaid; use rates were lower for hospitals in counties with a high proportion of residents who were dually eligible, lacked computer or internet access, or were Hispanic. Overall, our findings suggest that policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the "digital divide" that accompanies health care disparities. Additional-possibly targeted-policy incentives, as well as higher thresholds for meeting the requirements of the Promoting Interoperability Program, merit policy makers' consideration.
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Affiliation(s)
- Sunny C Lin
- Sunny C. Lin ( sunny. lin@pdx. edu ) is an assistant professor of public health at the Oregon Health and Science University-Portland State University School of Public Health, in Portland, Oregon
| | - Courtney R Lyles
- Courtney R. Lyles is an associate professor of medicine at the University of California San Francisco (UCSF)
| | - Urmimala Sarkar
- Urmimala Sarkar is an associate professor of medicine in the Division of General Internal Medicine, UCSF, and a primary care physician at Zuckerberg San Francisco General Hospital's Richard H. Fine People's Clinic
| | - Julia Adler-Milstein
- Julia Adler-Milstein is an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, UCSF
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28
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Turner K, Clary A, Hong YR, Alishahi Tabriz A, Shea CM. Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study. J Med Internet Res 2020; 22:e18870. [PMID: 32940620 PMCID: PMC7530687 DOI: 10.2196/18870] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/22/2020] [Accepted: 08/16/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Past studies examining barriers to patient portal adoption have been conducted with a small number of patients and health care settings, limiting generalizability. OBJECTIVE This study had the following two objectives: (1) to assess the prevalence of barriers to patient portal adoption among nonadopters and (2) to examine the association between nonadopter characteristics and reported barriers in a nationally representative sample. METHODS Data from this study were obtained from the 2019 Health Information National Trends Survey. We calculated descriptive statistics to determine the most prevalent barriers and conducted multiple variable logistic regression analysis to examine which characteristics were associated with the reported barriers. RESULTS The sample included 4815 individuals. Among these, 2828 individuals (58.73%) had not adopted a patient portal. Among the nonadopters (n=2828), the most prevalent barriers were patient preference for in-person communication (1810/2828, 64.00%), no perceived need for the patient portal (1385/2828, 48.97%), and lack of comfort and experience with computers (735/2828, 25.99%). Less commonly, individuals reported having no patient portal (650/2828, 22.98%), no internet access (650/2828, 22.98%), privacy concerns (594/2828, 21.00%), difficulty logging on (537/2828, 18.99%), and multiple patient portals (255/2828, 9.02%) as barriers. Men had significantly lower odds of indicating a preference for speaking directly to a provider compared with women (odds ratio [OR] 0.75, 95% CI 0.60-0.94; P=.01). Older age (OR 1.01, 95% CI 1.00-1.02; P<.001), having a chronic condition (OR 1.83, 95% CI 1.44-2.33; P<.001), and having an income lower than US $20,000 (OR 1.61, 95% CI 1.11-2.34; P=.01) were positively associated with indicating a preference for speaking directly to a provider. Hispanic individuals had significantly higher odds of indicating that they had no need for a patient portal (OR 1.59, 95% CI 1.24-2.05; P<.001) compared with non-Hispanic individuals. Older individuals (OR 1.05, 95% CI 1.04-1.06; P<.001), individuals with less than a high school diploma (OR 3.15, 95% CI 1.79-5.53; P<.001), and individuals with a household income of less than US $20,000 (OR 2.78, 95% CI 1.88-4.11; P<.001) had significantly higher odds of indicating that they were uncomfortable with a computer. CONCLUSIONS The most common barriers to patient portal adoption are preference for in-person communication, not having a need for the patient portal, and feeling uncomfortable with computers, which are barriers that are modifiable and can be intervened upon. Patient characteristics can help predict which patients are most likely to experience certain barriers to patient portal adoption. Further research is needed to tailor implementation approaches based on patients' needs and preferences.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Alecia Clary
- Center for Healthcare Transformation, Avalere Health, Washington, DC, United States
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Amir Alishahi Tabriz
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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29
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Sociodemographic Differences and Factors Affecting Patient Portal Utilization. J Racial Ethn Health Disparities 2020; 8:879-891. [PMID: 32839896 DOI: 10.1007/s40615-020-00846-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 07/08/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The primary function of the patient portal is to give patients greater access to their personal health information. Granting patients electronic access allows them to make well-informed health care decisions. OBJECTIVE This study aimed to identify sociodemographic differences in patient portal use and examine factors affecting patient portal utilization following the final stage of the Meaningful Use program which aimed to promote the use of certified electronic health record (EHR) technology. RESEARCH DESIGN Survey data from Health Information National Trends Survey (HINTS) 5, cycles 1, 2, and 3 were analyzed. The sample included 8291 completed surveys. Multivariable logistic regression on a selected response for each surveyed question was used to assess the racial and ethnic difference after controlling for age, sex, income, and education. SUBJECTS Subjects included English and Spanish speaking adults in the USA. MEASURES Measures included assessment of patient portal use, patient portal access, understanding health information, usefulness of health records, and privacy and security. RESULTS After adjusting for age, sex, income, and education, there was a significant association between race/ethnicity and patient portal non-users responding, "no need to use online medical record" as the reason for not using the patient portal (P = 0.005). Among the portal users, there were significant associations between race/ethnicity and health care provider maintaining an EHR (P = 0.006), being offered access to their portal (P < 0.001), understanding health information in the portal (P = 0.004), finding the portal useful for health monitoring (P < 0.001), reporting concern about unauthorized access (P = 0.017), and keeping information from health care providers (P = 0.012). CONCLUSIONS Race/ethnicity affects perceptions on the need for the patient portal, being offered access to a portal, and the reasons to access information online. Understanding the factors affecting patient portal use can inform future strategies aimed at increasing adoption.
