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Abel G, Atherton H, Sussex J, Akter N, Aminu AQ, Bak W, Bryce C, Clark CE, Cockcroft E, Evans H, Gkousis E, Jenkins G, Jenkinson C, Khan N, Lambert J, Leach B, Marriott C, Newbould J, Parkinson S, Parsons J, Pitchforth E, Sheard L, Stockwell S, Thomas C, Treadgold B, Winder R, Campbell JL. Current experience and future potential of facilitating access to digital NHS primary care services in England: the Di-Facto mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-197. [PMID: 39324475 DOI: 10.3310/jkyt5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Background Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services. Objectives Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support. Design Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings. Setting General practice in four regions of England. Participants Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants. Intervention Digital facilitation as undertaken in general practice. Main outcome measures Patient and practice staff reported use of, and views of, digital facilitation. Data sources Surveys, qualitative research; national General Practitioner Patient Survey (2019-22). Review methods Scoping-review methodology applied to academic and grey literature published 2015-20. Results While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients. Limitations The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork. Conclusions Digital facilitation, while not a widely recognised concept, is important in supporting the move to a National Health Service with enhanced digital opportunities and enhanced digital access. General practice staff are allocating resources to provide such efforts in general practices in England. The establishment of clear lines of responsibility, the development of digital tools and platforms that work for patients and practice staff, and investment in staff time and training are needed if digital facilitation is to support the intended digital revolution. Future work We did not find one single dominant or preferred model of digital facilitation which might reasonably be considered to form the basis of an intervention to be tested. Rather, there is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts. We outline a framework for a future evaluation of such an intervention. Study registration This study is registered as ResearchRegistry6523 (www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1) and PROSPERO CRD42020189019 (www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128268) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 32. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Gary Abel
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Jon Sussex
- RAND Europe, Westbrook Centre, Cambridge, UK
| | - Nurunnahar Akter
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Abodunrin Q Aminu
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Wiktoria Bak
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Carol Bryce
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Emma Cockcroft
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Georgia Jenkins
- PenARC Patient and Public Involvement Team, University of Exeter, Exeter, UK
| | - Caroline Jenkinson
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Nada Khan
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Christine Marriott
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Jo Parsons
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Emma Pitchforth
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | | | - Chloe Thomas
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Bethan Treadgold
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Rachel Winder
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - John L Campbell
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
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2
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Manarte L. Technology and Access to Healthcare with Different Scheduling Systems: A Scoping Review. Healthc Inform Res 2024; 30:194-205. [PMID: 39160779 PMCID: PMC11333816 DOI: 10.4258/hir.2024.30.3.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES Online consultation scheduling is increasingly common in health services across various countries. This paper reviews articles published in the past five years and reflects on the risks and benefits of this practice, linking it to a recent Portuguese pilot project. METHODS A search for articles from Web of Science and Scopus published since 2018 was conducted using the terms "online scheduling," "online booking," and "consultations." This search was completed in the last week of 2023. RESULTS Out of 64 articles retrieved, 26 were relevant to the topic. These articles were reviewed, and their main findings, along with those from other relevant sources, were discussed. CONCLUSIONS Several limitations of online consultations were identified, encompassing ethical, clinical, and economic aspects. While these consultations tend to be less expensive, their accessibility varies based on factors such as the users' age, whether they reside in rural or urban areas, and the technological capabilities of different countries, indicating that access disparities may continue to widen. Confidentiality concerns also arise, varying by medical specialty, along with issues related to payment. Overall, however, both users and health professionals view the advent of online consultation booking positively. In conclusion, despite the risks identified, online consultation booking has the potential to enhance user access to health services, provided that usage limitations and technological disparities are addressed. Research production has not kept pace with rapid technological advancements.
