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Johnson AM, Brimhall AS, Johnson ET, Hodgson J, Didericksen K, Pye J, Harmon GJC, Sewell KB. A systematic review of the effectiveness of patient education through patient portals. JAMIA Open 2023; 6:ooac085. [PMID: 36686972 PMCID: PMC9847535 DOI: 10.1093/jamiaopen/ooac085] [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: 11/30/2021] [Revised: 09/01/2022] [Accepted: 10/18/2022] [Indexed: 01/19/2023] Open
Abstract
Objective The objective of this study was to systematically review all literature studying the effect of patient education on patient engagement through patient portals. Introduction Patient portals provide patients access to health records, lab results, medication refills, educational materials, secure messaging, appointment scheduling, and telehealth visits, allowing patients to take a more active role in their health care decisions and management. A debate remains around whether these additional aids actually improve patient engagement and increase their ability to manage their own health conditions. This systematic review looks specifically at the effect of educational materials included in patient portals. Materials and Methods In accordance with PRISMA guidelines, the literature search was mapped across 5 databases (PubMed, CINAHL, Scopus, PsychINFO, Embase), and implemented on June 2, 2020. Results Fifty-two studies were included in the review. Forty-six (88.5%) reported rates of patient utilization of educational resources in the patient portal. Thirty (57.9%) shared patients' perceptions of the usefulness of the education materials. Twenty-one (40.4%) reported changes in health outcomes following educational interventions through the patient portal. This review found that efforts are indeed being made to raise awareness of educational resources in patient portals, that patients are increasingly utilizing these resources, that patients are finding them useful, and that they are improving health outcomes. Conclusion It seems that patient portals are becoming a powerful tool for patient education and engagement, and show promise as a means of achieving the quadruple aim of healthcare. Moving forward, research should establish more uniform methods of measurement in order to strengthen the literature surrounding the effectiveness of patient education through patient portals.
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Affiliation(s)
- Adam M Johnson
- Corresponding Author: Adam M. Johnson, MS, Department of Human Development & Family Science, East Carolina University, Greenville, North Carolina, USA;
| | - Andrew S Brimhall
- Department of Human Development & Family Science, East Carolina University, Greenville, North Carolina, USA
| | - Erica T Johnson
- Department of Human Development & Family Science, East Carolina University, Greenville, North Carolina, USA
| | - Jennifer Hodgson
- Department of Human Development & Family Science, East Carolina University, Greenville, North Carolina, USA
| | - Katharine Didericksen
- Department of Human Development & Family Science, East Carolina University, Greenville, North Carolina, USA
| | - Joseph Pye
- Department of Family Medicine, ECU Health, Greenville, North Carolina, USA
| | - G J Corey Harmon
- Laupus Library, East Carolina University, Greenville, North Carolina, USA
| | - Kerry B Sewell
- Laupus Library, East Carolina University, Greenville, North Carolina, USA
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2
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de Wijs LEM, van Egmond S, Devillers ACA, Nijsten T, Hijnen D, Lugtenberg M. Needs and preferences of patients regarding atopic dermatitis care in the era of new therapeutic options: a qualitative study. Arch Dermatol Res 2023; 315:75-83. [PMID: 35112162 PMCID: PMC8809237 DOI: 10.1007/s00403-021-02321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 01/07/2023]
Abstract
To optimally tailor atopic dermatitis (AD) care to patients' needs, especially considering the many emerging therapeutic options, insight into patients' needs and preferences regarding AD care is needed. To explore patients' needs and preferences regarding AD care, a qualitative study consisting of three focus groups with a total of 20 adult AD patients was conducted. All sessions were transcribed verbatim and inductively analyzed using several phases of coding to create an overview of patients' needs and preferences. AD patients emphasized the need for a patient-tailored approach in all identified aspects of AD care. With regard to consultations, patients stressed the need for a personal approach and increased recognition of the disease impact, which should mainly be determined by patients. With regard to the organization of AD care, the need for psychosocial and medical supportive care as well as quick access to health-care providers during disease flares was emphasized. Within the decision-making process, patients indicated that the provided information, the role of the patient and physician, whether or not treatment goals should be set, and decisive factors for indication and feasibility of novel therapies should be patient dependent. AD care should be patient tailored with increased attention for the psychosocial burden, as well as better access to health care during disease flares. To provide patient-tailored care, the personal situation, needs, and preferences of the patient should be taken into account in the therapeutic decision-making process, with respect for the autonomy of the patient.