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Abstract
Pediatric practice increasingly involves providing care for children with medical complexity. Telehealth offers a strategy for providers and health care systems to improve care for these patients and their families. However, lack of awareness related to the unintended negative consequences of telehealth on vulnerable populations--coupled with failure to intentional design best practices for telehealth initiatives--implies that these novel technologies may worsen health disparities in the long run. This article reviews the positive and negative implications of telehealth. In addition, to achieve optimal implementation of telehealth, it discusses 10 considerations to promote optimal care of children using these technologies.
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Affiliation(s)
- Eli M Cahan
- Clinical Excellence Research Center, Stanford School of Medicine, Stanford, CA 94305, USA; NYU School of Medicine, New York, NY 10010, USA.
| | | | - Nirav R Shah
- Clinical Excellence Research Center, Stanford School of Medicine, Stanford, CA 94305, USA
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31
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Casillas A, Cemballi AG, Abhat A, Lemberg M, Portz JD, Sadasivaiah S, Ratanawongsa N, Semere W, Brown A, Lyles CR. An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net. J Med Internet Res 2020; 22:e18466. [PMID: 32706709 PMCID: PMC7400036 DOI: 10.2196/18466] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. Objective Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. Methods We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Anupama Gunshekar Cemballi
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Anshu Abhat
- Los Angeles County Department of Health Services, Harbor-UCLA Medical Center, Los Angeles, CA, United States
| | - Miya Lemberg
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Jennifer D Portz
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Shobha Sadasivaiah
- Office of Health Informatics, San Francisco Health Network, San Francisco, CA, United States
| | - Neda Ratanawongsa
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Wagahta Semere
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Courtney Rees Lyles
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
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32
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Ochoa C, Baron-Lee J, Popescu C, Busl KM. Electronic patient portal utilization by neurology patients and association with outcomes. Health Informatics J 2020; 26:2751-2761. [PMID: 32674698 PMCID: PMC9215314 DOI: 10.1177/1460458220938533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Existing literature on electronic patient portals demonstrates mixed findings for portal user demographic patterns and relationships between portal usage and clinical outcomes. This study sought to determine characteristics of portal users specific to a neurology patient population and examine whether usage predicted decreased clinic visits and risk of hospitalization. A cross-sectional analysis on 13,483 patients seen at a tertiary neurology outpatient clinic over a 1-year period found significant associations between demographics, and interactions between age, sex, and race. Black and Hispanic patients were less likely to be portal users. While females had higher odds of portal usage overall, their probability decreased with increasing age. Portal users had higher rates of clinic utilization but no difference in hospitalization risk. These results highlight demographics that may need strategic targeting to increase portal uptake and the need for other interventions for populations more likely to experience health events resulting in hospitalization.
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Wildenbos GA, Jaspers M, Peute L. The equity paradox: older patients' participation in patient portal development. Int J Qual Health Care 2020; 31:793-797. [PMID: 30576454 DOI: 10.1093/intqhc/mzy245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/10/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE This paper reflects on ethical concerns to patient portals design and evaluation approaches and provides a comprehensive overview of methodological considerations to advance patient participation of older patients to patient portal research and development. REFLECTION Barriers to the use of current patient portals experienced by older patients are concentrated on access issues and difficulties with interpretation of medical content. As patient portals' functionalities are being expanded by means of co-creation and user-testing such barriers often remain unrecognized. A main challenge of these patient participation efforts is namely to include a variety of older patients; foremost autonomous patients seem to participate. By selecting autonomous participants in co-creation or user-testing, design solutions are proposed that specifically benefit the autonomy of that patient, whereas it does not do justice to values and interests of patients who are less independent and are confronted with a wider variety of use barriers. Consequently, there is a risk of widening the gap between those who can use and benefit from patient portals and those who cannot. To prevent this from happening, we propose three main methodological aspects to consider in co-creation and user-testing activities that aim to optimize patient portal functionalities. IMPLICATIONS We encourage policy makers and patient portal developers to use present-day's momentum to include older patients' abilities, needs and context in the decision-making and investments in further advancing patient portals. We further stimulate future research that aims to improve methods to overcome challenges of older patients' participation regarding design and evaluation of eHealth systems.