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Affiliation(s)
- Lucas Manarte
- Center for Research and Studies in Sociology at the University Institute of Lisbon (CIES-Iscte), Lisbon,
Portugal
- PSYLAB, Instituto de Saúde Ambiental (ISAMB), the Lisbon School of Medicine, University of Lisbon (FMUL), Lisbon,
Portugal
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Ewart C, Baharani J, Wilkie M, Thomas N. Patient perspectives and experiences of remote consultations in people receiving kidney care: A scoping review. J Ren Care 2022; 48:143-153. [PMID: 35338610 PMCID: PMC9545432 DOI: 10.1111/jorc.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in a rapid and sometimes chaotic change in how clinical care was delivered for people living with kidney disease, with increased reliance on digital technologies and the introduction of remote services. OBJECTIVES To conduct a scoping review of studies about patients' experiences and perspectives in receipt of remote consultations for kidney care. DESIGN Using Arksey and O'Malley's framework, three databases were searched on EBSCO (CINAHL, MEDLINE and Psych INFO). The search included studies published in English from August 2010 to August 2021. RESULTS Eight studies met the scoping review criteria (two cross-sectional, two mixed-method and four qualitative). Five themes were identified: overall satisfaction with remote services, benefits to patients (convenience, involvement in care and patient safety), barriers to remote consultations (technical difficulties, digital literacy and loss of interpersonal communication), patient concerns (need for physical examination, privacy and confidentiality) and prerequisites for successful remote care (existing patient-practitioner relationship, stable illness phase and access to technology). CONCLUSION Remote consultations confer multiple advantages to patients; therefore, remote consultations should be offered as an option to patients living with kidney disease beyond the COVID-19 pandemic. However, there are several barriers to remote consultation that need to be addressed and understood before implementing remote care long-term. Future research should examine the impact of remote consultations on people living with kidney disease from under-served groups to identify barriers and ensure their suitability and accessibility to the wider population for a more patient-centred approach to kidney care.
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Affiliation(s)
- Catriona Ewart
- Institute of Health and Social CareLondon South Bank UniversityLondonUK
| | | | | | - Nicola Thomas
- Institute of Health and Social CareLondon South Bank UniversityLondonUK
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4
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Rexhepi H, Moll J, Huvila I, Åhlfeldt RM. Do you want to receive bad news through your patient accessible electronic health record? A national survey on receiving bad news in an era of digital health. Health Informatics J 2021; 27:14604582211035817. [PMID: 34461772 DOI: 10.1177/14604582211035817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Despite the fact that patient accessible electronic health records (PAEHRs) have been around for many years in several countries, there is a lack of research investigating patient's preferences for receiving bad news, including through PAEHRs. Little is also known about the characteristics of the patients who prefer to receive bad news through the PAEHR in terms of, for example medical diagnosis, age and educational level. This study, based on a national patient survey in Sweden (N = 2587), investigated this. Results show that, generally, receiving bad news by reading in the PAEHR is still among the least preferred options. Additionally, a higher proportion of men want to receive bad news in the PAEHR compared to women (p = 0.001), and the same goes for those who are not working/have worked in healthcare (p = 0.007). An effect of disease groups was also found, showing that diabetes patients in particular, want to receive bad news through the PAEHR.
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Affiliation(s)
| | - Jonas Moll
- Örebro University School of Business, Sweden
| | - Isto Huvila
- Uppsala University, Sweden.,Åbo Akademi University, Finland
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Valeur HS, Lie AK, Moen K. Patient Rationales Against the Use of Patient-Accessible Electronic Health Records: Qualitative Study. J Med Internet Res 2021; 23:e24090. [PMID: 34047711 PMCID: PMC8196359 DOI: 10.2196/24090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/23/2021] [Accepted: 04/03/2021] [Indexed: 01/26/2023] Open
Abstract
Background Patient-accessible electronic health records (PAEHRs) enable patients to access their health records through a secure connection over the internet. Although previous studies of patient experiences with this kind of service have shown that a majority of users are positive toward PAEHRs, little is known about why some patients occasionally or regularly choose not to use them. A better understanding of why patients may choose not to make use of digital health services such as PAEHRs is important for further development and implementation of services aimed at having patients participate in digital health services. Objective The objective of the study was to explore patients’ rationales for not embracing online access to health records. Methods Qualitative interviews were conducted with 40 patients in a department of internal medicine in a Norwegian hospital in 2018-2019. Interview transcripts were subjected to thematic content analysis. In this paper, we focus on the subject of nonuse of PAEHRs. Results We identified 8 different rationales that study participants had for not embracing PAEHRs. When patients reflected on why they might not use PAEHRs, they variously explained that they found PAEHRs unnecessary (they did not feel they were useful), impersonal (they preferred oral dialogue with their doctor or nurse over written information), incomprehensible (the records contained medical terminology and explanations that were hard to understand), misery oriented (the records solely focused on disease), fear provoking (reading the records could cause unwanted emotional reactions), energy demanding (making sense of the records added to the work of being a patient), cumbersome (especially among patients who felt they did not have the necessary digital competence), and impoverishing (they were skeptical about the digital transformation of individual and social life). Conclusions It is often assumed that the barriers to PAEHR use are mostly practical (such as lack of hardware and access to the internet). In this study, we showed that patients may have many other valid reasons for not wanting to adopt this kind of service. The results can help guide how PAEHRs and other digital health services are promoted and presented to patients, and they may suggest that the goal of a given new digital health service should not necessarily be full uptake by all patients. Rather, one should recognize that different patients might prefer and benefit from different kinds of “analog” and digital health services.