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Affiliation(s)
- Linde E. M. de Wijs
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Sven van Egmond
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Arjan C. A. Devillers
- grid.416213.30000 0004 0460 0556Department of Dermatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Tamar Nijsten
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - DirkJan Hijnen
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Marjolein Lugtenberg
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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3
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Yousef CC, Salgado TM, Burnett K, Aldossary I, McClelland LE, Alhamdan HS, Khoshhal S, Aldossary I, Alyas OA, DeShazo JP. Perceived barriers and enablers of a personal health record from the healthcare provider perspective. Health Informatics J 2023; 29:14604582231152190. [PMID: 36645335 DOI: 10.1177/14604582231152190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Personal health records (PHRs) have been implemented around the world as a means to increase the safety, quality, and efficiency of health care. The Ministry of National Guard Health Affairs in the Kingdom of Saudi Arabia launched their PHR in 2018. This study aimed to explore healthcare provider (HCP) perspectives of barriers to and enablers of PHR adoption in Saudi Arabia. The 291 participating HCPs (40.5% nurses, 23.0% pharmacists, 17.2% physicians, 15.5% technicians, and 3.8% other) selected the following as top-3 barriers to PHR adoption: 1) lack of patient awareness (19.4%), 2) patient low literacy (17.7%), and 3) patient resistance to new technologies (12.5%). Of these, 36 responded to the open-ended question gauging feedback on the PHR. Three main themes were identified from the comments: 1) general perceptions of the PHR (positive attitudes, negative attitudes, additional features); 2) patient engagement as a requirement for the successful implementation of the PHR; and 3) education/training of HCPs, patients, and caregivers. This analysis extends our understanding of HCP perspectives of barriers and enablers to PHR adoption. Further qualitative research with patients is required to confirm our findings.
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Affiliation(s)
- Consuela C Yousef
- Department of Pharmaceutical Care, 47798Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia.,King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, 6889Virginia Commonwealth University, Richmond, VA, USA
| | - Keisha Burnett
- Department of Clinical Laboratory Sciences, Cytopathology Practice Program, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia.,Pharmaceutical Care Department, 47798Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Laura E McClelland
- Department of Health Administration, 6889Virginia Commonwealth University, Richmond, VA, USA
| | - Hani S Alhamdan
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia.,Department of Allied Health, 47798Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Sahal Khoshhal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia.,Pharmaceutical Care Department, 47798Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia.,King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia.,Pharmaceutical Care Department, 47798Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Omar A Alyas
- College of Medicine, 123320Royal College of Surgeons in Ireland-Medical University of Bahrain, Kingdom of Bahrain
| | - Jonathan P DeShazo
- Department of Health Administration, 6889Virginia Commonwealth University, Richmond, VA, USA
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4
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Choi W, Chang SH, Yang YS, Jung S, Lee SJ, Chun JW, Kim DJ, Lee W, Choi IY. Study of the factors influencing the use of MyData platform based on personal health record data sharing system. BMC Med Inform Decis Mak 2022; 22:182. [PMID: 35840936 PMCID: PMC9283557 DOI: 10.1186/s12911-022-01929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background The application of telemedicine and electronic health (eHealth) technology has grown in importance during the COVID-19 pandemic, and a new approach in personal data management and processing MyData, has emerged. Data portability and informational self-determination are fundamental concepts of MyData. This study analysed the factors that influence acceptance of the MyData platform, which, reflects the right to self-determine personal data. Methods The study involved participants having experience using the MyData platform, and the key factors of the unified theory of acceptance and use of technology were used in the research model (performance expectancy, effort expectancy, social influence, facilitation condition and behavioural intention to use). The questionnaire comprided 27 items, and system usage log data were used to confirm that behavioural intention to use affected actual use behaviour through structural equation modeling. Results In total, 1153 participants completed the survey. The goodness of fit in the structural equation model indices indicates that the data fit the research model well. Performance expectancy, social influence, and facilitating conditions had direct effects on behavioural intention to use. We used system usage log data to confirm that behavioural intention to use positively affected actual use behaviour. The impact of the main factors in the unified theory of acceptance and use of technology was not moderated by age or gender, except for performance expectancy. Conclusions This study is the first to examine the factors influencing the use of the MyData platform based on the personal health record data sharing system in Korea. In addition, the study confirmed the use behaviour of the MyData platform utilising the system’s actual usage log for each function and analysing the effect of the intention of use on actual use. Our study serves as a significant foundation for the acceptance of data portability and sharing concepts. It also lays the foundation for expanding the data economy and ecosystem in the pandemic era. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01929-z.