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Affiliation(s)
- Gaby Anne Wildenbos
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), University of Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Medical Informatics, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Monique Jaspers
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), University of Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Medical Informatics, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Linda Peute
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), University of Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Medical Informatics, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
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Hardeman AN, Kahn MJ. Technological Innovation in Healthcare: Disrupting Old Systems to Create More Value for African American Patients in Academic Medical Centers. J Natl Med Assoc 2020; 112:289-293. [PMID: 32279881 DOI: 10.1016/j.jnma.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
Healthcare in the United States (U.S.) has made incredible advances, but inefficiency and high costs continue to permeate the system. Urban and underserved communities face the greatest array of healthcare problems including the need to improve the quality of care provided them, disproportionate levels of poverty among different groups in the U.S., and the number of unhealthy people disproportionately represented by mostly African American and Hispanic populations. Academic medical centers (AMCs) are major community stakeholders who work to fulfill the increasing healthcare demands of underserved communities. With the tripartite mission of delivering high quality care to patients, undertaking clinical and laboratory research, and training future health professionals, AMCs have a unique ability to address health concerns of the most vulnerable populations. Innovations in healthcare technology are critical to ensure that AMCs properly address health disparities and the specific health concerns of rapidly growing African American populations. Awareness of these disparities may lead to improved processes and protocol implementation, which can promote innovation and quality improvement to allow AMCs to remain a key player in addressing population-based clinical research, quality of care, and health disparities nationwide.
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Affiliation(s)
- Amber N Hardeman
- Tulane University School of Medicine, New Orleans, LA, USA; AB Freeman School of Business, New Orleans, LA, USA
| | - Marc J Kahn
- University of Nevada Las Vegas School of Medicine, Office of the Dean, Las Vegas, NV, USA.
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Graetz I, Huang J, Brand R, Hsu J, Reed ME. Mobile-accessible personal health records increase the frequency and timeliness of PHR use for patients with diabetes. J Am Med Inform Assoc 2019; 26:50-54. [PMID: 30358866 DOI: 10.1093/jamia/ocy129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/12/2018] [Indexed: 11/13/2022] Open
Abstract
Personal health records (PHRs) offer patients a portal to view lab results, communicate with their doctors, and refill medications. Expanding PHR access to mobile devices could increase patients' engagement with their PHRs. We examined whether access to a mobile-optimized PHR changed the frequency and timeliness of PHR use among adult patients with diabetes in an integrated delivery system. Among patients originally using the PHR only by computer, PHR use frequency increased with mobile access. Non-White patients were more likely to view their lab results within 7 days if they had computer and mobile access compared with computer only; however, there were no statistically significant differences among White patients. More frequent and timely mobile access to PHR data and tools may lead to convenient and effective PHR engagement to support patient self-management. Future studies should evaluate whether PHR use with a mobile device is associated with changes in self-management and outcomes.
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Affiliation(s)
- Ilana Graetz
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jie Huang
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Richard Brand
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - John Hsu
- Mongan Institute and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary E Reed
- Kaiser Permanente Division of Research, Oakland, California, USA
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Ukoha EP, Feinglass J, Yee LM. Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study. J Med Internet Res 2019; 21:e14445. [PMID: 31586367 PMCID: PMC6818527 DOI: 10.2196/14445] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 01/20/2023] Open
Abstract
Background Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited. Objective This study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients’ demographics or clinical characteristics exist. Methods This was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (≥1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients’ characteristics. Results Of the 3450 women eligible for inclusion, 2530 (73.33%) enrolled in the portal. Of these enrollees, 72.09% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95% CI 0.69-0.89 for second trimester and aIRR 0.50, 95% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95% CI 1.01-1.23). Conclusions Among an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care.
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Affiliation(s)
- Erinma P Ukoha
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Vreugdenhil MMT, Ranke S, de Man Y, Haan MM, Kool RB. Patient and Health Care Provider Experiences With a Recently Introduced Patient Portal in an Academic Hospital in the Netherlands: Mixed Methods Study. J Med Internet Res 2019; 21:13743. [PMID: 31432782 PMCID: PMC6788335 DOI: 10.2196/13743] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/14/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the Netherlands, the health care system and related information technology landscape are fragmented. Recently, hospitals have started to launch patient portals. It is not clear how these portals are used by patients and their health care providers (HCPs). OBJECTIVE The objective of this study was to explore the adoption, use, usability, and usefulness of a recently introduced patient portal in an academic hospital to learn lessons for the implementation of patient portals in a fragmented health care system. METHODS A mixed methods study design was used. In the quantitative study arm, characteristics of patients who used the portal were analyzed, in addition to the utilization of the different functionalities of the portal. In the qualitative study arms, think-aloud observations were made to explore usability. Focus group discussions were conducted among patients and HCPs of the dermatology and ophthalmology outpatient departments. Thematic content analysis of qualitative data was carried out and overarching themes were identified using a framework analysis. RESULTS One year after the introduction of the portal, 24,514 patients, 13.49% of all patients who visited the hospital, had logged in to the portal. Adoption of the portal was associated with the age group 45 to 75 years, a higher socioeconomic status, and having at least one medical diagnosis. Overarching themes from the qualitative analyses were (1) usability and user-friendliness of the portal, (2) HCP-patient communication through the portal, (3) usefulness of the information that can be accessed through the portal, (4) integration of the portal in care and work processes, and (5) HCP and patient roles and relationships. CONCLUSIONS One year after the introduction of the patient portal, patients and HCPs who used the portal recognized the potential of the portal to engage patients in their care processes, facilitate patient-HCP communication, and increase patient convenience. Uncertainties among patients and HCPs about how to use the messaging functionality and limited integration of the portal in care and work processes are likely to have limited portal use and usefulness.