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Affiliation(s)
| | - Anne Kveim Lie
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, University of Oslo, Oslo, Norway
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6
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Varsi C, Stenehjem AE, Børøsund E, Solberg Nes L. Video as an alternative to in-person consultations in outpatient renal transplant recipient follow-up: a qualitative study. BMC Nephrol 2021; 22:105. [PMID: 33752608 PMCID: PMC7983085 DOI: 10.1186/s12882-021-02284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background Renal transplant recipients have to see a nephrologist for regular follow-up for the rest of their lives. To reduce the burden for the patients, video consultation can be an alternative to traditional in-person hospital consultations. The aim of the current study was, from the perspectives of patients and health care providers, to investigate the perceived benefits and challenges of using video consultations in outpatient renal transplant recipient follow-up. Methods Patients (i.e., renal transplant recipients; n = 18) alternated between regular in-person follow-up consultations and video consultations. Patients and health care providers were then invited to participate in semi-structured interviews. The interviews were analyzed using thematic analysis. Results Patients interviewed (n = 15) were median 53 years old (range 37–64) and 53% female. The video consultation solution used in the study turned out to have major technical deficiencies. Despite the technical challenges, however, the majority of the patients reported appreciating being able to alternate between video and in-person hospital consultations. Main benefits reported included not needing to travel to the hospital and thereby saving time, less focus on being chronically ill and potential economic benefits for patients and society. The health care providers (n = 3) also valued the benefits provided by the use of video consultations, but described the reoccurring technical challenges as disruptive. The fact that patients were in a stable phase of their health condition and already had an established, trusting relationship with their nephrologist, acted as facilitators for success. Possible challenges and harms described included concerns related to security, confidentiality and interruptions, as well as the potential need for physical examinations. Conclusions Benefits from using video consultations as an alternative to in-person consultations may outweigh potential technological challenges for patients as well as health care providers. A long-lasting mutually trusting relationship between patient and provider may be an important prerequisite for the experienced benefits of using video consultation. Findings also indicate that starting such care delivery changes in a small-scale, with a few selected patients in a stable phase of their condition, may be an important factor for success. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02284-3.
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Affiliation(s)
- Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway. .,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Aud-Eldrid Stenehjem
- Department of Nephrology, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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7
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McMillan B, Davidge G, Brown L, Lyons M, Atherton H, Goulding R, Mold F, Morris RL, Sanders C. A qualitative exploration of patients' experiences, needs and expectations regarding online access to their primary care record. BMJ Open 2021; 11:e044221. [PMID: 33707271 PMCID: PMC7957122 DOI: 10.1136/bmjopen-2020-044221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients' needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need. DESIGN Focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach. SETTING Focus groups and interviews were conducted in community settings in the UK. PARTICIPANTS Fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else. RESULTS Participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated. CONCLUSIONS Discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.