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Affiliation(s)
- Wona Choi
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Se-Hyun Chang
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoon-Sik Yang
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Surin Jung
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seo-Joon Lee
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji-Won Chun
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dai-Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Woonjeong Lee
- Department of Emergency Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Republic of Korea
| | - In Young Choi
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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5
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Davis S. Ready for Prime Time? Using Normalization Process Theory to Evaluate Implementation Success of Personal Health Records Designed for Decision Making. Front Digit Health 2021; 2:575951. [PMID: 34713047 PMCID: PMC8521962 DOI: 10.3389/fdgth.2020.575951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Personal health records designed for shared decision making (SDM) have the potential to engage patients and provide opportunities for positive health outcomes. Given the limited number of published interventions that become normal practice, this preimplementation evaluation of an integrated SDM personal health record system (e-PHR) was underpinned by Normalization Process Theory (NPT). The theory provides a framework to analyze cognitive and behavioral mechanisms known to influence implementation success. A mixed-methods investigation was utilized to explain the work required to implement e-PHR and its potential to integrate into practice. Patients, care providers, and electronic health record (EHR) and clinical leaders (n = 27) offered a rich explanation of the implementation work. Reliability tests of the NPT-based instrument negated the use of scores for two of the four mechanisms. Participants indicated that e-PHR made sense as explained by two qualitative themes: game-changing technology and sensibility of change. Participants appraised e-PHR as explained by two themes: reflecting on value and monitoring and adapting. The combined qualitative and quantitative results for the other two NPT mechanisms corroborated. Participants strongly agreed (score = 4.6/5) with processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (score = 3.6/5) was observed with processes requiring an investment in effort, explained by one theme: uncovering the challenge of building collective action, and three subthemes: assessing fit, adapting to change together, and investing in the change. Finally, participants strongly agreed (score = 4.5/5) that e-PHR would positively affect engagement in self-management decision-making in two themes: care is efficient, and care is patient-centered. Overall, successful integration of e-PHR will only be attained when systemic effort is invested to enact it. Additional investigation is needed to explore the collective action gaps to inform priorities and approaches for future implementation success. This research has implications for patients, care providers, EHR vendors, and the healthcare system for improving the effectiveness and efficiency of patient-centric services. Findings confirm the usefulness of NPT for planning and understanding implementation success of PHRs.
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Affiliation(s)
- Selena Davis
- Health Information Science, University Victoria, Victoria, BC, Canada
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6
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The Association of Mobile Health Applications with Self-Management Behaviors among Adults with Chronic Conditions in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910351. [PMID: 34639651 PMCID: PMC8507726 DOI: 10.3390/ijerph181910351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
Background: Mobile applications related to health and wellness (mHealth apps) are widely used to self-manage chronic conditions. However, research on whether mHealth apps facilitate self-management behaviors of individuals with chronic conditions is sparse. We aimed to evaluate the association of mHealth apps with different types of self-management behaviors among patients with chronic diseases in the United States. Methods: This is a cross-sectional observational study. We used data from adult participants (unweighted n = 2340) of the Health Information National Trends Survey in 2018 and 2019. We identified three self-management behaviors: (1) resource utilization using electronic personal health records; (2) treatment discussions with healthcare providers; and (3) making healthcare decisions. We analyzed the association of mHealth apps to self-management behaviors with multivariable logistic and ordinal regressions. Results: Overall, 59.8% of adults (unweighted number = 1327) used mHealth apps. Adults using mHealth apps were more likely to use personal health records (AOR = 3.11, 95% CI 2.26–4.28), contact healthcare providers using technology (AOR = 2.70, 95% CI 1.93–3.78), and make decisions on chronic disease management (AOR = 2.59, 95% CI 1.93–3.49). The mHealth apps were associated with higher levels of self-management involvement (AOR = 3.53, 95% CI 2.63–4.72). Conclusion: Among individuals with chronic conditions, having mHealth apps was associated with positive self-management behaviors.
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7
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Evaluating the Balance Between Privacy and Access in Digital Information Sharing. Crit Care Med 2021; 50:e109-e116. [PMID: 34637416 PMCID: PMC8797001 DOI: 10.1097/ccm.0000000000005234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Access to personal health records in an ICU by persons involved in the patient’s care (referred to broadly as “family members” below) has the potential to increase engagement and reduce the negative psychologic sequelae of such hospitalizations. Currently, little is known about patient preferences for information sharing with a designated family member in the ICU. We sought to understand the information-sharing preferences of former ICU patients and their family members and to identify predictors of information-sharing preferences.
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8
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Designing and usability assessing an electronic personal health record for patients with chronic heart failure in a developing country. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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9
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Tsai CH, Eghdam A, Davoody N, Wright G, Flowerday S, Koch S. Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content. Life (Basel) 2020; 10:E327. [PMID: 33291615 PMCID: PMC7761950 DOI: 10.3390/life10120327] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.
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Affiliation(s)
- Chen Hsi Tsai
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Aboozar Eghdam
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Nadia Davoody
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Graham Wright
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Stephen Flowerday
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Sabine Koch
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
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Alarifi M, Patrick T, Jabour A, Wu M, Luo J. Full Radiology Report through Patient Web Portal: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103673. [PMID: 32456099 PMCID: PMC7277373 DOI: 10.3390/ijerph17103673] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study discusses the gap between the patient web portal and providing a full radiology report. A literature review was conducted to examine radiologists, physicians, and patients’ opinions and preferences of providing patients with online access radiology reports. The databases searched were Pubmed and Google Scholar and the initial search included 927 studies. After review, 47 studies were included in the study. We identified several themes, including patients’ understanding of radiology reports and radiological images, as well as the need for decreasing the turnaround time for reports availability. The existing radiology reports written for physicians are not suited for patients. Further studies are needed to guide and inform the design of patient friendly radiology reports. One of the ways that can be used to fill the gap between patients and radiology reports is using social media sites.