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Affiliation(s)
| | - Sander Ranke
- IQ healthcare, Radboudumc, Nijmegen, Netherlands
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Antonio MG, Petrovskaya O, Lau F. Is research on patient portals attuned to health equity? A scoping review. J Am Med Inform Assoc 2019; 26:871-883. [PMID: 31066893 PMCID: PMC7647227 DOI: 10.1093/jamia/ocz054] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Our scoping review examined how research on patient portals addresses health equity. Questions guiding our review were: 1) What health equity concepts are addressed in patient portal research-both explicitly and implicitly? 2) What are the gaps? 3) Is the potential for ehealth-related health inequities explicitly acknowledged in studies on patient portals? 4) What novel approaches and interventions to reduce health inequities are tested in patient portal research? MATERIALS AND METHODS We searched 4 databases. Search terms included "patient portal" in combination with a comprehensive list of health equity terms relevant in ehealth context. Authors independently reviewed the papers during initial screening and full-text review. We applied the eHealth Equity Framework to develop search terms and analyze the included studies. RESULTS Based on eHealth Equity Framework categories, the main findings generated from 65 reviewed papers were governance structures, ehealth policies, and cultural and societal values may further inequities; social position of providers and patients introduces differential preferences in portal use; equitable portal implementation can be supported through diverse user-centered design; and intermediary strategies are typically recommended to encourage portal use across populations. DISCUSSION The predominant focus on barriers in portal use may be inadvertently placing individual responsibility in addressing these barriers on patients already experiencing the greatest health disparities. This approach may mask the impact of the socio-technical-economic-political context on outcomes for different populations. CONCLUSION To support equitable health outcomes related to patient portals we need to look beyond intermediary initiatives and develop equitable strategies across policy, practice, research, and implementation.
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Affiliation(s)
- Marcy G Antonio
- Schools of Health Information Science and Nursing, Victoria, British Columbia, Canada
| | - Olga Petrovskaya
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Engaging patients throughout the health system: A landscape analysis of cold-call policies and recommendations for future policy change. J Clin Transl Sci 2019; 2:384-392. [PMID: 31402985 PMCID: PMC6676437 DOI: 10.1017/cts.2019.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Healthcare institutions may often prohibit “cold-calling” or direct contact with a potential research participant when the person initiating contact is unknown to the patient. This policy aims to maintain patient privacy, but may have unintended consequences as a result of physician gatekeeping. In this review, we discuss recruitment policies at the top academic institutions. We propose an ethical framework for evaluating cold-call policies based on three principles of research ethics. In order to maximize engagement of potential research participants, while maintaining patient privacy and autonomy, we then propose several alternative solutions to restrictive cold-call policies, including opt-in or opt-out platforms, a team-based approach, electronic solutions, and best practices for recruitment. As healthcare has evolved with more collaborative, patient-centered, data-driven care, the engagement of potential research participants should similarly evolve.
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Gonzalez M, Sanders-Jackson A, Wright T. Web-Based Health Information Technology: Access Among Latinos Varies by Subgroup Affiliation. J Med Internet Res 2019; 21:e10389. [PMID: 30990462 PMCID: PMC6488958 DOI: 10.2196/10389] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/31/2018] [Accepted: 12/12/2018] [Indexed: 01/02/2023] Open
Abstract
Background There are significant health technology gaps between Latinos and non-Hispanic whites and between first- and second-generation Latinos. Objective This study aimed to examine disparities in Web-based health information–seeking behavior (HISB) and patient portal use among Latinos, taking into account nativity and subethnic affiliation. Methods We analyzed US-born, non-Hispanic whites and Latinos adults (N=49,259) and adult internet users (N=36,214) in the 2015 to 2016 National Health Interview Survey using a binary logistic regression controlling for individual difference level variables. Outcomes were internet use, HISB (health information-seeking online and using a chat group for health information), and patient portal use (using a computer to schedule an appointment, filling a prescription, and communicating with a provider). Results We found that US-born Mexicans (odds ratio [OR] 0.81, 95% CI 0.66-0.99), foreign-born Mexicans (OR 0.35, 95% CI 0.29-0.42), foreign-born Puerto Ricans (OR 0.62, 95% CI 0.44-0.87), foreign-born Central and South Americans (OR 0.42, 95% CI 0.33-0.53), and foreign-born other Latinos (OR 0.34, 95% CI 0.24-0.49) had lower odds of using the internet than US-born non-Hispanic whites. The relationship between subgroup affiliation and Web-based HISB varied by type of technology. US-born Mexicans (OR 0.77, 95% CI 0.66-0.9), foreign-born Mexicans (OR 0.51, 95% CI 0.43-0.61), foreign-born Central and South Americans (OR 0.53, 95% CI 0.43-0.64), and foreign-born other Latinos (OR 0.56, 95% CI 0.4-0.79) had lower odds of looking up health information online than US-born non-Hispanic whites. Controlling for age, sex, education, income to federal poverty level, and region, foreign-born Central and South Americans (OR 0.61, 95% CI 0.41-0.92) and foreign-born other Latinos (OR 0.26, 95% CI 0.1-0.68) had lower odds of filling a prescription using a computer than US-born non-Hispanic whites. Foreign-born Mexicans (OR 0.51, 95% CI 0.36-0.72) and foreign-born Central and South Americans (OR 0.7, 95% CI 0.5-0.99) have lower odds of emailing a health care provider than US-born non-Hispanic whites. Posthoc analyses were conducted among Mexican-Americans to see if age was significant in predicting Web-based HISB or other patient portal use. We found individuals aged 18 to 30 years had higher odds of using the internet (OR 3.46, 95% CI 2.61-4.59) and lower odds of looking up health information online (OR 0.75, 95% CI 0.58-0.96). A posthoc analysis was conducted among Mexican-Americans to see if nativity predicted Web-based HISB and patient portal use. We found that US-born individuals had higher odds (OR 52.9, 95% CI 1.2-1.93) of looking up health information online compared with foreign-born individuals. Conclusions We found Latino subgroups do not use health information channels equally, and attempts to target Latinos should take ethnicity and nativity into account.