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Affiliation(s)
- Brian McMillan
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Lindsey Brown
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Moira Lyons
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Helen Atherton
- Warwick Medical School, Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Rebecca Goulding
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Freda Mold
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Rebecca L Morris
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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8
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De Gagne JC, Yang Y, Rushton S, Koppel PD, Hall K. Email Use Reconsidered in Health Professions Education: Viewpoint. JMIR MEDICAL EDUCATION 2020; 6:e19300. [PMID: 32478659 PMCID: PMC7296417 DOI: 10.2196/19300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 05/06/2023]
Abstract
Email has become a popular means of communication in the past 40 years, with more than 200 billion emails sent each day worldwide. When used appropriately, email can be an effective and useful form of correspondence, although improper practices, such as email incivility, can present challenges. Email is ubiquitous in education and health care, where it is used for student-to-teacher, provider-to-provider, and patient-to-provider communications, but not all students, faculty members, and health professionals are skilled in its use. This paper examines the challenges and opportunities posed by email communication in health professions education and reveals important deficiencies in training, as well as steps that can be taken by health professions educators to address them. Recommendations are offered to help health professions educators develop approaches for teaching email professionalism.
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Affiliation(s)
| | - Yesol Yang
- Duke University School of Nursing, Durham, NC, United States
| | - Sharron Rushton
- Duke University School of Nursing, Durham, NC, United States
| | - Paula D Koppel
- Duke University School of Nursing, Durham, NC, United States
| | - Katherine Hall
- West Virginia University School of Nursing, Morgantown, WV, United States
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9
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Zanaboni P, Kummervold PE, Sørensen T, Johansen MA. Patient Use and Experience With Online Access to Electronic Health Records in Norway: Results From an Online Survey. J Med Internet Res 2020; 22:e16144. [PMID: 32031538 PMCID: PMC7055829 DOI: 10.2196/16144] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/04/2019] [Accepted: 12/16/2019] [Indexed: 01/16/2023] Open
Abstract
Background The electronic health record (EHR) has been fully established in all Norwegian hospitals. Patient-accessible electronic health records (PAEHRs) are available to citizens aged 16 years and older through the national health portal Helsenorge. Objective This study aimed at understanding how patients use PAEHRs. Three research questions were addressed in order to explore (1) characteristics of users, (2) patients’ use of the service, and (3) patient experience with the service. Methods We conducted an online survey of users who had accessed their EHR online at least once through the national health portal. Patients from two of the four health regions in Norway were invited to participate. Quantitative data were supplemented by qualitative information. Results A total of 1037 respondents participated in the survey, most of whom used the PAEHR regularly (305/1037, 29.4%) or when necessary (303/1037, 29.2%). Service utilization was associated with self-reported health, age, gender, education, and health care professional background. Patients found the service useful to look up health information (687/778, 88.3%), keep track of their treatment (684/778, 87.9%), prepare for a hospital appointment (498/778, 64.0%), and share documents with their general practitioner (292/778, 37.5%) or family (194/778, 24.9%). Most users found it easy to access their EHR online (965/1037, 93.1%) and did not encounter technical challenges. The vast majority of respondents (643/755, 85.2%) understood the content, despite over half of them acknowledging some difficulties with medical terms or phrases. The overall satisfaction with the service was very high (700/755, 92.7%). Clinical advantages to the patients included enhanced knowledge of their health condition (565/691, 81.8%), easier control over their health status (685/740, 92.6%), better self-care (571/653, 87.4%), greater empowerment (493/674, 73.1%), easier communication with health care providers (493/618, 79.8%), and increased security (655/730, 89.7%). Patients with complex, long-term or chronic conditions seemed to benefit the most. PAEHRs were described as useful, informative, effective, helpful, easy, practical, and safe. Conclusions PAEHRs in Norway are becoming a mature service and are perceived as useful by patients. Future studies should include experimental designs focused on specific populations or chronic conditions that are more likely to achieve clinically meaningful benefits. Continuous evaluation programs should be conducted to assess implementation and changes of wide-scale routine services over time.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | | | - Monika Alise Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Moll J, Cajander Å. Oncology health-care professionals’ perceived effects of patient accessible electronic health records 6 years after launch: A survey study at a major university hospital in Sweden. Health Informatics J 2019; 26:1392-1403. [DOI: 10.1177/1460458219881007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient accessible electronic health records have been launched in many countries, and generally, health-care professionals have had strong initial concerns related to the areas patient contact, documentation practices and quality of care. Especially, oncology care was discussed in media when launching patient accessible electronic health records in Sweden. However, few studies have investigated clinician-perceived effects several years after the launch. A survey covering these areas, as well as supposed effects for patients, was distributed to oncology health-care professionals 6 years after the launch of patient accessible electronic health records and answered by N = 176. Results show that patient accessible electronic health records have had small effects within the covered areas, and that the area most affected was documentation practices. Very few significant differences could be found between physicians and nurses. A comparison with results from interviews and surveys conducted shortly after the launch of patient accessible electronic health records clearly indicates that the experienced negative effects are not as big as originally feared.