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Affiliation(s)
- Mohammad Alarifi
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (M.A.); (M.W.)
- College of Medical Applied Sciences, King Saud University, Riyadh, SA 11451, USA
| | - Timothy Patrick
- College of Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
| | - Abdulrahman Jabour
- Health Informatics Department, Faculty of Public Health and Tropical Medicine at Jazan University, Jazan, SA 45142, USA;
| | - Min Wu
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (M.A.); (M.W.)
| | - Jake Luo
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (M.A.); (M.W.)
- Correspondence:
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11
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Häikiö J, Yli-Kauhaluoma S, Pikkarainen M, Iivari M, Koivumäki T. Expectations to data: Perspectives of service providers and users of future health and wellness services. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00410-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractThe healthcare and wellness sector currently attempts to provide more proactive service models with data-driven solutions. This study examines the expectations and values related to personal data i.e. data valences from the perspective of service providers and individual users. The study is based on the analysis of extensive empirical material collected through interviews and a collaborative workshop. The data was collected in one cultural context, Finland. The results suggest that the potential service providers and users have similar expectations regarding self-evidence of data while the main differences concern the expectations of transparency. The results of the study propose some basic requirements for the development of personalised data-driven services in future. The study suggests that basic requirements for the development of future data driven services concern expectations to usable data visualisations, data as a motivator, data accuracy and data transparency. Even though there are varying expectations to personal health data and even some concerns, it can be seen that here different ecosystem actors primarily perceived the wider use of personal health and wellness data as a positive trend. It can be concluded that collaborative personal data-driven service ecosystems are an integral part of development towards proactive service models in healthcare.
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12
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Davis S, MacKay L. Moving Beyond the Rhetoric of Shared Decision-Making: Designing Personal Health Record Technology With Young Adults With Type 1 Diabetes. Can J Diabetes 2020; 44:434-441. [PMID: 32616277 DOI: 10.1016/j.jcjd.2020.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Engaging young adults with type 1 diabetes (T1D) in the self-management of daily tasks and decision-making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. Shared decision-making (SDM) is an optimal approach for health decisions; however, it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today, PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision-making. The objective of this study was to confirm a functional model of an integrated shared decision-making-personal health record system (e-PHR) by young adults with T1D and care providers. METHODS User-centred design approach whereby young adults with T1D, 18 to 24 years of age, and care providers matched PHR functions for the SDM process to confirm an e-PHR functional model. RESULTS An e-PHR functional model justified by young adults (n=7) and providers (n=15) was confirmed. The conceptual design was architected within an interconnected digital health ecosystem and integrated 23 PHR functionalities for SDM with a moderate level of agreement between patients and providers (Cohen kappa 0.60 to 0.74). CONCLUSIONS The establishment of an e-PHR functional model is a precursor to system design requirements. Results highlight the conceivable value of integrating SDM into PHRs for engagement of young adults with T1D in self-management decision-making. Design implications highlight key challenges for future research and system development, including information exchange across disparate systems, usability considerations and system intelligence for information personalization and decision-support tools.
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Affiliation(s)
- Selena Davis
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.
| | - Lee MacKay
- Kootenay Lake Hospital Diabetes Clinic and Kootenay Boundary Division of Family Practice, Nelson, British Columbia, Canada
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13
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Aslani N, Ahmadi M, Samadbeik M. A systematic review of the attributes of electronic personal health Records for Patients with multiple sclerosis. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00387-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Collins S, Dykes P, Bates DW, Couture B, Rozenblum R, Prey J, O'Reilly K, Bourie PQ, Dwyer C, Greysen SR, Smith J, Gropper M, Dalal AK. An informatics research agenda to support patient and family empowerment and engagement in care and recovery during and after hospitalization. J Am Med Inform Assoc 2019. [PMID: 28633483 DOI: 10.1093/jamia/ocx054] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
As part of an interdisciplinary acute care patient portal task force with members from 10 academic medical centers and professional organizations, we held a national workshop with 71 attendees representing over 30 health systems, professional organizations, and technology companies. Our consensus approach identified 7 key sociotechnical and evaluation research focus areas related to the consumption and capture of information from patients, care partners (eg, family, friends), and clinicians through portals in the acute and post-acute care settings. The 7 research areas were: (1) standards, (2) privacy and security, (3) user-centered design, (4) implementation, (5) data and content, (6) clinical decision support, and (7) measurement. Patient portals are not yet in routine use in the acute and post-acute setting, and research focused on the identified domains should increase the likelihood that they will deliver benefit, especially as there are differences between needs in acute and post-acute care compared to the ambulatory setting.