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Affiliation(s)
- Mariaelena Gonzalez
- Department of Public Health, University of California - Merced, Merced, CA, United States.,Health Science Research Institute, University of California - Merced, Merced, CA, United States
| | - Ashley Sanders-Jackson
- Department of Advertising and Public Relations, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - Tashelle Wright
- Department of Public Health, University of California - Merced, Merced, CA, United States
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Portz JD, Bayliss EA, Bull S, Boxer RS, Bekelman DB, Gleason K, Czaja S. Using the Technology Acceptance Model to Explore User Experience, Intent to Use, and Use Behavior of a Patient Portal Among Older Adults With Multiple Chronic Conditions: Descriptive Qualitative Study. J Med Internet Res 2019; 21:e11604. [PMID: 30958272 PMCID: PMC6475817 DOI: 10.2196/11604] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/21/2018] [Accepted: 01/23/2019] [Indexed: 01/18/2023] Open
Abstract
Background Patient portals offer modern digital tools for older adults with multiple chronic conditions (MCC) to engage in their health management. However, there are barriers to portal adoption among older adults. Understanding portal user interface and user experience (UI and UX) preferences of older adults with MCC may improve the accessibility, acceptability, and adoption of patient portals. Objective The aim of this study was to use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the UI and UX, intent to use, and use behaviors among older patients with MCC. Methods We carried out a qualitative descriptive study of Kaiser Permanente Colorado’s established patient portal, My Health Manager. Older patients (N=24; mean 78.41 (SD 5.4) years) with MCC participated in focus groups. Stratified random sampling was used to maximize age and experience with the portal among participants. The semistructured focus groups used a combination of discussion and think-aloud strategies. A total of 2 coders led the theoretically driven analysis based on the TAM to determine themes related to use behavior, portal usefulness and ease of use, and intent to use. Results Portal users commonly used email, pharmacy, and lab results sections of the portal. Although, generally, the portal was seen to be easy to use, simple, and quick, challenges related to log-ins, UI design (color and font), and specific features were identified. Such challenges inhibited participants’ intent to use the portal entirely or specific features. Participants indicated that the portal improved patient-provider communication, saved time and money, and provided relevant health information. Participants intended to use features that were beneficial to their health management and easy to use. Conclusions Older adults are interested in using patient portals and are already taking advantage of the features available to them. We have the opportunity to better engage older adults in portal use but need to pay close attention to key considerations promoting usefulness and ease of use.
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Affiliation(s)
- Jennifer Dickman Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, United States.,Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States.,Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Sheana Bull
- mHealth Impact Lab, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - David B Bekelman
- Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, United States.,Department of Medicine, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, CO, United States
| | - Kathy Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - Sara Czaja
- Division of Geriatrics, Weill Cornell Medicine, New York, NY, United States.,Center for Research and Education on Aging and Technology Enhancement, University of Miami, Miami, FL, United States
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Sadasivaiah S, Lyles CR, Kiyoi S, Wong P, Ratanawongsa N. Disparities in Patient-Reported Interest in Web-Based Patient Portals: Survey at an Urban Academic Safety-Net Hospital. J Med Internet Res 2019; 21:e11421. [PMID: 30912747 PMCID: PMC6454341 DOI: 10.2196/11421] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/05/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Offering hospitalized patients' enrollment into a health system's patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. Patient portal disparities exist and may lead to differences in access or outcomes. As such, it is important to study upstream factors in a typical hospital workflow that could lead to those disparities in safety-net settings. OBJECTIVE The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system's portal among hospitalized patients and reasons for no interest. METHODS Nurses assessed interest in a Web-based patient portal, expressed by the patient as "yes" or "no," as part of the admission nursing assessment among patients at an academic urban safety-net hospital and recorded responses in the electronic health record (EHR), including reasons for no interest. We extracted patient responses from the EHR. RESULTS Among 23,994 hospitalizations over a 2-year period, 35.90% (8614/ 23,994) reported an interest in a Web-based portal. Reasons for no interest included the following: not interested/other reason 41.68% (6410/15,380), no ability to use/access computers/internet 29.59% (4551/15,380), doesn't speak English 11.15% (1715/15,380), physically or mentally unable 8.70% (1338/15,380), does not want to say 8.70% (1338/15,380), security concerns 0.03% (4/15,380), and not useful 0.16% (24/15,380). Among the 16,507 unique patients included in this sample, portal interest was lower in older, African American, non-English speaking, and homeless patient populations. CONCLUSIONS In a safety-net system, patient interest at the time of hospitalization in a Web-based enterprise portal-a required step before enrollment-is low with significant disparities by sociodemographic characteristics. To avoid worsening the digital divide, new strategies are needed and should be embedded within routine workflows to engage vulnerable safety-net patients in the use of Web-based health technologies.