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Gorfinkel I, Lexchin J. A call to mandate patient access to personal primary care medical records across Canada. CMAJ 2019; 190:E869-E870. [PMID: 30037887 DOI: 10.1503/cmaj.180522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Iris Gorfinkel
- PrimeHealth Clinical Research - Family Practice (Gorfinkel); School of Health Policy and Management (Lexchin), Faculty of Health, York University, Toronto, Ont.
| | - Joel Lexchin
- PrimeHealth Clinical Research - Family Practice (Gorfinkel); School of Health Policy and Management (Lexchin), Faculty of Health, York University, Toronto, Ont
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12
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Delvaux N, Aertgeerts B, van Bussel JC, Goderis G, Vaes B, Vermandere M. Health Data for Research Through a Nationwide Privacy-Proof System in Belgium: Design and Implementation. JMIR Med Inform 2018; 6:e11428. [PMID: 30455164 PMCID: PMC6300317 DOI: 10.2196/11428] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 01/19/2023] Open
Abstract
Background Health data collected during routine care have important potential for reuse for other purposes, especially as part of a learning health system to advance the quality of care. Many sources of bias have been identified through the lifecycle of health data that could compromise the scientific integrity of these data. New data protection legislation requires research facilities to improve safety measures and, thus, ensure privacy. Objective This study aims to address the question on how health data can be transferred from various sources and using multiple systems to a centralized platform, called Healthdata.be, while ensuring the accuracy, validity, safety, and privacy. In addition, the study demonstrates how these processes can be used in various research designs relevant for learning health systems. Methods The Healthdata.be platform urges uniformity of the data registration at the primary source through the use of detailed clinical models. Data retrieval and transfer are organized through end-to-end encrypted electronic health channels, and data are encoded using token keys. In addition, patient identifiers are pseudonymized so that health data from the same patient collected across various sources can still be linked without compromising the deidentification. Results The Healthdata.be platform currently collects data for >150 clinical registries in Belgium. We demonstrated how the data collection for the Belgian primary care morbidity register INTEGO is organized and how the Healthdata.be platform can be used for a cluster randomized trial. Conclusions Collecting health data in various sources and linking these data to a single patient is a promising feature that can potentially address important concerns on the validity and quality of health data. Safe methods of data transfer without compromising privacy are capable of transporting these data from the primary data provider or clinician to a research facility. More research is required to demonstrate that these methods improve the quality of data collection, allowing researchers to rely on electronic health records as a valid source for scientific data.