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Affiliation(s)
- Sarah Collins
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Partners Healthcare System, Somerville, MA, USA
| | - Patricia Dykes
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David W Bates
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Partners Healthcare System, Somerville, MA, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
| | | | - Ronen Rozenblum
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer Prey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | | | - Cindy Dwyer
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - S Ryan Greysen
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Michael Gropper
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Anuj K Dalal
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Karampela M, Ouhbi S, Isomursu M. Personal health data: A systematic mapping study. Int J Med Inform 2018; 118:86-98. [PMID: 30153927 DOI: 10.1016/j.ijmedinf.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/20/2018] [Accepted: 08/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Personal health data (PHD) research has been intensified over the last years, attracting the attention of scientists from different fields, such as software engineers, computer scientists and medical professionals. The increasing interest of researchers can be attributed to the exponential growth of the available PHD due to the widespread adoption of ubiquitous technology in everyday life, as well as to the potential of the ongoing digital transformation in healthcare. This increasing interest requires that academia has an overview of the published scientific literature to plan future endeavors. OBJECTIVE The main objective of this study is to identify and address research gaps in literature regarding PHD. METHOD This paper conducts a systematic mapping study to summarize the existing PHD approaches in literature and to organize the selected studies according to six classification criteria: publication source, publication year, research types, empirical types, contribution types and research topic. RESULTS In total 79 papers have been included after fulfilling the inclusion criteria and have been classified accordingly. There is an increasing amount of attention that has been paid to PHD since 2014. The majority of papers is published in journals. The two main research types found were solution proposals and evaluation research. The majority of the selected papers were empirically evaluated. The main contribution types were methods and frameworks. Data privacy is the most frequently addressed topic in PHD literature, followed by data sharing. CONCLUSIONS The findings of this systematic mapping study have implications for both researchers who are planning new studies in PHD and for practitioners who are working in connected health and would like to have an overview on the existent studies on PHD research area.
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Affiliation(s)
- Maria Karampela
- IT University of Copenhagen, Copenhagen, Rued Langgaards Vej 7, DK-2300 Copenhagen S, Denmark.
| | - Sofia Ouhbi
- TICLab, FIL, International University of Rabat, Technopolis Rabat-Shore Rocade Rabat-Salé, Rabat, Morocco.
| | - Minna Isomursu
- IT University of Copenhagen, Copenhagen, Rued Langgaards Vej 7, DK-2300 Copenhagen S, Denmark.
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Davis S, Roudsari A, Raworth R, Courtney KL, MacKay L. Shared decision-making using personal health record technology: a scoping review at the crossroads. J Am Med Inform Assoc 2018; 24:857-866. [PMID: 28158573 DOI: 10.1093/jamia/ocw172] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/29/2016] [Indexed: 11/13/2022] Open
Abstract
Objective This scoping review aims to determine the size and scope of the published literature on shared decision-making (SDM) using personal health record (PHR) technology and to map the literature in terms of system design and outcomes. Materials and Methods Literature from Medline, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Engineering Village, and Web of Science (2005-2015) using the search terms "personal health records," "shared decision making," "patient-provider communication," "decision aid," and "decision support" was included. Articles ( n = 38) addressed the efficacy or effectiveness of PHRs for SDM in engaging patients in self-care and decision-making or ways patients can be supported in SDM via PHR. Results Analysis resulted in an integrated SDM-PHR conceptual framework. An increased interest in SDM via PHR is apparent, with 55% of articles published within last 3 years. Sixty percent of the literature originates from the United States. Twenty-six articles address a particular clinical condition, with 10 focused on diabetes, and one-third offer empirical evidence of patient outcomes. The tethered and standalone PHR architectural types were most studied, while the interconnected PHR type was the focus of more recently published methodological approaches and discussion articles. Discussion The study reveals a scarcity of rigorous research on SDM via PHR. Research has focused on one or a few of the SDM elements and not on the intended complete process. Conclusion Just as PHR technology designed on an interconnected architecture has the potential to facilitate SDM, integrating the SDM process into PHR technology has the potential to drive PHR value.
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Affiliation(s)
- Selena Davis
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Abdul Roudsari
- School of Health Information Science, University of Victoria, Victoria, Canada
| | | | - Karen L Courtney
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Lee MacKay
- Kootenay Lake Hospital Diabetes Clinic and Kootenay Boundary Division of Family Practice, Nelson, BC, Canada
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Feller DJ, Zucker J, Yin MT, Gordon P, Elhadad N. Using Clinical Notes and Natural Language Processing for Automated HIV Risk Assessment. J Acquir Immune Defic Syndr 2018; 77:160-166. [PMID: 29084046 PMCID: PMC5762388 DOI: 10.1097/qai.0000000000001580] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Universal HIV screening programs are costly, labor intensive, and often fail to identify high-risk individuals. Automated risk assessment methods that leverage longitudinal electronic health records (EHRs) could catalyze targeted screening programs. Although social and behavioral determinants of health are typically captured in narrative documentation, previous analyses have considered only structured EHR fields. We examined whether natural language processing (NLP) would improve predictive models of HIV diagnosis. METHODS One hundred eighty-one HIV+ individuals received care at New York Presbyterian Hospital before a confirmatory HIV diagnosis and 543 HIV negative controls were selected using propensity score matching and included in the study cohort. EHR data including demographics, laboratory tests, diagnosis codes, and unstructured notes before HIV diagnosis were extracted for modeling. Three predictive algorithms were developed using machine-learning algorithms: (1) a baseline model with only structured EHR data, (2) baseline plus NLP topics, and (3) baseline plus NLP clinical keywords. RESULTS Predictive models demonstrated a range of performance with F measures of 0.59 for the baseline model, 0.63 for the baseline + NLP topic model, and 0.74 for the baseline + NLP keyword model. The baseline + NLP keyword model yielded the highest precision by including keywords including "msm," "unprotected," "hiv," and "methamphetamine," and structured EHR data indicative of additional HIV risk factors. CONCLUSIONS NLP improved the predictive performance of automated HIV risk assessment by extracting terms in clinical text indicative of high-risk behavior. Future studies should explore more advanced techniques for extracting social and behavioral determinants from clinical text.