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Affiliation(s)
- Shobha Sadasivaiah
- Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Stephen Kiyoi
- Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States
| | - Piera Wong
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Neda Ratanawongsa
- Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
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A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal. J Am Board Fam Med 2019; 32:248-258. [PMID: 30850461 PMCID: PMC6647853 DOI: 10.3122/jabfm.2019.02.180263] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/06/2018] [Accepted: 11/30/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patient portals are becoming ubiquitous. Previous research has documented substantial barriers, especially among vulnerable patient subgroups such as those with lower socioeconomic status or limited health literacy (LHL). We tested the effectiveness of delivering online, video-based portal training to patients in a safety net setting. METHODS We created an online video curriculum about accessing the San Francisco Health Network portal, and then randomized 93 English-speaking patients with 1+ chronic diseases to receive 1) an in-person tutorial with a research assistant, or 2) a link to view the videos on their own. We also examined a third, nonrandomized usual care comparison group. The primary outcome was portal log-in (yes/no) 3 to 6 months post-training, assessed via the electronic health record. Secondary outcomes were self-reported attitudes and skills collected via baseline and follow-up surveys. RESULTS Mean age was 54 years, 51% had LHL, 60% were nonwhite, 52% were female, 45% reported fair/poor health, and 76% reported daily Internet use. At followup, 21% logged into the portal, with no differences by arm (P = .41), but this was higher than the overall clinic rate of 9% (P < .01) during the same time period. We found significant prepost improvements in self-rated portal skills (P = .03) and eHealth literacy (P < .01). Those with LHL were less likely to log in post-training (P < .01). CONCLUSIONS Both modalities of online training were comparable, and neither mode enabled a majority of vulnerable patients to use portals, especially those with LHL. This suggests that portal training will need to be more intensive or portals need improved usability to meaningfully increase use among diverse patients.
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Kolodychuk NL, Wong M, Chimento G, Adams T, Gastanaduy M, Waddell BS. Web-based patient portal access in an orthopedic adult reconstruction patient population. Arthroplast Today 2019; 5:83-87. [PMID: 31020029 PMCID: PMC6470345 DOI: 10.1016/j.artd.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 11/26/2022] Open
Abstract
Background We surveyed patients in an adult reconstruction practice as to their use of the Web-based portal provided by our electronic health record, seeking to reveal patterns of use and helpfulness. Methods A total of 150 completed surveys were received. The survey queried demographics, the number of clinic visits, Internet access, portal activation, portal use frequency, and portal information questions and how patients answered them. Helpfulness was rated from 1 (not helpful) to 5 (very helpful). Statistical analysis included bivariate analysis and logistic regression, with odds ratio (OR) and 95% confidence interval (CI) reported. Results The mean age was 67.6 years. Most were females (n = 97, 65.1%). Most (68.7%) patients used the portal. Younger age (OR, 0.94; CI, 0.90-0.99) and access to Internet (OR, 31.8; CI, 8.5-119.4) predicted portal use (P < .005), whereas gender and number of clinic visits did not (P > .373). Of all, 47.5% of patients were unclear about online chart information. Older age indicated being unclear of portal information (68.5 vs 66, P = .0002). Of those who clarified doubts regarding information (n = 67), 23 used the Internet (34.3%), 32 (47.7%) called the physician, and 12 (17.9%) asked a friend and/or family member. Most (90.3%) patients felt the portal was helpful in gathering health information. Conclusions Age and Internet access affected portal usage; ability to understand chart information decreased with age. Most patients used the Internet or a family member to clarify doubts regarding portal information. The use of portal data resulted in 32 extra communications to the physician.