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Affiliation(s)
- Nicolas Delvaux
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Geert Goderis
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Moll J, Rexhepi H, Cajander Å, Grünloh C, Huvila I, Hägglund M, Myreteg G, Scandurra I, Åhlfeldt RM. Patients' Experiences of Accessing Their Electronic Health Records: National Patient Survey in Sweden. J Med Internet Res 2018; 20:e278. [PMID: 30389647 PMCID: PMC6238103 DOI: 10.2196/jmir.9492] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/08/2018] [Accepted: 07/19/2018] [Indexed: 12/17/2022] Open
Abstract
Background Internationally, there is a movement toward providing patients a Web-based access to their electronic health records (EHRs). In Sweden, Region Uppsala was the first to introduce patient-accessible EHRs (PAEHRs) in 2012. By the summer of 2016, 17 of 21 county councils had given citizens Web-based access to their medical information. Studies on the effect of PAEHRs on the work environment of health care professionals have been conducted, but up until now, few extensive studies have been conducted regarding patients’ experiences of using PAEHRs in Sweden or Europe, more generally. Objective The objective of our study was to investigate patients’ experiences of accessing their EHRs through the Swedish national patient portal. In this study, we have focused on describing user characteristics, usage, and attitudes toward the system. Methods A national patient survey was designed, based on previous interview and survey studies with patients and health care professionals. Data were collected during a 5-month period in 2016. The survey was made available through the PAEHR system, called Journalen, in Sweden. The total number of patients that logged in and could access the survey during the study period was 423,141. In addition to descriptive statistics reporting response frequencies on Likert scale questions, Mann-Whitney tests, Kruskal-Wallis tests, and chi-square tests were used to compare answers between different county councils as well as between respondents working in health care and all other respondents. Results Overall, 2587 users completed the survey with a response rate of 0.61% (2587/423,141). Two participants were excluded from the analysis because they had only received care in a county council that did not yet show any information in Journalen. The results showed that 62.97% (1629/2587) of respondents were women and 39.81% (1030/2587) were working or had been working in health care. In addition, 72.08% (1794/2489) of respondents used Journalen about once a month, and the main reason for use was to gain an overview of one’s health status. Furthermore, respondents reported that lab results were the most important information for them to access; 68.41% (1737/2539) of respondents wanted access to new information within a day, and 96.58% (2454/2541) of users reported that they are positive toward Journalen. Conclusions In this study, respondents provided several important reasons for why they use Journalen and why it is important for them to be able to access information in this way—several related to patient empowerment, involvement, and security. Considering the overall positive attitude, PAEHRs seem to fill important needs for patients.
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Affiliation(s)
- Jonas Moll
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Hanife Rexhepi
- School of Informatics, University of Skövde, Skövde, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Christiane Grünloh
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden.,Institute of Informatics, TH Köln University of Applied Sciences, Gummersbach, Germany
| | - Isto Huvila
- Department of ALM, Uppsala University, Uppsala, Sweden
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gunilla Myreteg
- Department of Information Technology, Uppsala University, Uppsala, Sweden.,Department of Business Studies, Uppsala University, Uppsala, Sweden
| | - Isabella Scandurra
- Centre for Empirical Research on Information Systems, Örebro University School of Business, Örebro, Sweden
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14
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De Lusignan S. In this issue: Digital disparities, complexity and patient safety. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:1129. [PMID: 30398455 DOI: 10.14236/jhi.v25i3.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 09/16/2018] [Indexed: 11/18/2022] Open
Abstract
In this issue we publish articles about how digital health and the skills needed to use it may increase disparities.
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15
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Hoonakker PLT, Carayon P, Cartmill RS. The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study. Int J Med Inform 2017; 100:63-76. [PMID: 28241939 DOI: 10.1016/j.ijmedinf.2017.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Secure messaging is a relatively new addition to health information technology (IT). Several studies have examined the impact of secure messaging on (clinical) outcomes but very few studies have examined the impact on workflow in primary care clinics. In this study we examined the impact of secure messaging on workflow of clinicians, staff and patients. METHODS We used a multiple case study design with multiple data collections methods (observation, interviews and survey). RESULTS Results show that secure messaging has the potential to improve communication and information flow and the organization of work in primary care clinics, partly due to the possibility of asynchronous communication. However, secure messaging can also have a negative effect on communication and increase workload, especially if patients send messages that are not appropriate for the secure messaging medium (for example, messages that are too long, complex, ambiguous, or inappropriate). Results show that clinicians are ambivalent about secure messaging. Secure messaging can add to their workload, especially if there is high message volume, and currently they are not compensated for these activities. Staff is -especially compared to clinicians- relatively positive about secure messaging and patients are overall very satisfied with secure messaging. Finally, clinicians, staff and patients think that secure messaging can have a positive effect on quality of care and patient safety. CONCLUSION Secure messaging is a tool that has the potential to improve communication and information flow. However, the potential of secure messaging to improve workflow is dependent on the way it is implemented and used.
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Affiliation(s)
- Peter L T Hoonakker
- Center for Quality and Productivity Improvement (CQPI), University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA.
| | - Pascale Carayon
- Center for Quality and Productivity Improvement (CQPI), University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Randi S Cartmill
- Department of Surgery, University of Wisconsin-Madison, K6/117 s Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
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