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Affiliation(s)
- Daniel J Feller
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, NY
| | - Michael T Yin
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, NY
| | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, NY
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, NY
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18
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Collins SA, Rozenblum R, Leung WY, Morrison CR, Stade DL, McNally K, Bourie PQ, Massaro A, Bokser S, Dwyer C, Greysen RS, Agarwal P, Thornton K, Dalal AK. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices. J Am Med Inform Assoc 2018; 24:e9-e17. [PMID: 27357830 DOI: 10.1093/jamia/ocw081] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/22/2016] [Indexed: 01/24/2023] Open
Abstract
Objective To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Materials and Methods Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Results Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Discussion Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Conclusion Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals.
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Affiliation(s)
- Sarah A Collins
- Partners Healthcare System, Wellesley, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ronen Rozenblum
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Anthony Massaro
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Cindy Dwyer
- Johns Hopkins Medical Center, Baltimore, Maryland
| | | | | | | | - Anuj K Dalal
- Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Lai AM, Hsueh PYS, Choi YK, Austin RR. Present and Future Trends in Consumer Health Informatics and Patient-Generated Health Data. Yearb Med Inform 2017; 26:152-159. [PMID: 29063559 PMCID: PMC6239232 DOI: 10.15265/iy-2017-016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives: Consumer Health Informatics (CHI) and the use of Patient-Generated Health Data (PGHD) are rapidly growing focus areas in healthcare. The objective of this paper is to briefly review the literature that has been published over the past few years and to provide a sense of where the field is going. Methods: We searched PubMed and the ACM Digital Library for articles published between 2014 and 2016 on the topics of CHI and PGHD. The results of the search were screened for relevance and categorized into a set of common themes. We discuss the major topics covered in these articles. Results: We retrieved 65 articles from our PubMed query and 32 articles from our ACM Digital Library query. After a review of titles, we were left with 47 articles to conduct our full article survey of the activities in CHI and PGHD. We have summarized these articles and placed them into major categories of activity. Within the domain of consumer health informatics, articles focused on mobile health and patient-generated health data comprise the majority of the articles published in recent years. Conclusions: Current evidence indicates that technological advancements and the widespread availability of affordable consumer-grade devices are fueling research into using PGHD for better care. As we observe a growing number of (pilot) developments using various mobile health technologies to collect PGHD, major gaps still exist in how to use the data by both patients and providers. Further research is needed to understand the impact of PGHD on clinical outcomes.
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Affiliation(s)
- A. M. Lai
- Institute for Informatics, Washington University in St. Louis, USA
| | - P.-Y. S. Hsueh
- Computational Health Behavior and Decision Science, Center for Computational Health, IBM T.J. Watson Research Center, USA
| | - Y. K. Choi
- Department of Biomedical Informatics and Medical Education, University of Washington, USA
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20
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Greenberg AJ, Falisi AL, Finney Rutten LJ, Chou WYS, Patel V, Moser RP, Hesse BW. Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis. J Med Internet Res 2017; 19:e188. [PMID: 28576755 PMCID: PMC5473948 DOI: 10.2196/jmir.7417] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/24/2017] [Accepted: 04/29/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC. OBJECTIVE The aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public's use of ePHRs varies across subpopulations, including those with MCC. METHODS This study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models. RESULTS Those with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03). CONCLUSIONS We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC.