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Affiliation(s)
| | - Michael Wong
- Department of Orthopedics, Ochsner Medical Center, Jefferson, LA, USA
| | - George Chimento
- Department of Orthopedics, Ochsner Medical Center, Jefferson, LA, USA
| | - Tyler Adams
- Department of Orthopedics, Ochsner Medical Center, Jefferson, LA, USA
| | - Mariella Gastanaduy
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Bradford S Waddell
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
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A Comparison of Electronic Patient-Portal Use Among Patients with Resident and Attending Primary Care Providers. J Gen Intern Med 2018; 33:2085-2091. [PMID: 30187376 PMCID: PMC6258601 DOI: 10.1007/s11606-018-4637-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/28/2018] [Accepted: 07/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Electronic patient-portals offer the potential to enhance patient-physician communication and health outcomes but differential use may create or worsen disparities. While prior studies identified patient characteristics associated with patient-portal use, the role of physician factors is less known. We investigated differences in overall and patterns of portal use for patients with resident and attending primary care providers (PCPs). METHODS Cross-sectional study of all established patients with a resident or attending PCP seen at an academic internal medicine practice (two sites) between May 1, 2014, and April 30, 2015. We defined patient-portal use as having accessed any "active" (secure messaging, medication refill request), or "passive" (viewing labs, after visit summaries, or appointments) patient-portal function more than once over the study period. We used generalized linear models clustered on PCP to examine the odds of patient-portal use by PCP type, adjusted for patient age, gender, preferred language, race/ethnicity, insurance, and visits. Among patient-portal users, we examined the association of PCP type with "active use" utilizing the same method. RESULTS The mean patient age (n = 17,699) was 54.2 (SD 17.5), with 47.2% White, 23.6% Asian, 8.8% Black, 8.4% Latino, and 12% other/unknown. The majority (61.8%) had private insurance, and attending PCPs (76.9%). Although 72.3% enrolled in the patient-portal, only 53.4% were portal users; 40.0% were active users. There were 47 attending and 62 resident physicians. Patients with resident PCPs had lower odds of using the portal compared to those with attending PCPs (OR = 0.54, 95% CI 0.50-0.59). Similarly, among portal users, residents' patients had lower odds of being active users of the portal (OR = 0.76, 95% CI 0.68-0.87). CONCLUSION Given the lower patient-portal use among residents' patients, residency programs should develop curricula to bolster trainee competence in using the patient-portal for communication and to enhance the patient-physician relationship. Future research should explore additional physician factors that impact portal use.
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Anthony DL, Campos-Castillo C, Lim PS. Who Isn’t Using Patient Portals And Why? Evidence And Implications From A National Sample Of US Adults. Health Aff (Millwood) 2018; 37:1948-1954. [DOI: 10.1377/hlthaff.2018.05117] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Denise L. Anthony
- Denise L. Anthony is a professor of health management and policy and of sociology in the Department of Health Management and Policy, University of Michigan School of Public Health, in Ann Arbor
| | - Celeste Campos-Castillo
- Celeste Campos-Castillo is an assistant professor in the Department of Sociology, University of Wisconsin–Milwaukee
| | - Paulina S. Lim
- Paulina S. Lim is a graduate student in the Department of Psychology, University of Wisconsin–Milwaukee
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Wildenbos GA, Horenberg F, Jaspers M, Peute L, Sent D. How do patients value and prioritize patient portal functionalities and usage factors? A conjoint analysis study with chronically ill patients. BMC Med Inform Decis Mak 2018; 18:108. [PMID: 30463613 PMCID: PMC6249922 DOI: 10.1186/s12911-018-0708-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/13/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patient portal use can be a stimulant for patient engagement. Yet, the heterogeneous landscape of tethered patient portals, is a major barrier to further portal development and implementation. A variety in portal access means, functionalities, usability and usefulness exists; without having accurate sight on patient perspectives. We aimed to get insights on possible coherence between patients' preferred usage factors of portals and patients' prioritization of functionalities, within the complexity of their disease management across different healthcare organizations. METHODS A conjoint analysis questionnaire was sent to patient panels of two large patient associations in The Netherlands, centered on heart and vascular diseases and lung diseases. RESULTS Of 1294 patient respondents, 81% were 55+ years old and 49% were 65+ years old. Overall respondents significantly prioritized user-friendly access to a portal, via a laptop or desktop. Patients aged < 65 were less negative about using tablets to access a portal compared to the total respondents. Patients had no preference for a digital interoperable export functionality; most respondents preferred to create printable overviews. Built-in publication delay of two weeks for medical information was not preferred. Our results show no significant preference of patients between 'instant publication' versus 'publication after new information has been explained by a healthcare provider'. Overall respondents and experienced portal users had a strong preference to be able to communicate with their provider via a portal and to use a portal providing information from multiple providers. Lung patients preferred information from one provider and did not require the possibility to ask online questions. CONCLUSIONS Heart and vascular patients as well as lung patients prefer similar technical patient portal aspects, independent of their medical condition. Yet, in current portals consistency on this matter is lacking. It is highly assumable that offering a more consistent user-experience across the variety of patient portals could help increase patient portal acceptance, ultimately helping to stimulate patient engagement via patient portal use. We further affirm the need for customization on medical information publication and sharing information of various providers through patient portals, where information provision can be adapted to preferences of patients related to their medical condition(s).