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Affiliation(s)
| | - Angela L Falisi
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | | | - Wen-Ying Sylvia Chou
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Vaishali Patel
- Office of the National Coordinator, US Department of Health and Human Services, Washington, DC, United States
| | - Richard P Moser
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Bradford W Hesse
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
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21
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White H, Gillgrass L, Wood A, Peckham DG. Requirements and access needs of patients with chronic disease to their hospital electronic health record: results of a cross-sectional questionnaire survey. BMJ Open 2016; 6:e012257. [PMID: 27742623 PMCID: PMC5073570 DOI: 10.1136/bmjopen-2016-012257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To identify patient's views on the functionality required for personalised access to the secondary care electronic health record (EHR) and their priorities for development. DESIGN Quantitative analysis of a cross-sectional self-complete survey of patient views on required EHR functionality from a secondary care EHR, including a patient ranking of functionality. SETTING Secondary care patients attending a regional cystic fibrosis unit in the north of England. PARTICIPANTS 201 adults (106 (52.7%) males), median age 29 years (range 17-58 years), entered and completed the study. Inclusion criteria are as follows: a confirmed diagnosis of cystic fibrosis, aged 16 years and over, at the time of clinical stability. OUTCOME MEASURES Quantitative responses within 4 themes; (1) value placed on aspects of the EHR; (2) access requirements to functions of the EHR; (3) views on information sent to the EHR and (4) patient feedback entered into the EHR. A ranked score for 15 functions of the EHR was obtained. RESULTS Highest ratings (% reporting item as very important/important) were reported for access to clinical measures (lung function (94%), C reactive protein (84%), sputum microbiology (81%) and blood results (80%)), medication changes (82%) and lists (83%) and sending repeat prescription (83%) and treatment requests (80%), while sending symptom diaries was less so (62%). Email contact with clinicians was the most valuable communication element of the EHR (84% very important/important). Of 15 features of the EHR (1=most desirable to 15=least desirable), patients identified 'clinical measures' (2.62 (CI 2.07 to 3.06)), and 'access to medication lists' (4.91 (CI 4.47 to 5.44)), as highest priority for development and the ability to comment on errors/omissions (11.0 (CI 10.6 to 11.5)) or experience of care (11.8 (CI 11.4 to 12.2)) as lowest. CONCLUSIONS Patients want extensive personal access to their hospital EHR, placing high importance on the viewing of practical clinical measures and medication management. These influence routine day-to-day care and are priorities for development.
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Affiliation(s)
- H White
- School of Clinical and Applied Science, Leeds Beckett University, Leeds, West Yorkshire, UK
| | - L Gillgrass
- Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds, West Yorkshire, UK
| | - A Wood
- Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds, West Yorkshire, UK
| | - D G Peckham
- Respiratory Medicine/School of Medicine, St James's University Hospital/University of Leeds, Leeds, West Yorkshire, UK
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Kneale L, Choi Y, Demiris G. Assessing Commercially Available Personal Health Records for Home Health: Recommendations for Design. Appl Clin Inform 2016; 7:355-67. [PMID: 27437046 DOI: 10.4338/aci-2015-11-ra-0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. OBJECTIVES To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. METHODS Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. RESULTS Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. CONCLUSIONS The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.
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Affiliation(s)
- Laura Kneale
- University of Washington Biomedical and Health Informatics
| | - Yong Choi
- University of Washington Biomedical and Health Informatics
| | - George Demiris
- University of Washington Biomedical and Health Informatics; University of Washington School of Nursing
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Abstract
Despite growing interest in patient engagement, the concept remains poorly defined. Moreover, patients' perspectives on engagement are lacking, particularly those of minority patients. A better understanding of patients' views and what influences their engagement in health services will facilitate better patient education and implementation practices to enhance patient participation in health care. This article addresses patients' perspectives of facilitators and barriers to engagement in outpatient mental health services. Forty-nine African-American veterans with mental illness receiving routine medication management visits were interviewed. Qualitative data analysis was guided by a constructivist grounded theory approach. Participants identified several barriers and facilitators to engagement in mental health services, including patient as well as provider-related factors. Results emphasize the role of providers in facilitating sustained involvement of patients in their own care. Based on the findings, the authors offer a preliminary framework for patient engagement that encompasses patient and provider factors.
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Brown SM, Aboumatar HJ, Francis L, Halamka J, Rozenblum R, Rubin E, Sarnoff Lee B, Sugarman J, Turner K, Vorwaller M, Frosch DL. Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit. J Am Med Inform Assoc 2016; 23:995-1000. [PMID: 26984048 DOI: 10.1093/jamia/ocv182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
Patients in intensive care units (ICUs) may lack decisional capacity and may depend on proxy decision makers (PDMs) to make medical decisions on their behalf. High-quality information-sharing with PDMs, including through such means as health information technology, could improve communication and decision making and could potentially minimize the psychological consequences of an ICU stay for both patients and their family members. However, alongside these anticipated benefits of information-sharing are risks of unwanted disclosure of sensitive information. Approaches to identifying the optimal balance between access to digital health information to facilitate engagement and protecting patient privacy are urgently needed. We identified eight themes that should be considered in balancing health information access and patient privacy: 1) potential benefits to patients from PDM data access; 2) potential harms to patients from such access; 3) the moral status of families within the patient-clinician relationship; 4) the scope of relevant information provided to PDMs; 5) issues around defining PDMs' authority; 6) methods for eliciting and documenting patient preferences about their family's information access; 7) the relevance of methods for ascertaining the identity of PDMs; and 8) the obligations of hospitals to prevent privacy breaches by PDMs. We conclude that PDMs should typically have access to health information from the current episode of care when the patient is decisionally impaired, unless the patient has previously expressed a clear preference that PDMs not have such access.
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Affiliation(s)
- Samuel M Brown
- Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S. Cottonwood St, Murray, UT USA and Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hanan J Aboumatar
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Leslie Francis
- University of Utah S.J. Quinney College of Law, Salt Lake City, UT, USA
| | - John Halamka
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ronen Rozenblum
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD USA Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD USA Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen Turner
- San Francisco Medical Center, University of California, San Francisco, CA, USA
| | - Micah Vorwaller
- University of Utah S.J. Quinney College of Law, Salt Lake City, UT, USA
| | - Dominick L Frosch
- Gordon and Betty Moore Foundation, San Francisco, CA, USA and Department of Medicine, University of California, Los Angeles, CA, USA
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Lehmann CU, Gundlapalli AV. Improving Bridging from Informatics Practice to Theory. Methods Inf Med 2015; 54:540-5. [PMID: 26577504 DOI: 10.3414/me15-01-0138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND In 1962, Methods of Information in Medicine ( MIM ) began to publish papers on the methodology and scientific fundamentals of organizing, representing, and analyzing data, information, and knowledge in biomedicine and health care. Considered a companion journal, Applied Clinical Informatics ( ACI ) was launched in 2009 with a mission to establish a platform that allows sharing of knowledge between clinical medicine and health IT specialists as well as to bridge gaps between visionary design and successful and pragmatic deployment of clinical information systems. Both journals are official journals of the International Medical Informatics Association. OBJECTIVES As a follow-up to prior work, we set out to explore congruencies and interdependencies in publications of ACI and MIM. The objectives were to describe the major topics discussed in articles published in ACI in 2014 and to determine if there was evidence that theory in 2014 MIM publications was informed by practice described in ACI publications in any year. We also set out to describe lessons learned in the context of bridging informatics practice and theory and offer opinions on how ACI editorial policies could evolve to foster and improve such bridging. METHODS We conducted a retrospective observational study and reviewed all articles published in ACI during the calendar year 2014 (Volume 5) for their main theme, conclusions, and key words. We then reviewed the citations of all MIM papers from 2014 to determine if there were references to ACI articles from any year. Lessons learned in the context of bridging informatics practice and theory and opinions on ACI editorial policies were developed by consensus among the two authors. RESULTS A total of 70 articles were published in ACI in 2014. Clinical decision support, clinical documentation, usability, Meaningful Use, health information exchange, patient portals, and clinical research informatics emerged as major themes. Only one MIM article from 2014 cited an ACI article. There are several lessons learned including the possibility that there may not be direct links between MIM theory and ACI practice articles. ACI editorial policies will continue to evolve to reflect the breadth and depth of the practice of clinical informatics and articles received for publication. Efforts to encourage bridging of informatics practice and theory may be considered by the ACI editors. CONCLUSIONS The lack of direct links from informatics theory-based papers published in MIM in 2014 to papers published in ACI continues as was described for papers published during 2012 to 2013 in the two companion journals. Thus, there is little evidence that theory in MIM has been informed by practice in ACI.
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Affiliation(s)
| | - A V Gundlapalli
- Adi V. Gundlapalli, MD, PhD, MS, Chief Health Informatics Officer, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA, E-mail:
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Wells S, Rozenblum R, Park A, Dunn M, Bates DW. Organizational strategies for promoting patient and provider uptake of personal health records. J Am Med Inform Assoc 2015; 22:213-22. [PMID: 25326601 PMCID: PMC4433381 DOI: 10.1136/amiajnl-2014-003055] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate organizational strategies to promote personal health records (PHRs) adoption with a focus on patients with chronic disease. METHODS Using semi-structured interviews and a web-based survey, we sampled US health delivery organizations which had implemented PHRs for at least 12 months, were recognized as PHR innovators, and had scored highly in national patient satisfaction surveys. Respondents had lead positions for clinical information systems or high-risk population management. Using grounded theory approach, thematic categories were derived from interviews and coupled with data from the survey. RESULTS Interviews were conducted with 30 informants from 16 identified organizations. Organizational strategies were directed towards raising patient awareness via multimedia communications, and provider acceptance and uptake. Strategies for providers were grouped into six main themes: organizational vision, governance and policies, work process redesign, staff training, information technology (IT) support, and monitoring and incentives. Successful organizations actively communicated their vision, engaged leaders at all levels, had clear governance, planning, and protocols, set targets, and celebrated achievement. The most effective strategy for patient uptake was through health professional encouragement. No specific outreach efforts targeted patients with chronic disease. Registration and PHR activity was routinely measured but without reference to a denominator population or high risk subpopulations. DISCUSSION AND CONCLUSION Successful PHR implementation represents a social change and operational project catalyzed by a technical solution. The key to clinician acceptance is making their work easier. However, organizations will likely not achieve the value they want from PHRs unless they target specific populations and monitor their uptake.
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Affiliation(s)
- Susan Wells
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Health Care Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Ronen Rozenblum
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea Park
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marie Dunn
- Department of Health Care Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - David W Bates
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Health Care Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
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