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Affiliation(s)
- Gaby Anne Wildenbos
- Center for Human Factors Engineering of Health Information Technology, Department of Medical Informatics, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 Meibergdreef 9 , DD Amsterdam, The Netherlands
| | - Frank Horenberg
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 Meibergdreef 9 , DD Amsterdam, The Netherlands
- ZIVVER, PO Box 75293, 1070 AG Amsterdam, The Netherlands
| | - Monique Jaspers
- Center for Human Factors Engineering of Health Information Technology, Department of Medical Informatics, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 Meibergdreef 9 , DD Amsterdam, The Netherlands
| | - Linda Peute
- Center for Human Factors Engineering of Health Information Technology, Department of Medical Informatics, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 Meibergdreef 9 , DD Amsterdam, The Netherlands
| | - Danielle Sent
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 Meibergdreef 9 , DD Amsterdam, The Netherlands
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Latulipe C, Quandt SA, Melius KA, Bertoni A, Miller DP, Smith D, Arcury TA. Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study. J Med Internet Res 2018; 20:e10524. [PMID: 30389654 PMCID: PMC6240158 DOI: 10.2196/10524] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 01/22/2023] Open
Abstract
Background Electronic patient portals have become common and offer many potential benefits for patients’ self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access. Objective The objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers. Methods We conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver’s use of the portal, and their perceptions about the benefits and risks of their caregiver’s use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data. Results All patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information. Conclusions Patients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.
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Affiliation(s)
- Celine Latulipe
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Kathryn Altizer Melius
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Alain Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Douglas Smith
- Greene County Health Care, Inc, Snow Hill, NC, United States
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Ukoha EP, Yee LM. Use of Electronic Patient Portals in Pregnancy: An Overview. J Midwifery Womens Health 2018; 63:335-339. [PMID: 29758124 DOI: 10.1111/jmwh.12761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Abstract
Electronic patient portals are increasingly utilized in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, particularly in management of chronic diseases. However, there are disparities within portal use. For example, individuals who are racial and ethnic minorities and persons from lower socioeconomic status are less likely to enroll and use patient portals than non-Hispanic white persons and persons with higher socioeconomic status. Because portal use and, specifically, patient-provider secure messaging has been associated with favorable health outcomes, disparities in use of these portals could affect health outcomes. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited. This article reviews the current literature regarding electronic patient portal use and highlights the need for further maternity care-focused research regarding this new avenue of care delivery during pregnancy.
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Li J, Yazdany J, Trupin L, Izadi Z, Gianfrancesco M, Goglin S, Schmajuk G. Capturing a Patient-Reported Measure of Physical Function Through an Online Electronic Health Record Patient Portal in an Ambulatory Clinic: Implementation Study. JMIR Med Inform 2018; 6:e31. [PMID: 29743158 PMCID: PMC5966655 DOI: 10.2196/medinform.8687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/25/2018] [Accepted: 02/19/2018] [Indexed: 11/24/2022] Open
Abstract
Background Despite significant interest in the collection of patient-reported outcomes to make care more patient-centered, few studies have evaluated implementation efforts to collect patient-reported outcomes from diverse patient populations Objective We assessed the collection of patient-reported outcomes from rheumatoid arthritis patients in an academic rheumatology clinic, using a paper and an online form through the electronic health record patient portal. Methods We identified patients seen between 2012-2016 with ≥2 face-to-face encounters with a rheumatology provider and International Classification of Diseases codes for RA, ≥30 days apart. In 2013, our clinic implemented a paper version of the Patient Reported Outcome Measurement Information System (PROMIS) physical function form that was administered to patients upon their check-in at the clinic. In 2015, an online version of the form became available by way of the electronic health record patient portal to patients with active portal accounts. We compared the proportion of visits with documented PROMIS scores across age, race and ethnicity, and language and examined trends over time using a control chart. Results We included 1078 patients with rheumatoid arthritis with 7049 in-person encounters at the rheumatology clinic over 4 years, with an average of 168 visits per month. Of the included patients, 80.4% of patients (867/1078) were female and the mean age was 58 (SD 16) years. The overall PROMIS physical function score documentation increased from 60.4% (1081/1791) of visits in 2013 to 74.4% (905/1217) of visits in 2016. Online score documentation increased from 10.0% (148/1473) in 2015 to 19.3% (235/1217) in 2016. African American patients were least likely to have a PROMIS physical function score recorded (55/88, 62.5% compared to 792/990, 80.0% for other racial or ethnic groups; P<.001). Compared with white patients, both African American and Hispanic patients were less likely to have active online electronic health record portal accounts (44/88, 50% and 90/157, 57.3% respectively, compared to 437/521, 83.9% of white patients; P<.001) and, once activated, less likely to use the online survey (6/44, 13.6% and 16/90, 17.8% respectively, compared to 135/437, 30.9% of white patients; P=.02). There was no significant difference in the proportion of any PROMIS physical function forms recorded between non-English vs English preferred patients. No significant differences were found across age or gender. Conclusions PROMIS physical function form completion improved overall from 2012-2016 but lagged among racial and ethnic minorities and non-English preferred patients. Future studies should address issues of portal access, enrollment, satisfaction, and persistence and focus on developing PRO implementation strategies that accommodate the needs and preferences of diverse populations.
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Affiliation(s)
- Jing Li
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Zara Izadi
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Sarah Goglin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gabriela Schmajuk
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,VA Medical Center, San Francisco, CA, United States
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